Tufan Arslanca

The link between chronic inflammation and cancer was first proposed by Virchow in the nineteenth century, and inflammation is now recognised as both a contributor to carcinogenesis and a consequenc...

Neuropelviology in minimally invasive surgery: a surgical anatomy-based demonstration - Journal of the Turkish-German Gynecological Association

In cytoreductive surgery for gynecological cancers, 13-25% of patients require splenectomy. Therefore, hematological parameters change in the post-splenectomy period, especially leucocytosis and thrombocytosis. In this study, we aimed to evaluate the changing of leucocyte and neutrophil between the groups with and without infection in the early postoperative period in patients who underwent splenectomy during cytoreductive surgery for gynecological cancer. This retrospective study included 96 patients who underwent splenectomy during cytoreductive surgery for gynecological malignancies. Leukocyte levels, CRP, procalcitonin, and platelet counts were recorded daily during the first five postoperative days. Postoperative infections were identified based on clinical and laboratory findings. Postoperative infection was observed in 23 patients (24.0%). On postoperative day 4, the mean leukocyte count was 13.2±4.5 ×10³/µL in infected patients vs. 9.8±3.2 ×10³/µL in non-infected patients (p=0.01). By day 5, leukocyte levels remained significantly elevated in the infection group (p<0.05). Leukocyte trends, especially between days 4 and 5, may serve as a practical marker for early postoperative infection in patients undergoing splenectomy during cytoreductive surgery.

Aim: This study aims to investigate the effects of COVID-19 (SARS-CoV-2) vaccines on high-risk Human Papillomavirus (hr-HPV) clearance and cervical cytology results in patients undergoing cervical excisional procedures. Materials and Methods: A total of 686 patients were analyzed in the Gynecological Oncology Surgery Clinic between October 2020 and July 2022. Among these, 350 patients had not received the COVID-19 vaccine, and 336 had received it. Cervical cytology and hr-HPV DNA analysis were performed on the patients 6 months after the cervical excisional procedure. Clinical data, including patients' vaccination status, were obtained from the national electronic medical record database, patient files, and face-to-face inquiries. Results: There was no significant difference between the vaccinated and unvaccinated groups in terms of age, parity, smoking, oral contraceptive use, cervical cytology, hr-HPV DNA status, cervical biopsy, endocervical curettage, type of excisional procedure, results of excisional procedure and endocervical curettage, and surgical margin status (p>0.05 for all comparisons). No significant difference was observed in the cervical cytology results 6 months post-procedure between the vaccinated and unvaccinated groups (p=0.566, 95% CI=1.130-1.549). Similarly, no significant difference was found in hr-HPV DNA clearance between the two groups 6 months post-procedure (p=0.217, 95% CI=1.412-1.750). Conclusion: The systemic effects of COVID-19 vaccines are not fully understood. Our study is among the few that investigate the impact of COVID-19 vaccines on hr-HPV DNA clearance and cervical cytology results. Current literature, similar to our findings, does not demonstrate a significant effect of COVID-19 vaccination on hr-HPV clearance and cervical cytology results. Given the strong immunogenic response elicited by COVID-19 vaccination, the potential impact of this non-specific systemic inflammatory response on hr-HPV DNA clearance warrants further investigation. This study found no difference in cervical cytology and hr-HPV DNA persistence between vaccinated and unvaccinated patients 6 months post-cervical excisional procedure. However, comprehensive studies are needed for better interpretation and acceptance of these findings.

Predictive efficacy of rectus abdominis muscle and psoas major muscle thickness for postoperative morbidity in patients with endometrial cancer - Journal of the Turkish-German Gynecological Association

Aim: Our aim is to analyze the malignant mixed germ cell tumors of the ovary that recur due to sarcomatous transformation in the literature, with a case report. Materials and Methods: An electronic database search was conducted from January 1980 to January 2023 using PubMed/MEDLINE. We evaluated the 10 cases included in these articles together with our own case. Patient age (years), first surgery type, tumor types, adjuvant therapy type, recurrence time, recurrent tumor types, and recurrence site were analyzed. Results: We evaluated 11 cases, including our own. The mean age of the 11 patients was 27.36±16.39 years. Nine patients (81.8%) had rhabdomyosarcoma differentiated areas in primary pathology. Ten patients (90.1%) received adjuvant chemotherapy. The mean recurrence time was 10±8.94 months, ranging from 2 to 24 months. Reported areas of recurrence included retroperitoneal, peritoneal, pelvic, scapula, aortic bifurcation, abdominal cavity, and mediastinal area. Discussion: We compiled ten cases in the literature with rhabdomyosarcoma transformation, including our case. Although the prognosis of GCT depends on the clinical stage and location, the presence of a sarcomatous area in GCT is a factor indicating a more aggressive behavior. Diagnostic imaging, including PET-CT scans, can be used for staging recurrent lesions and demonstrating local lymphatic metastasis or lung metastasis, which may indicate sarcomatous differentiation. Conclusion: In patients with sarcomatous differentiation, the choice of chemotherapy may vary according to this component. It is important to determine the presence of the sarcomatous component in malignant germ cell tumors with detailed pathological examination. Close follow-up with radiological means is crucial to detect early recurrence and distant metastases as a result of sarcomatous transformation, as in our case.

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.

Objectives: The study aimed to evaluate the expression of CD44, CD47, interleukin‐1 (IL‐1), and tumor necrosis factor alpha (TNF‐α) in immunohistochemically stained (IHS) samples from endometrioid endometrial cancer (EEC) and to examine their correlation with clinicopathologic parameters.Methods: IHS was used to assess CD44, CD47, IL‐1, and TNF‐α expression in 53 EEC samples. Immunostaining was scored as negative (−), slightly positive (+), moderately positive (++), or strongly/diffuse positive (+++). The prognostic value of these markers was analyzed in relation to clinicopathologic features, including survival.Results: In endometrial cancer tissues, positivity rates were CD44 (81%), CD47 (81%), TNF‐α (40.5%), and IL‐1 (42.9%). Strong and diffuse CD44 staining was associated with improved survival and linked to endocervical invasion and stage. Patients with slightly positive CD47 had significantly higher rates of pelvic and para‐aortic lymph node metastases. Strong TNF‐α staining correlated with grade 3 EEC, while slightly positive IL‐1 staining was associated with increased endocervical invasion. No significant correlation was found between CD47, IL‐1, and TNF‐α expression and survival.Conclusion: CD44 and CD47 were positive in most EEC specimens. CD44 expression was the only marker significantly correlated with overall survival and recurrence. TNF‐α showed a positive correlation with high‐grade tumors, and IL‐1 staining was inversely associated with endocervical invasion. These findings suggest that CD44 is a prognostic marker for survival, while TNF‐α and IL‐1 may have indirect prognostic roles in EEC.

Amaç: Bu çalışmanın amacı, Serebroplasental Doppler Oranı (CPR) ile fetal distress ve düşük doğum ağırlığı (DDA) arasındaki ilişkiyi incelemektir. Çalışmada CPR'nin fetal distressi öngörmedeki etkinliği ve klinik uygulamalardaki önemi değerlendirildi. Gereç ve Yöntem: Kasım 2015-Mayıs 2016 tarihleri arasında, doğum eylemi sırasında fetal distress riski taşıyan 93 gebe üzerinde bir prospektif çalışma yapıldı. Katılımcıların demografik ve obstetrik özellikleri, CPR değerleri ve diğer Doppler parametreleri (MCA S/D oranı, UA S/D oranı, PI ve RI) değerlendirildi. CPR'nin 50. persentil dilimlerindeki değerleri ile fetal distress ve DDA gelişimi arasındaki ilişki analiz edildi. Bulgular: Çalışmamızda, CPR’nin

Aim: Adnexal mass is one of the most common surgical indications in gynecology clinics, and laparoscopy is generally accepted as a gold standard in the management of adnexal mass. Materials and Method: Single incision laparoscopic surgery (SILS) is an evolving endoscopic approach in the era of minimal access surgery. Recently, it has been reported that adnexal mass may also be managed by SILS. In this report, we present 3 symptomatic patients with a huge adnexal mass operated by a single port laparoscopic approach. Results: The mean duration of the operations 95 minutes (range 75-135 minutes). None of the patients converted to laparotomy. All patients discharged on postoperative day 1. None of the patients required readmission to the hospital. Postoperatively all patients were satisfied with their incision and cosmetic results. Conclusion: Single port laparoscopic management can be successfully completed via SILS PortTM in patients with large adnexal masses with better cosmetic outcomes.