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Biomedical subjects

Ali Ayhan

Publications and source records attributed to Ali Ayhan.

At least 37 records · Page 2Linked to original sources
PubMed2005

Routine appendectomy in epithelial ovarian carcinoma: is it necessary?

OBJECTIVE: To detect risk factors for the appendiceal metastasis and to define the role of routine appendectomy in patients with epithelial ovarian carcinoma. METHODS: A total of 285 patients with epithelial ovarian carcinoma who had undergone primary cytoreductive surgery including appendectomy were retrospectively evaluated. Appendiceal involvement was divided into 2 groups: gross and microscopic. Clinicopathologic variables were evaluated for possible significance in terms of appendiceal metastasis. A second analysis was performed using the same variables to detect a possible relation with microscopic metastasis. In a subgroup analysis, we also analyzed the role of routine appendectomy in patients with clinically early stage disease. RESULTS: One-hundred six patients were found to have appendiceal metastasis (37%). Univariate and multivariate analysis revealed stage of disease as the unique factor determining the appendiceal metastasis (P < .001). Five patients with apparently stage I-II disease were upstaged due to isolated appendiceal metastasis (4.9%). In the second analysis excluding the patients with gross involvement, ascites was an independent predictor of microscopic involvement (P < .01). CONCLUSION: Routine appendectomy is indicated in all epithelial ovarian carcinoma patients as part of the initial surgical staging procedure because of a considerable rate of upstaging in early stage disease and optimal cytoreduction in advanced stages. LEVEL OF EVIDENCE: II-3.

Adult↗
PubMed2005

Atypical endometrial stromal cells related with a polypoid leiomyoma with bizarre nuclei: a case report.

We presented a polypoid leiomyoma with bizarre nuclei having atypical endometrial stromal cells adjacent to the leiomyoma. Although atypical stromal cells of the female genital tract have been described, to our knowledge, no lesion identical to ours has been reported thus far. These atypical cells may be mistaken for malignant cells on histologic examination, especially in small endometrial samples. To differentiate these kinds of atypical-featured lesions from sarcoma is important, especially in curettage materials. The etiology and precise nature of multinucleated giant cells and atypical stromal cells in the endometrium are unclear. To prevent radical surgery, pathologists must be familiar with these atypical cells in the female genital tract.

Biopsy↗
PubMed2004

Primary neuroendocrine carcinoma of the fallopian tube: a case report.

Neuroendocrine carcinomas arise from Kulchitsky cells and are frequently seen in gastrointestinal tract and lungs. But they are unusual in gynecology practice. The Fallopian tube is one of the rarest locations for the development of a female genital malignancy. The most common histologic subtype is adenocarcinoma in malignancies of fallopian tubes, but rarely other histologic subtypes have been reported. Here we present a primary neuroendocrine carcinoma of the fallopian tube. To the best of the our knowledge, it was not reported previously.

Carcinoma, Neuroendocrine↗
PubMed2004

A successful pregnancy after intracytoplasmic sperm injection and embryo transfer in a patient with endometrial cancer who was treated conservatively.

OBJECTIVE: To describe a patient with polycystic ovary syndrome (PCOS) conceiving with intracytoplasmic sperm injection (ICSI) and embryo transfer after conservative treatment of early stage endometrial cancer. DESIGN: Case report. SETTING: Tertiary center for assisted reproductive technologies.A 32-year-old woman with PCOS, primary infertility of 4 years duration, and grade 1 endometrioid endometrial cancer. INTERVENTION(S): Assessment of myometrial invasion and extrauterine spread with magnetic resonance imaging (MRI) and explorative laparotomy. High-dose progestin treatment and ICSI and embryo transfer. MAIN OUTCOME MEASURE(S): Successful take-home baby and no residual endometrial cancer. RESULT(S): A healthy normal female infant with a birth weight of 1740 g was born by cesarean section at 30 weeks' gestation. No residual cancer was detected at the follow-up curettage performed 2 months after the delivery. CONCLUSION(S): Conservative uterus-preserving treatment may be considered in patients with early stage endometrial cancer. Assisted reproductive technologies may be used in such patients for immediate achievement of pregnancy.

Adenocarcinoma↗
PubMed2004

Two successful spontaneous pregnancies in a patient with a primary primitive neuroectodermal tumor of the ovary.

OBJECTIVE: To describe a patient with primary primitive neuroectodermal tumor of the ovary with two successful spontaneous pregnancies. DESIGN: Case report. SETTING: Tertiary center for gynecologic oncology. PATIENT(S): A 25-year-old woman with two spontaneous pregnancies 5 months after and 2 years after conservative treatment of International Federation of Gynecology and Obstetrics stage IC primary primitive neuroectodermal tumor of the ovary. INTERVENTION(S): Assessment of extraovarian spread with staging laparotomy. Four courses of BEP (bleomysin, etoposide, cisplatin) and, for recurrent disease, six courses of salvage VIP (vinblastin, iphosphamide, mesna, cisplatin) chemotherapy. MAIN OUTCOME MEASURE(S): Two successful deliveries and no residual ovarian cancer. RESULTS(S): A healthy, normal female infant weighing 3600 g was delivered by cesarean section at 38 weeks' gestation. Sixteen months later another infant, a healthy, normal male weighing 3500 g, was delivered by cesarean section at 38 weeks' gestation. No residual cancer was detected at follow-up 12 months after the last delivery. CONCLUSION(S): Conservative fertility-preserving treatment might be considered in patients with primary primitive neuroectodermal tumor of the ovary. Without any assisted reproductive technologies, spontaneous pregnancies might occur.

Adult↗
PubMed2004

The long-term survival of women with surgical stage II endometrioid type endometrial cancer.

OBJECTIVES: The aim of this study was to evaluate the survival estimates, treatment outcomes, prognostic factors, and recurrence patterns of patients with surgical stage II endometrial cancer. METHODS: Forty-eight stage II endometrial cancer patients treated between 1982 and 2000 were included. All the patients were subjected to the initial surgical staging procedure consisting of peritoneal cytology, infracolic omentectomy, abdominal hysterectomy (radical or simple), bilateral salpingo-oophorectomy, and complete pelvic-paraaortic lymphadenectomy. Of these 48 patients, 21 (44%) were treated with radical hysterectomy (RH) without adjuvant therapy. The remaining 27 (56%) patients were treated with simple hysterectomy plus adjuvant radiotherapy. With respect to the prognostic factors, no statistically significant difference was found between these two groups. The median follow-up period was 5 years (range, 2-9). RESULTS: The mean age at the time of diagnosis was 55.8 years (range, 34-75). The 5-year disease-free and overall survival (OS) rates of entire group were 83% and 86%, respectively. These figures for 27 (56%) patients treated with simple hysterectomy plus radiation were 81% and 83%, respectively. For 21 (44%) patients who were treated with radical hysterectomy without adjuvant therapy, the 5-year disease-free and overall survival rates were 85% and 90%, respectively. When these two groups were compared, survival rates were not significantly different from each other (P = 0.60 for disease-free survival and P = 0.46 for overall survival). In multivariate analysis, only the high grade predicted poor survival significantly (P = 0.04). Eight patients (17%) had recurrence: two local, five distant, and one both local and distant. Initial therapeutic approach was not related with the subsequent site of relapse. Two patients with only local failure were successively treated, but all the six patients who had distant component of relapse died within the same year. Surgical morbidity was seen in six (12.5%) patients. No surgical mortality was seen, and no patient developed a major complication directly related to the radical hysterectomy or lymphadenectomy. CONCLUSIONS: Without adjuvant radiotherapy, initial surgical staging procedure consisting radical hysterectomy and complete pelvic-paraaortic lymphadenectomy achieved excellent survival and minimal morbidity in stage II endometrial cancer. Distant failure was the main problem.

Adult↗
PubMed2004

Bilateral ovarian fibromatosis presenting with ascites and hirsutism.

BACKGROUND: Ovarian fibromatosis is a very rare nonneoplastic disease. Due to the rarity and atypical clinical presentations, they may give rise to a misdiagnosis of malignancy and unnecessary extensive surgical interventions. Literature lacks definitive data about this rare disease and its preoperative evaluations. MRI together with the intraoperative frozen section may help us to define the benign nature of the disease. In this report, we aimed to review the literature and give a highlight to the gynecologic oncologists about this rare disease. CASE HISTORY: A 19-year-old female patient admitted to our hospital with the complaints of menstrual irregularity, hirsutism, and increased abdominal girth. Physical examination revealed bilateral ovarian mass, hirsutism, and ascites. Serum CA-125 levels were slightly elevated. Preoperative MRI study showed bilateral hypointense lobulated ovarian masses. With the initial diagnosis of ovarian tumor, we performed explorative laparotomy and excised both masses. Final pathology was reported as bilateral ovarian fibromatosis. CONCLUSION: Ovarian fibromatosis commonly presents with ascites and solid pelvic mass and can be misdiagnosed as a malignant ovarian tumor. In young patients, clinicians should consider ovarian fibromatosis in differential diagnosis of pelvic mass. Preoperative MRI findings and intraoperative frozen examination may be used to avoid unnecessary aggressive surgical management.

Adult↗
PubMed2004

Vulvar edema as a rare complication of laparoscopy.

Vulvar edema as a complication of laparoscopy is a rare condition. A 23-year-old woman was admitted with progressive dysmenorrhea and underwent laparoscopic bilateral endometrioma cystectomy. Twenty-seven hours after surgery, unilateral vulvar edema was observed. It resolved with the application of ice packs and insertion of a Foley catheter. We conclude that this is a rare, normally benign condition that is easy to manage.

Adult↗
PubMed2004

Correlation of platelet count with second-look laparotomy results and disease progression in patients with advanced epithelial ovarian cancer.

OBJECTIVE: To evaluate the significance of preoperative platelet counts in advanced epithelial ovarian cancer with respect to second-look laparotomy results and disease progression. METHODS: We prospectively evaluated 37 consecutive patients with advanced epithelial ovarian cancer who underwent primary surgical treatment. In addition to platelet counts, all patients were evaluated with respect to age, gravida, parity, and stage and grade of tumor. Thirty-six patients had stage III, and 1 patient had stage IV disease. Optimal debulking (diameter of residual tumor, less than 1 cm) was performed in all patients who subsequently received adjuvant chemotherapy (platin-paclitaxel). According to second-look laparotomy and follow-up results patients were divided into 2 groups. The first group had negative second-look laparotomy or no evidence of disease during follow-up (n = 20), and the second group had positive second-look laparotomy or progressive disease (n = 17). Sensitivity and specificity values were calculated for different cutoff values of platelet counts with receiver operating characteristic curve analysis. RESULTS: Age, gravida, and parity were not significantly different compared with controls (P >.05). Mean platelet counts were 371 x 109/L and 446 x 109/L in the first and second groups, respectively (P =.03). Different cutoff values of platelet counts for the diagnosis of thrombocytosis were evaluated. A cutoff value of 380 x 109/L had sensitivity 77% and specificity 60% for recurrence, whereas a cutoff value of 400 x 109/L had sensitivity 59% and specificity 65%. Area under the curve (+/- standard error) was 0.72 +/- 0.08 (P =.026). CONCLUSION: In patients with progressive disease and positive second-look laparotomy, preoperative platelet counts were significantly higher compared with patients with no evidence of disease on follow-up.

Carcinoma, Endometrioid↗
PubMed2004

Association between fertility drugs and gynecologic cancers, breast cancer, and childhood cancers.

Ovulation-inducing drugs have been widely used for various types of infertility since the beginning of 1960s and their use increases day by day parallel to the success achieved in fertility treatment. However, the researches performed in the last two decades have begun to discuss about the safety of these drugs and the risks associated with their use. Especially, the potential neoplastic effects of these drugs are increasingly questioned. The studies have discussed whether there is an association between the exposure to ovulation-inducing drugs and the incidence of various cancers. Moreover, several studies have been performed to reveal whether there is an increased risk of childhood cancers in children conceived after fertility treatment. The point we reached through the available data is that the risk of breast, uterine and invasive ovarian cancers is not increased, but the risk of borderline ovarian tumors might increase after such a therapy. The risk of cancer has been found similar for children conceived after fertility treatment and those conceived naturally. It should also be kept in mind that cancers are overdiagnosed in infertile women population because of the close medical surveillance, which may also contribute to the early detection of cancers. Although it is still early to state the last words on this topic, the possible association should be addressed when obtaining an informed consent before starting treatment.

Breast Neoplasms↗
PubMed2003

Overexpression of the c-Met/HGF receptor and its prognostic significance in uterine cervix carcinomas.

OBJECTIVE: The purpose of this study is to evaluate the significance of the c-Met/hepatocyte growth factor receptor expression in invasive cervical carcinoma. METHODS: Ninety-Four patients with FIGO stage 1B disease, treated primarily with surgery, were studied immunohistochemically. Of the cases, 67 were squamous carcinoma and 27 were nonsquamous (10 were adenocarcinoma, 15 were adenosquamous carcinoma, and 2 were indifferentiated carcinoma). Immunohistochemically stained c-Met slides of primary malignancies were evaluated blindly of clinical outcome and other histopathological factors. RESULTS: Overexpression of c-Met was found in 56 of 94 specimens. Primary tumors which show recurrences were found to be c-Met overexpressors. Univariate survival analysis (Kaplan-Meier) showed that c-Met overexpression is significantly correlated with disease-free survival. Moreover the diameter of the primary tumor, deep cervical stromal invasion, presence of metastatic lymph node, number of metastatic lymph nodes and c-Met overexpression were significantly correlated with overall 5-year survival. Furthermore multivariant analysis with Cox regression showed that the presence of metastatic lymph node and immunopositivity for c-Met are significantly correlated with overall survival, while c-Met overexpression was found to be an independent variable for disease-free survival. CONCLUSION: These results reveal that c-Met oncogene overexpression is an important parameter for disease progression, recurrence, and survival in early-stage invasive uterine cervix carcinomas.

Adenocarcinoma↗