Şahin Yüksek

Introduction and importance: Mature cystic teratoma (MCT) is the most common benign ovarian germ cell neoplasm. Rupture is uncommon and may, rarely, lead to delayed intraperitoneal dissemination mimicking advanced ovarian cancer. This case is notable for the 22-year interval between surgery for a ruptured dermoid cyst and presentation with extensive disease resembling peritoneal carcinomatosis. Case presentation: A 46-year-old premenopausal woman with a history of left salpingo-oophorectomy for a ruptured dermoid cyst in 2004 presented with abdominal pain, distension, and a palpable mass. Magnetic resonance imaging revealed a 6–7 cm complex right adnexal mass and multiple peritoneal, omental, and mesenteric lesions measuring up to 3–4 cm. CA-125 (cancer antigen 125) (61 U/mL) and CA19-9 (carbohydrate antigen 19-9) (56 U/mL) were mildly elevated, whereas alpha-fetoprotein, beta-human chorionic gonadotropin, carcinoembryonic antigen, and lactate dehydrogenase were normal. Total abdominal hysterectomy, right salpingo-oophorectomy, omentectomy, appendectomy, and excision of all visible implants achieved no macroscopic residual disease. Frozen section and final histopathology showed mature teratomatous tissue without immature or malignant elements. Clinical discussion: The findings were most consistent with disseminated mature teratomatous implants, most likely associated with the previous rupture, although occult residual implants or a contralateral MCT could not be excluded. The main differential diagnoses were malignancy, growing teratoma syndrome, and gliomatosis peritonei. Conclusion: In women with a prior MCT rupture, multifocal fat-containing peritoneal lesions should raise suspicion for disseminated mature teratoma. In this patient, complete macroscopic excision was associated with a favorable short-term outcome; longer follow-up is required.

Background: Endometrial intraepithelial neoplasia/atypical endometrial hyperplasia (EIN/AEH) carries a substantial risk of concurrent endometrial carcinoma at hysterectomy. Sentinel lymph node (SLN) mapping requires cervical injection into an intact uterus, so the decision to map must be made before uterine pathology is known. A strategy that defers that decision to intraoperative frozen section therefore does not choose between mapping and no mapping; it forecloses mapping altogether. We evaluated the technical feasibility and diagnostic yield of SLN mapping performed without frozen section in patients with preoperative EIN/AEH and estimated how much of the nodal disease identified might not have been detected under a frozen-section-guided pathway. Methods: In this retrospective single-center study, 86 patients with a preoperative diagnosis of EIN/AEH underwent hysterectomy, bilateral salpingo-oophorectomy, and SLN mapping with methylene blue between November 2021 and May 2026. No patient underwent intraoperative frozen section, and all SLNs underwent ultrastaging. Patients were grouped by final histopathology, and carcinomas were staged according to FIGO 2023. A counterfactual analysis applied the Mayo intraoperative triage criteria to the final uterine pathology and considered two mechanisms separately: patients who would not have undergone nodal assessment at all, and patients who would have undergone lymphadenectomy but whose disease volume might not have been detected by conventional nodal pathology. Results: Final pathology showed persistent EIN/AEH in 37 patients (43.0%) and endometrial carcinoma in 49 (57.0%). Patients upgraded to carcinoma were older (60.3 ± 9.5 vs. 53.1 ± 10.4 years, p = 0.001), more often postmenopausal (87.8% vs. 54.1%, p = 0.001), and had greater endometrial thickness (18.6 ± 8.7 vs. 13.5 ± 5.4 mm, p = 0.004). At least one SLN was retrieved in 82 of 86 patients (95.3%) and bilaterally in 76 (88.4%); bilateral detection did not differ significantly between groups (94.6% vs. 83.7%, p = 0.177). SLNs lay in the obturator region in 62.2% of hemipelves and in the external iliac region in 26.3%, together accounting for 88.5%. Nodal involvement was identified in 11 patients (12.8% of the cohort; 22.4% of carcinomas): isolated tumor cells in two, micrometastasis in six, and macrometastasis in three. Among the patients who underwent additional non-sentinel nodal assessment, no metastatic non-SLN was identified in the presence of negative SLNs; no reference standard was applied to the remaining SLN-negative patients, so a false-negative rate cannot be estimated. No patient with EIN/AEH-only pathology had nodal involvement. Under simulated frozen-section triage, 2 of the 11 node-positive patients (18.2%) would not have undergone nodal assessment at all; a further 6 had low-volume disease that might not have been identified by conventional nodal pathology. Taken together, up to 8 of 11 (72.7%), and up to 6 of the 9 with micro- or macrometastasis (66.7%), might have remained undetected under the specified hypothetical pathway. Conclusions: SLN mapping performed before hysterectomy and without intraoperative frozen section was technically feasible with methylene blue alone and identified occult nodal disease, a substantial part of which might not have been detected under a frozen-section-guided pathway. These findings establish feasibility and diagnostic yield only: the study has no comparison group and supports no conclusion about survival, morbidity, or cost-effectiveness. Because 43.0% of patients had EIN/AEH-only pathology, mapping should form part of individualized preoperative counseling rather than be applied universally.

Background: Loop electrosurgical excision procedure (LEEP) is the standard treatment for high-grade cervical intraepithelial neoplasia (CIN) and is performed predominantly in women of reproductive age. Data on subsequent pregnancy outcomes from Turkish cohorts are limited. We described obstetric outcomes after LEEP and examined whether excision dimensions — depth, diameters and calculated cone volume — were associated with preterm birth and spontaneous miscarriage. Methods: Single-centre retrospective cohort study at a tertiary gynaecological oncology referral centre. Forty women who conceived after LEEP for CIN were identified; each contributed one pregnancy. One elective termination of pregnancy was excluded because it is not an obstetric outcome, leaving 39 pregnancies for analysis. Cone volume was calculated from pathology-reported specimen dimensions using the hemi-ellipsoid formula. Group comparisons used the Mann–Whitney U and Fisher exact tests. Because outcome events were few (eight preterm births, seven miscarriages), regression models were restricted to a single predictor and fitted with Firth penalized likelihood; two-predictor models are reported only as sensitivity analyses. There was no concurrent untreated comparison group, so no causal effect of LEEP can be estimated. Results: Of 39 pregnancies, 31 (79.5%) ended in live birth, seven (17.9%, 95% CI 7.5–33.5) in spontaneous miscarriage before 20 weeks and one (2.6%) in stillbirth at 36 weeks. Among live births, preterm birth before 37 weeks occurred in 8/31 (25.8%, 95% CI 11.9–44.6) and before 34 weeks in 2/31 (6.5%). There were no cases of PPROM or clinically diagnosed cervical insufficiency. Cone depth was greater in preterm than in term deliveries (median 32.5 vs. 23.0 mm; p = 0.004) and was associated with preterm birth in penalized regression (odds ratio [OR] 1.19 per mm, 95% CI 1.05–1.41; p = 0.006); a depth of 30 mm or more carried an OR of 9.20 (95% CI 1.70–61.09; p = 0.010). Cone depth was also associated with miscarriage (OR 1.13 per mm, 95% CI 1.02–1.27; p = 0.025), although this attenuated to OR 1.07 ( p = 0.23) once maternal age was included. Maternal age was the strongest correlate of miscarriage (OR 1.37 per year, 95% CI 1.10–1.87; p = 0.004). Calculated cone volume was strongly collinear with depth (Spearman ρ = 0.84) and showed a weaker association with preterm birth (OR 1.29 per cm³, 95% CI 1.02–1.71; p = 0.035). The LEEP-to-conception interval was not associated with either outcome. Conclusions: In this small cohort, greater cone depth was associated with both preterm birth and spontaneous miscarriage, and maternal age was the dominant correlate of miscarriage. Calculated cone volume was strongly collinear with depth and did not improve prediction. Half of the preterm births were medically indicated, and the depth association did not persist when analysis was restricted to spontaneous preterm birth. Event counts were low and confidence intervals were wide, so these findings are exploratory and hypothesis-generating rather than confirmatory. They are consistent with existing evidence supporting excision of the minimum adequate cone depth.

Background/Objectives: Rare histologic subtypes of cervical cancer are uncommon and may be misclassified during initial diagnosis. Their recognition depends on subtype-directed immunohistochemistry, which excludes metastatic mimics, and on high-risk HPV (hrHPV) testing, which establishes HPV status. Published series rarely report how the diagnosis was reached. We therefore documented the full diagnostic work-up, together with treatment and outcomes, in a consecutive single-center series. Methods: This was a retrospective, single-center case series (January 2020–January 2025). Rare tumors were defined per the 2020 WHO Classification as subtypes other than squamous cell carcinoma and usual-type adenocarcinoma. Immunohistochemistry was used to confirm lineage and exclude mimics. hrHPV DNA testing and p16 immunohistochemistry were performed where tissue permitted. A tumor was called HPV-associated only when diffuse block-type p16 positivity accompanied hrHPV DNA; HPV DNA alone was not accepted as evidence of an HPV-driven tumor. Results: Ten patients were included (median age 53 years). There were two signet-ring cell adenocarcinomas, two small cell neuroendocrine carcinomas (SCNECC), two serous adenocarcinomas, and one each of sarcomatoid carcinoma, clear cell carcinoma, granulocytic sarcoma, and poorly differentiated adenosquamous (glassy cell) carcinoma. hrHPV DNA was detected in six of the seven tumors tested. Three of these six were p16-negative: one serous, the clear cell, and the glassy cell carcinoma. Because diffuse block-type p16 expression is a validated surrogate marker of transcriptionally active hrHPV, we classified these three as HPV-independent. This matches the known biology of these histotypes. Lymphovascular space invasion was present in eight patients (80%). Over a median follow-up of 10.5 months, four patients developed distant metastases and three died. Conclusions: Accurate diagnosis of rare cervical tumors requires subtype-directed immunohistochemistry to exclude mimics and hrHPV testing interpreted together with p16; HPV DNA positivity alone does not establish HPV-association. Given the small, heterogeneous series, outcome data are descriptive and hypothesis-generating. We propose a diagnostic algorithm and immunohistochemical framework and advocate centralized review and prospective registries.

Objective. Endometrial intraepithelial neoplasia (EIN) is a premalignant lesion associated with a substantial risk of concurrent endometrial carcinoma. This study aimed to evaluate whether preoperative endometrial thickness measured by transvaginal ultrasonography could predict concurrent endometrial carcinoma in patients diagnosed with EIN. Methods. This retrospective study included 102 patients diagnosed with EIN on endometrial sampling who subsequently underwent hysterectomy. Demographic and clinical data and preoperative endometrial thickness were collected, and final histopathology after hysterectomy was recorded. Receiver operating characteristic (ROC) curve analysis and multivariable logistic regression were performed. Results. The median endometrial thickness was 13 mm (range 4–45), and most patients were postmenopausal (68.6%). Final pathology revealed endometrial carcinoma in 50 patients (49.0%) and persistent EIN in 52 (51.0%). Endometrial thickness significantly predicted concurrent carcinoma (AUC 0.679, 95% CI 0.575–0.784; p = 0.002), with an optimal cut-off of 14.5 mm (sensitivity 58.0%, specificity 75.0%). Carcinoma was found in 69.0% of patients with thickness ≥ 14.5 mm versus 35.0% below this value (p < 0.001). On multivariable analysis, endometrial thickness (OR 1.15 per mm; 95% CI 1.05–1.24; p = 0.001) and age (OR 1.11; 95% CI 1.02–1.19; p = 0.007) were independently associated with concurrent carcinoma. Conclusions. Preoperative endometrial thickness is independently associated with concurrent endometrial carcinoma in patients diagnosed with EIN. A thickness of 14.5 mm or greater may indicate a higher risk of malignancy; however, given its moderate diagnostic accuracy, it should complement rather than replace a comprehensive preoperative assessment.

Systemic inflammatory and nutritional indices derived from routine blood tests have been widely investigated as prognostic markers; however, their diagnostic value in differentiating benign endometrial disease from endometrial cancer (EC) remains insufficiently defined. This study aimed to evaluate the diagnostic performance of inflammatory and nutritional indices and to explore their associations with clinicopathological features in EC. This retrospective observational study included 270 patients who underwent surgical evaluation for endometrial pathology. The cohort comprised 135 patients with histopathologically confirmed endometrial cancer and 135 patients with benign endometrial conditions. Preoperative inflammatory indices, including neutrophil-to-lymphocyte ratio (NLR), platelet-to-lymphocyte ratio (PLR), monocyte-to-lymphocyte ratio (MLR), systemic immune-inflammation index (SII), systemic inflammation response index (SIRI), and prognostic nutritional index (PNI), were calculated. Clinicopathological characteristics and immunohistochemical findings were recorded. Multivariable logistic regression analysis was performed to identify independent predictors of malignancy. All inflammatory indices and PNI were significantly higher in the malignant group (all p < 0.001). In multivariable analysis, age, body mass index, haemoglobin level, SII (OR = 1.004, 95% CI 1.001-1.007; p = 0.018), and PNI (OR = 1.380, 95% CI 1.228-1.550; p < 0.001) emerged as independent predictors of malignancy. Receiver operating characteristic (ROC) analysis showed that PNI had limited discriminative ability (area under the curve [AUC] = 0.620, 95% CI 0.554-0.687), with a cut-off value of 52.0 (sensitivity 69.6%, specificity 50.4%). Within the malignant cohort, lower PNI values were significantly associated with adverse clinicopathological features, including deep myometrial invasion, cervical stromal invasion, lymph node metastasis, higher tumour grade, serous histology, and abnormal p53 expression. Systemic inflammatory and nutritional indices may provide complementary information in the evaluation of endometrial pathology. While SII appears to be associated with malignancy risk, PNI primarily reflects tumour aggressiveness rather than diagnostic discrimination. These readily available biomarkers may support preoperative risk stratification, particularly in patients with inconclusive imaging or biopsy results, where additional risk stratification may help guide the urgency or extent of surgical planning; however, further prospective studies are required to confirm their clinical utility.

To evaluate the relationship between serum Anti-Mullerian hormone (AMH) levels, antral follicle count (AFC), and histologically quantified primordial follicle numbers in premenopausal women, in order to validate the clinical accuracy of AMH and AFC as surrogate markers of true ovarian reserve. This prospective cross-sectional study included 89 healthy, menstruating women aged 35–48 years who underwent unilateral or bilateral oophorectomy for benign gynecological conditions. Preoperative serum levels of AMH, follicle-stimulating hormone (FSH), and estradiol (E2) were measured, and AFC was assessed by transvaginal ultrasonography during the early follicular phase. Excised ovarian tissues were processed for histological evaluation, and primordial follicles were counted by a blinded pathologist. AMH and AFC were both positively correlated with primordial follicle count (ρ = 0.75 and ρ = 0.85, respectively; p < 0.001). AMH also showed strong inverse correlations with FSH (ρ = − 0.89) and moderate inverse correlation with E2 (ρ = − 0.62). AFC was moderately negatively correlated with FSH (ρ = − 0.67). Among all tested biomarkers, AMH and AFC demonstrated the strongest associations with histologically determined follicular reserve. AMH and AFC are strongly associated with the histological size of the primordial follicle pool and represent reliable, non-invasive markers of ovarian reserve. These findings provide histological validation for their continued use in reproductive assessment and individualized fertility planning.

Akademisyen Yayınevi yöneticileri, yaklaşık 30 yıllık yayın tecrübesini, kendi tüzel kişiliklerine aktararak uzun zamandan beri, ticarî faaliyetlerini sürdürmektedir. Anılan süre içinde, başta sağlık ve sosyal bilimler, kültürel ve sanatsal konular dahil 2000 kitabı yayımlamanın gururu içindedir. Uluslararası yayınevi olmanın alt yapısını tamamlayan Akademisyen, Türkçe ve yabancı dillerde yayın yapmanın yanında, küresel bir marka yaratmanın peşindedir.Bilimsel ve düşünsel çalışmaların kalıcı belgeleri sayılan kitaplar, bilgi kayıt ortamı olarak yüzlerce yılın tanıklarıdır. Matbaanın icadıyla varoluşunu sağlam temellere oturtan kitabın geleceği, her ne kadar yeni buluşların yörüngesine taşınmış olsa da, daha uzun süre hayatımızda yer edineceği muhakkaktır.

Minimal invaziv cerrahi, açık cerrahilere göre bir çok avantajı mevcuttur. Dünyada artan teknolojik ve inovatif gelişmeler minimal invaziv cerrahinin yaygınlaşmasına katkıda bulundu. Endoskopik cerrahideki artan gelişmeler ile jinekolojik endoskopik cerrahide de ilerlemeler sağlandı. Ülkemiz de son yıllarda hem temel endoskopik hemde advanced endoskopik cerrahide dünya literatürüne makale ve teknik anlamda bir çok katkısı olmuştur. Buna karşın, jinekolojik endoskopik cerrahideki uzun öğrenme süreci ve merkezi olmayan sağlık merkezlerinde yeterli endoskopik alet alt yapısına erişim zorluğu nedeniyle istenilen seviyeye yeterince yayılmamıştır. Ayrıca, kitap ve diğer dökümanlar konusunda dünya ve ülkemizde yeterli kaynak bulunamamaktadır. Kitabımız bu konuda kaynak ihtiyacınıkapatma amacıyla yola çıktı. Konusunda yetkin uzman ve hocalar tarafından son güncel bilgiler dikkate alınarak yazıldı. Kitabımızınmeslektaşlarımıza ve jinekolojik endoskopi camiasına verimli bir kaynak olması en büyük temmenimizdir.