Zehra Öztürk Başarir

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: 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<0.003). Aynı ilişki HİPEK sonrasında gözlenen sağkalımda da aynı yönde devam etmiştir (p<0.004). Yan etki ve komplikasyon oranlarımız daha çok grade 1 ve 2 düzeyinde ve palyatif olarak tedavi edilmiş olup, sekiz hastada Grade III ve iki hastada Grade IV yan etki gözlenmiştir. Sonuç: HİPEK yöntemi kabul edilebilir yan etki oranı ile yüksek dozlarda kemoterapi uygulamasına imkan vermektedir. Bu yöntemin ideal kullanım alanının tespiti için farklı parametrelerin irdelenmesi büyük önem taşımaktadır. Çalışmamızda ilk cerrahinin rezeksiyon sınırlarının tedavi sonrası sağkalım oranları üzerine etkisinin olduğu saptanmıştır. Bu bulgular ışığında HİPEK uygun hasta profilinde kabul edilebilir bir tedavi yöntemi olarak sunulabilir. Aim: Hyperthermic intraperitoneal chemotherapy (HIPEC) is treatment method used in advanced-stage ovarian cancers. It aims to control peritoneal metastases in conjunction with cytoreductive surgery by directly administering cancer drugs into the peritoneum along with heat. We aimed to examine relationship between clinical-pathological features at the time of initial treatment and survival of patients diagnosed with advanced-stage ovarian cancer, treated primary cytoreductive surgery, subsequently with secondary cytoreduction + HIPEC following recurrence. Materials and Methods: Patients diagnosed advanced-stage ovarian cancer, detected after primary treatment, and treated secondary cytoreductive surgery and HIPEC were retrospectively examined. Patients demographic characteristics, stages, laboratory, clinical courses were retrospectively analyzed. Results: 29 patients with recurrent advanced-stage ovarian cancer treated with HIPEC were included in our study. During primary surgery, eight cases had R0, 20 had R1, one patient had R2 resection. Statistically significant higher survival rate was observed in patients undergoing R0 resection (p<0.003), same relationship continued in the survival observed after HIPEC (p<0.004). Our rates of side effects and complications were mostly at grade 1, 2 and were managed palliatively, with grade III in eight patients , grade IV in two patients. Conclusion: HIPEC method allows the administration of high doses of chemotherapy with an acceptable rate of side effects. It is crucial to examine different parameters to determine the ideal application of HIPEC. We found that resection margins of the initial surgery had an impact on post-treatment survival rates. Based on these findings, HIPEC can be presented as an acceptable method in an appropriate patient profile.

Amaç: Bu çalışmada müsinöz borderline over tümörlerinin (MBOT) klinik ve patolojik özellikleri ile birlikte stromal mikroinvazyona etki eden risk faktörleri incelenmiştir. Gereç ve Yöntemler: Jinekolojik onkoloji kliniğinde 2005-2019 yılları arasında histopatolojik tanısı MBOT olan 76 hasta dahil edildi. Bu hastaların preoperative Ca125, CA-19-9 düzeyi, FIGO evresi, tümörün bilateralite olması, tümor boyutu, en büyük tümor çapı, stromal mikroinvazyon varlığı, fertilite sonuçları, uygulanan cerrahi prosedür tipi, rekürrens varlığı retrospektif olarak incelendi Bulgular: Preoperative ortanca Ca125 seviyesi 22 (5-249) IU/mL iken, Ca19.9 ölçümleri 34 (1-1065) IU/mL idi. 76 hastanın %9,2’sinde (n=7) mikroinvazyon saptanırken, %90,8’inde (n=69) saptanmadı. 76 hastanın %53,9’una (n=41) definitif cerrahi (TAH ve bilateral saipingooferektomi ), %46,1’ine (n=35) konservatif cerrahi (unilateral salpingo oferektomi) uygulanmıştır. Mikroinvaziv grupta preoperative Ca125 düzeyi, mikroinvazyon saptanmayanlara göre istatistiksel olarak anlamlı düzeyde yüksek saptandı (p<0,001). Mikroinvazyon görülen grupta hastaların ileri evre (evre 3-4) saptanma olasılığı anlamlı düzeyde yüksek saptandı (p<0,001). Definitif cerrahi yapılan grup ile konservatif cerrahi yapılan grup arasında nüks oranları açısından fark izlenmedi Sonuç: MBOT malign epiteyal over kanserlerine göre genç yaş grubunda tanı aldıklarından, fertilite istemi olan hastalarda konservatif cerrahi düşünülebilir. Preoperatif CA-125 yüksekliği olan hastalarda stromal mikroinvazyon riski artmaktadır ve nüks açısından CA 125 serum seviyesi yüksekliği olan hastaların düzenli takip edilmesi gerekmektedir.

Background: Papanicolau smear (Pap) is an effective technique for the diagnosis of cervix cancer. Atypical glandular cells may be revealed in this examination and occasionally may be the first sign of extratuerine malignancy. The 8 cases presented in this study are uncommon cases of previously unknown extrauterine tumors all detected on classical Pap smears. Patients and Method: A retrospective analysis of the clinical database identified eight women with previously undiagnosed extrauterine tumor detected on standard Pap smear. Clinical data were obtained from patient files and microscopic examination was repeated on the material obtained from the cytology archives. Cellblock and cytomorphology examinations were made, and clinical data were reviewed together with histopathology. Results: Pap smear was the first sign of malignancy in all cases. The patients were asymptomatic or had non-specific symptoms. Definitive diagnosis was made after adequate radiological work up and biopsy. All eight cases had similar cytomorphological features of a histologically proven primary tumor. Atypical glandular cell groups were the most remarkable sign in six patients. In the other two patients, cells of lymphatic origin and atypical lymphocytes were detected. Cellblock with immunohistochemistry confirmed the diagnosis in three cases. Conclusion: Pap smear is a worldwide accepted method for cancer screening. Although it has high specificity and sensitivity for cervical cancers, the results of this study highlight that rigorous examination of Pap

Citation: Arslanca SB, Sahin O, Erkayıran U, Basarır ZO, Arslanca T. Can Stria Gravidarum Predict Surgical Fluid Loss in Cesarean Section? Dermatol Pract Concept. 2023;13(3):e2023175. DOI: https://doi.org/10.5826/dpc.1303a175 Accepted: November 7, 2022; Published: July 2023 Copyright: ©2023 Arslanca et al. This is an open-access article distributed under the terms of the Creative Commons Attribution-NonCommercial License (BY-NC-4.0), https://creativecommons.org/licenses/by-nc/4.0/, which permits unrestricted noncommercial use, distribution, and reproduction in any medium, provided the original authors and source are credited. Funding: None. Competing interests: None. Authorship: All authors have contributed significantly to this publication. Corresponding author: Tufan Arslanca, Department of Gynecologic Oncology, Ankara City Hospital, University of Health Sciences, Ankara, Turkey. ORCID:0000-0001-9686-1603 E-mail: drtufanarslanca@hotmail.com Introduction: Alterations in collagen subtypes and matrix can potentially cause fluid loss in surgery which are important in terms of liqud loss. Objectives: The study aimed to analyze stria gravidarum (SG) and its severity in pregnant who had undergone cesarean section (CS) and to evaluate surgical fluid loss (SFL) that occurred during CS operation. Methods: The research was designed as a prospective clinical cohort study to compare the amount of SFL in the second cesarean section with the severity of SG at 34-37 weeks pregnant (n:308). The severity of SG was evaluated in the preoperative period using the Davey scoring. All patients were defined none, mild stria and severe stria. The SFL was calculated by weighing the pre-and post-operative weights of the sponges. Results: The weight gain (p=0,008) and BMI (p=0,017) gradually increased toward severe SG. In correlation analysis of SFL, a positive correlation was found with Davey (r=0.791; p=0.0001), weight gained during pregnancy (r=0.328;p=0.0001), BMI (r=0.453;p=0.001) and newborn’s weight (r=0.139;p=0.003). In the ROC for the predictability of SG severity on SFL, severe SG showed a potential for SFL with %95.1 specificity and %93.2 sensitivity at 791 cut-offs (Area Under the Curve:0,987; p=0.00001; %95 Confidence Interval: 0.977-0.997). Conclusion: The SG severity and SFL showed a very strong relationship, which was a very important finding that would affect the approach of the surgeons to the patients with SG in terms of fluid loss in CS. Keywords : Stria gravidarum, surgical fluid loss, cesarean section, Davey score This work is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License.

Objective: COVID-19 has caused a rapid transformation in the healthcare system, including in particular, the care of vulnerable cancer patients. The aim of this study was to present our clinical experience in gynecological cancer surgeries in a COVID-19-free cancer hospital during the pandemic. Methods: A retrospective analysis was made of the data of patients with ovarian, endometrium, cervix and vulva cancers who were treated with surgery between March 2020 and March 2021, with particular focus on the complication rates on day 30, and at the end of one year. Results: The study included a total of 74 patients with mean age of 59 years. The most common diagnosis was ovarian cancer (48.6%) followed by endometrial (43.2%), cervical (6.8%) and vulvar cancer (1.4%). Most of the patients were in advanced stage (FIGO 3 and 4) of ovarian (86%), endometrial (59.4%) and cervical local advanced (60%) cancer. The complication rate was 17.6 %. Surgery was delayed in one patient with a preoperative positive polymerase chain reaction (PCR) test for COVID-19 infection, and none of the patients had a positive test result in the early postoperative period. Conclusion: COVID-19-free institutions for cancer surgery, is an effective treatment strategy in the context of the pandemic. The results of this study indicate that continuity of cancer treatment can be achieved safely, with strict adherence to COVID-19 precautions for both patients and healthcare workers. Keywords: COVID-19, gynecological cancer, surgery, treatment

Joint Diseases and Related Surgery (JDRS), the official journal of the Turkish Joint Diseases Foundation, is an international, peer-reviewed, immediate open access journal. All published articles in JDRS has been free for everyone, without embargo, since 1990.

Objective: This study aimed to analyze the patient-reported outcomes and survival following surgical treatment of bone metastases from (uLMS) uterine leiomyosarcoma. Methods: A retrospective review of six patients undergoing surgical procedures for metastatic uLMS over seven years was conducted at a single center. All patients were reviewed for their primary malignancy and characteristics of bone metastasis during follow-up. Clinical presentation of bone metastasis, modality, and the type of treatment related to musculoskeletal involvement were also analyzed. The visual analog pain scale (VAS) and Eastern Cooperative Oncology Group (ECOG) performance status scale were used pre-and postoperatively to evaluate the patient-reported outcome. Results: Four patients had solitary bone metastases, whereas multiple bone metastases were diagnosed in two. Of those who had solitary bone metastasis, all of them were treated with wide resection. One of the two patients with multiple bone metastases was also treated with wide resection, and the other was treated with intralesional curettage. Four patients died from primary disease, and two were alive without evidence of disease recurrence. The median survival time following a diagnosis of bone metastasis was 15.0 months (95% CI, 0.6 to 29.4 months). The mean VAS scores for all six patients improved. However, the improvement in ECOG performance status was seen in only four patients. Conclusion: Although the prognosis of uLMS patients with bone metastasis seems poor, wide resection of the solitary bone metastasis may help prolong the overall survival. Performing orthopedic surgeries for the bone metastasis from uLMS in case of intractable pain after palliative radiotherapy, impending or pathological fracture, or solitary disease has been shown to decrease the pain significantly and improve the performance status in the majority. Level of Evidence: Level IV, Therapeutic Study Cite this article as: Öztürk Başarır Z, Karaca MO, Balaban K, Başarır K. Clinical outcomes and survival following treatment of bone metastases from uterine leiomyosarcoma: a report of 6 cases. Acta Orthop Traumatol Turc. 2022;56(4):278-282.