Tumour markers and histopathologic features of ovarian endometriotic cysts

Endometriosis is one of the most common benign gynaecologic diseases and its clinical presentation is generally ovarian endometrioma. We aimed to assess the association of tumour markers with histopathological structure of ovarian endometriomas to assess their roles in clinical management. Data from 86 women who underwent laparoscopic surgery for ovarian endometrioma were evaluated. The possible risk factors for inadvertently removed normal ovarian parenchyma (IRNOP) during laparoscopic cystectomy and the relationship between tumour markers and histopathologic parameters of ovarian endometrioma were assessed. Age and the depth of penetration of endometrial tissue into the cyst wall showed a significant positive correlation with thickness of IRNOP. There was a significant negative correlation between IRNOP and the thickness of fibrosis on cyst wall. Thickness of fibrosis and the depth of penetration represented significant positive correlations with tumour markers (CA 125, CA 15-3, and CA 19-9), respectively. This is the first study that reveals the association between tumour markers and the histopathologic features of ovarian endometrioma. The outcome of the present study indicated that lower levels of tumour markers may permit a conservative management, rising levels may help in timing of a possible surgical intervention and high levels may help in counselling postoperative outcomes.Impact statementWhat is already known on this subject? Endometriosis is defined as a benign gynaecologic disease, and the vast majority of women who suffer from endometriosis are of reproductive age. Ovarian endometriotic cysts are found in one-fifth to one-half of patients with endometriosis. Laparoscopic cystectomy is accepted as the gold standard for the surgical management of ovarian endometriotic cysts because of the procedure's several clinical advantages, such as lower recurrence and higher pregnancy rates. However, studies have indicated that laparoscopic excision of an ovarian endometrioma capsule could be associated with a reduction in both the ovarian volume and the follicle count.What do the results of this study add? Our retrospective data indicate that tumour markers may have role in planning the management of ovarian endometriomas.What are the implications of these findings for clinical practice and/or further research? Low tumour markers levels may permit a conservative management, elevating levels may help in timing of a possible surgical intervention and finally high levels may help in counselling the patient about her possible postoperative outcomes.

Comparison of ovarian responsiveness tests with outcome of assisted reproductive technology - a retrospective analysis

INTRODUCTION

This study aims to compare the association between the most commonly used ovarian responsiveness markers - age, anti-Müllerian hormone levels (AMH), antral follicle count (AFC), ovarian sensitivity index (OSI), and ovarian response prediction index (ORPI) - and ovarian responsiveness to gonadotropin stimulation in assisted reproductive technology (ART) cycles.

MATERIAL AND METHODS

Patients who underwent intracytoplasmic sperm injection treatment using either a gonadotropin releasing hormone (GnRH) antagonist or agonist protocol were enrolled in the study. Data of the patients were abstracted from the hospital's database. Tests were compared for total number of retrieved oocytes, metaphase II (MII) oocytes, embryos, good quality embryos on day 1 and day 3, and ongoing pregnancies per cycle.

RESULTS

The OSI was the ovarian response test that had the strongest relationship with the ART outcomes. The level of association between the ovarian response tests and poor ovarian response data was (in descending order): OSI, ORPI, AFC, AMH, and age (AUC_OSI = 0.976, AUC_ORPI = 0.905, AUC_AFC = 0.899, AUC_AMH = 0.864, AUC_age = 0.617). The overall association between OSI and poor ovarian response was significantly higher than the other parameters (p₁ = 0.0023, p₂ = 0.0014, p₃ = 0.0001, p₄ ≤ 0.0001). In patients with high ovarian response data, OSI had the highest association, followed by AFC and ORPI age (AUC_OSI = 0.984, AUC_AFC = 0.907, AUC_ORPI = 0.887). There was no statistically significant difference among the tests for the data of patients with ongoing pregnancies.

CONCLUSIONS

In this study, which is the first study comparing the five most frequently used ovarian responsiveness markers and the second study signifying the role of OSI in an antagonist protocol, OSI was found to be more convenient to calculate, and it could be superior to other ovarian responsiveness markers for poor and high ovarian responses on cycles with agonist or antagonist protocols.

Colloid Carcinoma of the Uterine Cervix and Its Immunohistochemical Analysis: A Case Report

Colloid carcinoma, which is a very rare tumor of the uterine cervix, is composed of an excessive amount of mucus and a relative paucity of tumoral glandular cells within them. Herein, we report a rare case of colloid carcinoma of the cervix with adenocarcinoma in situ (AIS), intestinal and usual types, and endocervical adenocarcinoma (usual type) components. We also discuss the morphological and immunohistochemical characteristics of this tumor. A 51-year-old woman was referred to our outpatient clinic with the symptom of genital bleeding lasting for 5 months. She had a cervix surrounded by an irregular tumor with a diameter of 5 cm. The colloid carcinoma cells were positive for MUC2, MUC5AC, and cytokeratin (CK) 7, focal positive for CDX2, and negative for MUC6 and CK20. Also, the intestinal type AIS showed a similar staining pattern. Colloid carcinoma cells producing mucin showed an intestinal phenotype and AIS. The intestinal type can be considered as a precursor lesion of colloid carcinoma.

Evaluation of risk factors for the recurrence of ovarian endometriomas

OBJECTIVES

To evaluate the risk factors for the recurrence of ovarian endometrioma after laparoscopic cystectomy.

STUDY DESIGN

Reproductive aged patients who underwent laparoscopic ovarian endometriotic cystectomy and with histopathologically confirmed diagnosis of ovarian endometrioma were evaluated retrospectively. Histopathologic specimens were reevaluated and histopathologic characteristics of ovarian endometriotic cysts (thickness of cyst wall, thickness of fibrosis [ToF], thickness of ovarian tissue, the number of follicles per cyst, the depth of penetration [DoP] of endometrial tissue into the cyst wall) were determined. Along the determined histopathologic findings, demographic characteristics (age at surgery, number of pregnancies), clinical symptoms (dysmenorrhea, infertility), intraoperative findings (revised American Society for Reproductive Medicine [rASRM] stage), imaging features (bilaterality, cyst diameter), and biochemical parameters (Ca125, Ca19.9, Ca15.3) were evaluated as possible risk factors for the recurrence of endometrioma. The variables with p<0.2 in univariate analysis were introduced into regression analysis to determine the risk factors for recurrence.

RESULTS

There were statistically significant differences in age group (≤35 years and >35 years), the ToF and DoP between patients with recurrence and those with no recurrence. In Cox regression analysis, age ≤35 years and DoP were significant risk factors for presence of recurrence. DoP, ToF, preoperative cyst diameters in ultrasonographic examination were inversely correlated with recurrence interval. In multivariate regression analysis, the DoP was found the only significant risk factor for the recurrence interval. 1.2mm of DoP was found as the optimum cut off value for presence of recurrence according to Youden index criteria in ROC curve analyze. The sensitivity (62.9%), specificity (75%) were obtained at the cut off value of 1.2mm for DoP.

CONCLUSION

Histopathological features of ovarian endometriotic cyst may have important roles on predicting the recurrence of the endometrioma. Predicting the recurrence risk of particular patient is very important in future management of the disease. Knowing the recurrence risk of an endometrioma will help in deciding the optimal treatment modalities for each individual patient. High risk patients should be offered appropriate treatments according to the clinical status without delay and low risk patients should be protected from overtreatment.

Validation of the Turkish Version of the Sexual Health Outcomes in Women Questionnaire (SHOW-Q) in Turkish-Speaking Women

INTRODUCTION

The Sexual Health Outcomes in Women Questionnaire (SHOW-Q) is designed to evaluate the sexual life of women for satisfaction, orgasm, desire, and pelvic problem interference. The SHOW-Q is important for evaluating worsening of sexual life for patients with pelvic problems and the management of these women to improve their sexual life.

AIMS

To validate the Turkish versions of the SHOW-Q for Turkish-speaking women.

METHODS

The Turkish version of the SHOW-Q was generated by two independent professional English-to-Turkish translators. The translated version of the SHOW-Q was reverse translated by two bilingual translators whose native language was English. Women with at least one symptom related to pelvic problems (n = 71) and those with no symptoms (n = 38) were included in the present study.

MAIN OUTCOME MEASURES

Test-retest reliability analysis, content-face validity, internal consistency reliability, item-total correlations, convergent validity, construct validity, and factorial validity were performed to assess the psychometric properties of the Turkish versions of the SHOW-Q.

RESULTS

Test-retest reliability demonstrated good correlation for all subscales. Cronbach α values ranged from 0.735 to 0.892 and indicated high internal consistency. There was a strong correlation for the corresponding subscales between the SHOW-Q and the Female Sexual Function Index. The mean score of each SHOW-Q subscale showed significant differences between symptomatic and asymptomatic patients.

CONCLUSION

The Turkish version of the SHOW-Q is a valid and reliable instrument that can be used to evaluate the sexual life of Turkish-speaking women with different pelvic problems.

Translation and validation of the Endometriosis Health Profile (EHP-5) in patients with laparoscopically diagnosed endometriosis

OBJECTIVES

To validate the Turkish-translated versions of the Endometriosis Health Profile 5 (EHP-5) for use in patients with laparoscopically proven endometriosis.

STUDY DESIGN

This case control study was conducted in a tertiary referral teaching institution between April and June 2014. Fifty-eight patients with surgically proven endometriosis were enrolled. The EHP-5 questionnaire was evaluated for patients with laparoscopically diagnosed endometriosis. Test-retest reliability, descriptive statistics, reliability analysis (internal consistency and item-total correlation), data completeness, and known-group comparison were all assessed in the validation of the EHP-5 form as translated into the Turkish language.

RESULTS

Two weeks test-retest reliability showed statistically significant correlation; Spearman's rho was 0.885 (p<0.001) for the EHP-5 core questionnaire and 0.896 (p<0.001) for the EHP-5 modular questionnaire. Cronbach's alpha values for the translated form of the EHP-5 core and modular questionnaires were 0.829 and 0.804, respectively, with a high level of internal consistency. In known group comparison, there were statistically significant differences in all subgroups except in the infertility group on the core questionnaire. Pain scales on the core questionnaire and infertility scales on the modular questionnaire showed the highest mean scores (1.14±1.16 and 1.78±1.77).

CONCLUSION

Like the original English questionnaire, the Turkish-translated version of the EHP-5 is a reliable and valid instrument for assessing symptom severity and the impact of endometriosis on health-related quality of life in Turkish-speaking women.

Intrinsic factors rather than vitamin D deficiency are related to insulin resistance in lean women with polycystic ovary syndrome

OBJECTIVE

To investigate the correlation between insulin resistance (IR) and serum 25-OH-Vit D concentrations and hormonal parameters in lean women with polycystic ovary syndrome (PCOS).

PATIENTS AND METHODS

50 lean women with PCOS and 40 body mass index (BMI) matched controls were compared in terms of fasting insulin and glucose, homeostatic model assessment insulin resistance (HOMA-IR), 25-OH-Vit D, high sensitivity C-reactive protein (hs-CRP), luteinizing hormone (LH), follicle-stimulating hormone (FSH), total testosterone, dehydroepiandrosterone sulfate (DHEA-S), total cholesterol, high density lipoprotein (HDL), low density lipoprotein (LDL), triglycerides and Ferriman-Gallway (FG) scores. Correlation analyses were performed between HOMA-IR and metabolic and endocrine parameters.

RESULTS

30% of patients with PCOS demonstrated IR. Levels of 25-OH-Vit D, hsCRP, cholesterol, HDL, LDL, triglyceride and fasting glucose did not differ between the study and control groups. Fasting insulin, HOMA-IR, LH, total testosterone, and DHEA-S levels were higher in PCOS group. HOMA-IR was found to correlate with hs-CRP and total testosterone but not with 25-OH-Vit D levels in lean patients with PCOS.

CONCLUSIONS

An association between 25-OH-Vit D levels and IR is not evident in lean women with PCOS. hs-CRP levels do not indicate to an increased risk of cardiovascular disease in this population of patients. Because a strong association between hyperinsulinemia and hyperandrogenism exists in lean women with PCOS, it is advisable for this population of patients to be screened for metabolic disturbances, especially in whom chronic anovulation and hyperandrogenism are observed together.

Is there a relationship between endometrial polyps and obesity, diabetes mellitus, hypertension?

OBJECTIVE

The purpose of our study was to evaluate the relationship between endometrial polyps and obesity, diabetes mellitus (DM) and hypertension (HT).

MATERIALS AND METHODS

202 patients who applied to our gynecology clinic with complaints of infertility, recurrent pregnancy loss and abnormal uterine bleeding, diagnosed to have endometrial polyps by hysteroscopy, were compared with 79 patients without polyps, retrospectively. The relationships between risk factors and presence of a polyp and polyp size were analyzed.

RESULTS

The mean age of cases with endometrial polyps was significantly greater than the controls. The mean body mass index (BMI) of the cases with polyps was also significantly greater than the controls. There was no significant difference between groups with respect to prevalence of DM or HT.

CONCLUSION

This study suggests that obesity is an independent risk factor in the development of endometrial polyps. Clinicians should be aware in terms of endometrial polyps in the assessment of patients with BMI ≥30. There was no relationship between HT or DM with presence of polyps.

Effects of urinary incontinence subtypes on women's quality of life (including sexual life) and psychosocial state

OBJECTIVE

Our aim was to investigate the effects of urinary incontinence subtypes on women's quality of life (including sexual life) and psychosocial state.

STUDY DESIGN

The patients, who applied to our clinic from March 2011 to August 2011, were identified and stratified into three groups: those with stress incontinence proved urodynamically (USI), those with urge incontinence (UI), and those with mixed incontinence urge incontinence (UI) proved by urodynamic and clinic evaluation. Scores on the Beck anxiety inventory (BAI), pelvic organ prolapse/urinary incontinence sexual questionnaire (PISQ-12), urogenital distress inventory (UDI-6), and incontinence impact questionnaire (IIQ-7) were compared between the urinary incontinence subtypes.

RESULTS

According to urodynamic and clinical examination of 111 women with urinary incontinence, 59 (53%) had USI, 35 (32%) had UI, and 17 (15%) had MI. BAI-scores significantly differed between the USI and UI groups (p=0.030) and between the USI and MI groups (p=0.011) not between the UI and MI groups (p=0.597). UDI-6 scores did not significantly differ between the three groups (p=0.845). IIQ-7 scores significantly differed between the USI and MI groups (p=0.003) and between the UI and MI groups (p=0.006) but not between the USI and UI groups. Patients with USI had significantly lower PISQ-12 scores than those with UI (p=0.015).

CONCLUSIONS

These differences in the effects of incontinence subtypes should be kept in mind in the evaluation of patients with urinary incontinence. Psychiatric assessment may improve the management of incontinence in women, especially UI and MI.

Pregnancy in a patient with Wegener's granulomatosis: a case report

BACKGROUND

Pregnancy in patients with Wegener's granulamotosis (WG) is rare, and differential diagnosis of WG flare and preeclampsia is difficult.

CASE

A pregnant 35 year old with WG was referred with diagnosis of severe preeclampsia; caesarean section was performed. Intubation of the patient was difficult due to subglottic stenosis. Because of the clinical symptom, the case was considered preeclampsia, but p-ANCA of the patient was positive. In pregnancies with WG, differential diagnosis of WG flare-ups from preeclampsia should be made from clinical symptoms and laboratory findings. Serum ANCA titers are not useful in the differential diagnosis of WG flare-ups and preeclampsia because it may be positive in preeclampsia.

CONCLUSION

Differential diagnosis of WG flare-up and preeclampsia should be made by clinical features. In the patients with subglottic stenosis, general anesthesia should not be preferred due to the probability of difficult intubation.

Effects of single vaginal incision technique on quality of life in women with stress urinary incontinence

STUDY OBJECTIVE

To estimate the short-term effects of a minimally invasive single vaginal incision technique without passing through the abdomen or groin (ContaSure Needleless System) on the quality of life in women with incontinence.

DESIGN

Prospective cohort study (Canadian Task Force classification II-2).

SETTING

Tertiary referral urogynecology clinic.

PATIENTS

50 consecutive patients with urodynamically proved stress urinary incontinence from October 2008 to March 2009.

INTERVENTIONS

Preoperative and postoperative scores on the short forms of the IIQ-7 (Incontinence Impact Questionnaire, UDI-6 (Urinary Distress Inventory) PISQ-12 (Pelvic Organ Prolapse/Urinary Incontinence Sexual Function), and long form of the P-QOL (Prolapse Quality of Life) were evaluated in 50 patients with urodynamically proved stress urinary incontinence. Scores were compared with postoperative urodynamic findings.

MEASUREMENTS AND MAIN RESULTS

Mean (SD) follow-up was 433.5 (44.1) days (95% CI, 420.1-445.1). Patients showed statistically significant improvement insofar as preoperative and postoperative scores on the IIQ-7, P-QOL, and PISQ-12 and the irritative and stress subgroups of UDI-6. Obstructive score of UDI-6 worsened, consistent with the findings of pressure-flow studies. Postoperatively, 40 patients (80%) were urodynamically continent. Eight patients (16%) were still incontinent; however, their quality of life scores (IIQ-7 and UDI-6 stress) improved. Two patients (4%) continued to experience leakage, with equal or worsened quality-of-life scores.

CONCLUSION

Early clinical results of the present trial demonstrate that the ContaSure Needleless System seems to be capable of improving significantly all aspects of quality of life in women with incontinence. To improve the willingness for treatment of women with stress incontinence, this minimally invasive technique should be encouraged after confirming its efficacy in larger prospective, randomized, comparative trials.

Does mediolateral episiotomy decrease central defects of the anterior vaginal wall?

OBJECTIVE

This retrospective study investigates the effects of mediolateral episiotomy on the pelvic floor.

METHODS

Premenopausal women suffering from urinary incontinence/genital prolapse who delivered only by vaginal route were enrolled into the study. History of diabetes, morbid obesity (BMI > 40 kg/m(2)), vacuum/forceps extraction, perineal lacerations that warranted repair during labor and any pelvic surgery were the exclusion criteria. Evaluation of the patients included pelvic organ prolapse quantification scores, presence of stress incontinence, urethral hypermobility, and questionnaires were obtained for overactive bladder and anal incontinence symptoms. These data obtained from patients with the history of mediolateral episiotomy were compared with those of patients with no episiotomy or any other pelvic injury that warranted surgical repair.

RESULTS

Groups were identical by means of demographic data, POP-Q findings, signs and symptoms of the pelvic floor. However, in the MLE group, central defects on the anterior vaginal wall were less frequent.

CONCLUSION

According to the results of this retrospective study, MLE seems to prevent central defects on the anterior vaginal wall. Prospective randomized studies are needed to draw a sufficient conclusion.

Discrepancy of pre- and postoperative grades of patients with endometrial carcinoma

PURPOSE

To investigate the diagnostic accuracy of endometrial curettage in patients with endometrial carcinoma. In this retrospective study, pre- and postoperative histopathologic findings of patients with endometrial cancer were investigated.

METHODS

168 patients with the final diagnosis of endometrial cancer were enrolled in the study. Pre- and postoperative histopathologic diagnoses and grades (according to the 1988 FIGO classification) of the patients were compared retrospectively.

RESULTS

22 patients were diagnosed as having endometrial hyperplasia and the remaining 136 patients had endometrial carcinoma preoperatively. Overall discrepancy rate of grades was 39% (31% upgrade, 8% downgrade; p < 0.05). There was also 9% discrepancy between the pre- and postoperative histopathological types.

CONCLUSION

It has been suggested that since endometrial cancer patients with low grades according to the preoperative pathologic diagnosis have a potential to upgrade, the management of these patients if myometrial invasion is less than one-half thickness, simply by hysterectomy plus bilateral salpingo-oophorectomy (without lymph node sampling), might actually miss some patients who actually deserve surgical staging. Further studies are needed to draw a sufficient conclusion.

Possible cause of failure after McCall culdoplasty

OBJECTIVE

To evaluate prospectively the rate of postoperative failure of McCall culdoplasty and the presence of a history of vaginal delivery of macrosomic infants as risk factors in patients with stage III or symptomatic stage II apical prolapse without any other pelvic floor defects.

MATERIALS AND METHODS

Patients with pelvic organ prolapse who underwent vaginal hysterectomy and McCall culdoplasty procedures were staged according to the POP-Q system before and after the operation (n = 70). POP-Q stages, age, gravidity, parity, body mass index (BMI), and the presence of diabetes mellitus in patients with or without history of vaginal delivery of macrosomic infants were analyzed. A birth weight of ≥4,000 g was accepted as macrosomia. Operative failure was defined as a postoperative POP-Q stage ≥ stage III of the apical segment. Follow-up period was 26.5 ± 6.37 months.

RESULTS

Twenty-seven women had a history of macrosomic delivery and the remaining 43 did not. Postoperative failure was observed in 15 patients (44.4%) in the macrosomia group and in 3 patients (6.9%) in the control group. Postoperative failure was seen more frequently in the macrosomia group (Pearson's chi-square test, P = 0.000). No significant difference was found between the groups regarding age, gravidity, parity, BMI and the presence of diabetes mellitus.

CONCLUSION

Failure of McCall culdoplasty occurs more frequently in patients with history of vaginal delivery of macrosomic infants, possibly due to direct pelvic floor damage. This technique should not be used in patients with a possible history of direct pelvic floor damage.

Intrinsic tunneling in phase separated manganites

We present evidence of direct electron tunneling across intrinsic insulating regions in submicrometer wide bridges of the phase-separated ferromagnet (La,Pr,Ca)MnO3. Upon cooling below the Curie temperature, a predominantly ferromagnetic supercooled state persists where tunneling across the intrinsic tunnel barriers (ITBs) results in metastable, temperature-independent, high-resistance plateaus over a large range of temperatures. Upon application of a magnetic field, our data reveal that the ITBs are extinguished resulting in sharp, colossal, low-field resistance drops. Our results compare well to theoretical predictions of magnetic domain walls coinciding with the intrinsic insulating phase.

Trapped electromagnetic modes and scaling in the transmittance of perforated metal films

We describe measurements and simulations of the enhanced transmittance by subwavelength hole arrays in silver films. The array period and hole size are systematically varied to give peak transmittances at wavelengths spanning a factor of 14. The spectra coincide when scaled using the array geometry and substrate refractive index alone, thus showing no significant dependence on the dielectric function of the metal. We argue that the spectra can be explained by interference of diffractive and resonant scattering. The resonant contribution comes from electromagnetic modes trapped in the film vicinity.