The Role of Lymphovascular Space Invasion and Cytology in the Prognosis of Endometrial Cancer

BACKGROUND

Lymphovascular space invasion (LVSI) and cytology are both independent and strong prognostic factors in endometrial cancer. This study aims to highlight the impact of LVSI and cytology positivity on prognosis, in addition to molecular classification.

METHODS

A retrospective review was conducted on the records of 223 patients with endometrial cancer diagnosed between January 2011 and January 2021. The inclusion criteria stipulated that the patients were diagnosed with endometrial cancer by endometrial biopsy and were operated in the clinic. The exclusion criteria included sarcoma in the postoperative pathology report results or synchronous tumor. Staging was performed according to the Fédération internationale de gynécologie et d'obstétrique (FIGO) 2009 criteria. Cytology (using 50 cc saline) was obtained upon entry into the peritoneal cavity. In 20 patients, saline was not used due to the presence of ascites in the abdomen. The Kaplan-Meier method was employed to evaluate overall survival and progression-free survival. Survival rates were compared in terms of cytology and LVSI.

RESULTS

After analyzing the postoperative pathology results, it was found that the mean tumor size was 4.03 ± 2.3 cm. The most common histological type was endometrioid carcinoma, with stage IA being the most common stage. Out of 223 patients with endometrial cancer, the overall survival rate was 82.4%, and the progression-free survival rate was 88.3%. For patients negative for LVSI, the progression-free survival rate was 93%, while for LVSI-positive patients, it was 77.3% (p < 0.001). Additionally, the progression-free survival rate for patients negative for cytology was 90.4%, whereas for cytology-positive patients, it was 77.1% (p < 0.05).

CONCLUSIONS

In our study, we observed that LVSI positivity and cytology positivity also reduced the overall survival rate. We aimed to highlight that, in addition to molecular classification, cytology positivity and LVSI positivity are still highly significant and independent factors in prognosis.

Two-Year Follow-Up Results of Transobturator Tape Procedure with and without Concomitant Vaginal Surgery

OBJECTIVE

This study aims to evaluate the subjective and objective outcomes of the transobturator tape (TOT) procedure performed to treat stress urinary incontinence and to determine the efficacy and safety of the TOT procedure when used along with vaginal surgery.

METHODS

This is a prospective review of 24 women who had the TOT procedure done only due to stress incontinence; 22 women who underwent concomitant TOT and pelvic floor repair; and 20 women who received concurrent TOT, transvaginal hysterectomy, and sacrospinous ligament fixation.

RESULTS

When compared to the patients who had TOT with pelvic floor repair, the patients who underwent TOT with hysterectomy declared to have more dyspareunia (p = 0.008) and they were found to have significantly higher post-void residual volume (p = 0.014). When compared to the patients who had only TOT, the patients who underwent TOT with hysterectomy claimed to have more pelvic pain (p = 0.012) and significantly higher post-void residual volume (p = 0.020).

CONCLUSION

The TOT procedure results in moderately high objective cure rates, and concurrent application of pelvic floor repair or transvaginal hysterectomy does not affect these rates. The relatively higher incidences for voiding problems and pelvic pain in women who underwent TOT, hysterectomy, and sacropinous fixation simultaneously suggest that the extent of surgery directly correlates with the severity of postoperative complications.

Plasma L-carnitine levels of obese and non-obese polycystic ovary syndrome patients

It is well-known that plasma L-carnitine concentrations are significantly decreased in obese individuals. A study showed that L-carnitine concentrations are significantly lower in lean PCOS patients than in lean healthy women. Thus, it has been suggested that lowered L-carnitine is associated with PCOS. This study also showed that the women with PCOS had significantly lower L-carnitine levels than those of the healthy controls. In addition, this study hypothesised that low L-carnitine levels in PCOS patients were associated with obesity and/or insulin resistance. Moreover, plasma L-carnitine concentrations were found to be statistically similar in PCOS patients and healthy controls, when controlled for obesity. This study implied that L-carnitine could be used as an adjunctive therapy in the management of insulin resistance or obesity in women who have PCOS. Further research might be planned to clarify the clinical effects of L-carnitine administration in PCOS patients with insulin resistance and/or obesity.

Could the platelet-to-lymphocyte ratio be a novel marker for predicting invasiveness of cervical pathologies?

PURPOSE

To determine whether the preoperative platelet to lymphocyte ratio (PLR) could predict invasiveness of cervical pathologies.

MATERIALS AND METHODS

Patients with preinvasive and invasive diseases were reviewed retrospectively, over a nine-year period, 2005-2014. The pathological records and completed blood counts of the patients were collected and recorded in the SPSS program. Patients were divided in two groups, preinvasive and invasive.

RESULTS

The median PLR was significantly higher in the invasive group than in the preinvasive group (p=0.03). There was a correlation between invasion of cervical cancer and white blood cell count, red cell distributing width (RDW), neutrophil-lymphocyte ratio (NLR), and PLR.

CONCLUSIONS

This study showed that patients with uterine cervical cancer may present with leukocytosis, increased RDW, NLR and PLR. These cheap and easily available parameters, especially PLR, may provide useful information about the invasiveness of cervical lesions.

L-Carnitine: a new insight into the pathogenesis of endometrial cancer

OBJECTIVES

The present study aims to specify the role of L-carnitine in the pathogenesis of endometrial cancer by comparing the serum total L-carnitine levels of endometrial cancer patients with those of healthy women.

METHODS

Serum total L-carnitine concentrations were measured in patients with endometrioid-type endometrial cancer (n = 20) and healthy controls (n = 20) who were matched with respect to age and body mass index (BMI).

RESULTS

Stage I endometrial cancer was diagnosed in 12 women (60.0%) whereas three women (15.0%) had stage II disease, three women (15.0%) had stage III disease and two women (10.0%) had stage IV disease. The healthy controls and endometrial cancer patients were statistically similar in aspect of age, gravidity, parity, BMI, waist-to-thigh ratio, waist-to-hip ratio, menopause, complete blood count parameters, and serum biochemistry. Serum total L-carnitine levels of women with endometrial cancer were significantly lower than those of healthy women (respectively, 5,519.4 ± 2,712.5 vs 7,940.8 ± 3,566.6 ng/dl, p = 0.021). Moreover, serum total L-carnitine levels decreased significantly and progressively with advancing stage (stage I vs II vs III vs IV; 6,294.0 ± 2,885.1 vs 5,800.0 ± 441.2 vs 4,016.0 ± 2,833.3 vs 2,560.0 ± 67.9 ng/dl; p = 0.021).

CONCLUSIONS

This is the first study to hypothesize that L-carnitine deficiency participates in the pathogenesis of endometrial cancer by means of a mechanism which is unrelated with obesity and increased amount of fat in human body.

Maternal blood pressure and dominant sleeping position may affect placental localization

OBJECTIVE

This study investigates whether maternal socio-demographic and clinical characteristics influence the site of placental implantation so that placental localization and associated abnormalities can be predicted.

METHODS

This study reviews 500 healthy women with singleton pregnancy that were consecutively admitted to the study center and eventually delivered healthy newborns.

RESULTS

The most frequently observed sites of placentation were anterior uterine wall (53.2%), posterior uterine wall (28.8%), lateral uterine walls (10.0%) and uterine fundus (8.0%), respectively. The women with fundal placentation had significantly higher systolic and diastolic blood pressures (p = 0.044 and p = 0.040, respectively). Supine sleeping position was more frequent in women with anterior placenta and (OR: 11.568, 95% CI: 2.720-49.193) and prone sleeping position was more frequent in women with posterior placenta (OR: 15.449, 95% CI: 2.151-52.978) (p = 0.001). The women who favored to sleep in right lateral position were more likely to have lateral placentation, while the women who used to sleep in left lateral position were more likely to have fundal placentation (p = 0.001).

CONCLUSIONS

Sleeping position in early pregnancy may influence placental implantation site. The probable mechanism may refer to the alterations in uterine perfusion which is induced by the change in systemic blood pressure and dominant sleeping position.

Very rare cause of vaginal mass in pregnancy: cavernous hemangioma

Vaginal cavernous hemangioma is a considerably rare condition during pregnancy. There has only been one reported case to date. A multiparous, 24-year-old woman in the 32nd week of pregnancy was admitted with a mass prolapsed from the vagina, which had suddenly increased in size over the previous few days. A necrotic mass obstructing the vaginal canal and originating from the posterior wall was observed in a pelvic physical examination and carefully excised. The patient had contractions after the intervention and was administered tocolytic treatment with bed-rest and fluids. Her obstetric clinical status was stable after treatment and she gave birth without complication at 37 weeks and 5 days from the vaginal canal. The main approach to these very rare tumors of pregnancy, especially in the presence of necrosis, infection and/or obstruction, should be excision. But the potential for increased blood loss that may occur due to the hypervascular structure of the tumor should be taken into account.

Serum prolidase activity and oxidative status in patients with stage I endometrial cancer

INTRODUCTION

We aimed to investigate the serum prolidase activity, total oxidant status (TOS), total antioxidant capacity (TAC), and total free sulfhydryl (-SH) groups in patients with stage I endometrial cancer.

METHODS

Serum prolidase activity, TOS, TAC, and -SH levels were measured in patients with endometrial cancer (n = 23) and controls (n = 25).

RESULTS

Serum prolidase activity and TOS were significantly higher in patients with endometrial cancer than in controls (P = 0.02 and P = 0.02, respectively), whereas TAC and -SH group levels were significantly lower (P = 0.004 and P = 0.001, respectively). There were no differences between surgical stages IA and IB or between stages IB and IC (P = 0.189 and P = 0.161, respectively) with respect to prolidase levels, whereas there was a significant difference between stages IA and IC (P < 0.001).

CONCLUSIONS

Increased serum prolidase activity and oxidative stress may be associated with endometrial cancer, and increased serum prolidase activity may be related to local invasion of endometrial cancer.

Assessment of preoperative serum prolidase activity in epithelial ovarian cancer

OBJECTIVE

Prolidase is a cytosolic exopeptidase that cleaves iminodipeptides with C-terminal proline and hydroxyproline and plays a major role in collagen turnover. The aim of this study was to evaluate preoperative serum prolidase activity, total oxidant status (TOS), and total antioxidant capacity (TAC) in patients with newly diagnosed epithelial ovarian cancer (EOC).

STUDY DESIGN

Serum prolidase activity, TOS, and TAC were measured spectrophotometrically in both EOC cases (n=28) and controls (n=28).

RESULTS

Preoperative serum prolidase activity and TOS were significantly higher in patients with EOC compared to controls (p=0.009 and 0.008, respectively), whereas TAC was significantly lower in cases (p<0.001). A significant positive correlation was found between the stage, grade, and CA-125 level of EOC and serum prolidase activity (rho=0.466, p=0.012; rho=0.501, p=0.007; and rho=0.447, p=0.017, respectively) and TOS (rho=0.588, p=0.001; rho=0.412, p=0.029; and rho=0.568, p=0.002, respectively). In contrast, there was a negative correlation between TAC and the stage, grade, and CA-125 level of EOC (rho=-0.555, p=0.002; rho=-0.566, p=0.002; and rho=-0.581, p=0.001, respectively).

CONCLUSION

Findings of the present study demonstrate that serum prolidase activity is significantly associated with the stage, tumor grade, and preoperative CA-125 level of EOC.

What should be the ideal time for ischemic preconditioning in a laparoscopic rat model?

BACKGROUND

Pneumoperitoneum (Pp) induces an ischemia and reperfusion (I/R) injury as a result of released oxidative stress markers. Ischemic preconditioning (IP) is one of the used methods to reduce the harmful effects of Pp, which is a mechanism for reducing organ I/R injury by a brief period of organ ischemia. The aim of this study was to investigate the ideal time for IP in the laparoscopic model.

METHODS

Thirty-two rats were assigned into four groups: group 1 (control, n = 8) was subjected to a sham operation. Group 2 (5-minutes IP, n = 8) was subjected to 5 minutes of Pp with 15 mm Hg of pressure followed immediately by 5 minutes of deflation, and after that, 60 minutes of Pp with 15 mm Hg, followed by 60 minutes of deflation. Group 3 (10-minutes IP, n = 8) was subjected to 10 minutes of Pp and 10 minutes of deflation. Group 4 (Pp only, n = 8) was subjected to 60 minutes of Pp with 15 mm Hg of pressure, followed by 60 minutes of deflation. At the end of the experiment, plasma malondialdehyde (MDA) values, the oxidative stress marker, and plasma-reduced glutathione (GSH) levels, the marker showing antioxidant activity, were determined.

RESULTS

Highest plasma MDA values were in group 4 (Pp only), followed by groups 2 and 3 and group 1 (P = 0.181). In addition, IP groups had almost the same values for MDA. Plasma GSH levels in the control group were significantly higher than those in the IP groups and the Pp-only group (P < 0.001). Similarly, as in MDA levels, no difference was found between plasma GSH levels of the IP 5-minutes and IP 10-minutes groups.

CONCLUSIONS

Five minutes of the IP model may be as reliable as 10 minutes of the IP model. In that case, 5 minutes of IP can be more suitable in reducing I/R injury in laparoscopy.

Assessment of serum paraoxonase and arylesterase activity in patients with endometrial cancer

PURPOSE OF INVESTIGATION

Serum paraoxonase (PON 1) is one of the most important enzymatic antioxidants that hydrolyzes lipid peroxidation, an indicator of carcinogenic activity. The aim of this study was to compare the serum levels of paraoxonase and arylesterase activity in patients with endometrial cancer to those of healthy controls.

METHODS

Serum paraoxonase and arylesterase activities, total free sulphydryl (-SH) groups and lipid hydroperoxide (LOOH) levels were measured in patients with endometrial cancer (n = 20) and controls (n = 23).

RESULTS

Serum paraoxonase, arylesterase activities and total -SH group levels were significantly lower in patients compared to controls (p < 0.05, p < 0.05 and p < 0.001; respectively), while LOOH levels were significantly higher (p < 0.001). Among patients, serum paraoxonase and arylesterase activities were inversely correlated with LOOH levels (r = -0.680, p < 0.05; r = -0.708, p < 0.001; respectively), while these were positively correlated with the total -SH group (r = 0.526, p < 0.05; r = 0.508, p < 0.05; respectively).

CONCLUSION

Reduced serum PON 1 activity might contribute to an impaired antioxidant defense system which plays a critical role in carcinogenesis in patients with endometrial cancer.

Serum paraoxonase and arylesterase activities in patients with epithelial ovarian cancer

OBJECTIVE

The HDL-associated paraoxonase and arylesterase activities play a role in decreasing oxidative stress, which is known to contribute to cancer development. The aim of this study was to evaluate serum paraoxonase and arylesterase activities and lipid hydroperoxide (LOOH) levels in patients with newly-diagnosed epithelial ovarian cancer.

MATERIALS

Serum paraoxonase and arylesterase activities, total free sulfhydryl (-SH) levels and LOOH levels were measured in patients with epithelial ovarian cancer (n=24) and controls (n=29).

RESULTS

Serum paraoxonase activity and arylesterase activity, as well as -SH levels were significantly lower (p=0.003, p<0.001 and p<0.001, respectively) in patients with epithelial ovarian cancer compared to controls, while LOOH levels were significantly higher (p<0.001). A significant inverse correlation was found between the stage, grade and CA-125 level of ovarian cancer and paraoxonase activity (rho=-0.630, p=0.001 and rho=-0.601, p=0.002 and rho=-0.436, p=0.033, respectively), arylesterase activity (rho=-0.601, p=0.002 and rho=-0.713, p<0.001 and rho=-0.580, p=0.003, respectively), and -SH levels (rho=-0.642, p=0.001 and rho=-0.637, p=0.001 and rho=-0.530, p=0.008, respectively). In contrast, there was a positive correlation between LOOH and the stage, grade and CA-125 level of ovarian cancer (rho=0.565, p=0.004 and rho=0.479, p=0.018 and rho=0.642, p=0.001).

CONCLUSION

Our results suggest that diminished paraoxonase and arylesterase activity, -SH levels and increased LOOH levels are associated with particular stage, grade and CA-125 level of ovarian cancer.

Body fat composition and distribution in women with polycystic ovary syndrome

OBJECTIVES

The aims of the present study were to compare the distribution and accumulation of body fat in women with polycystic ovary syndrome (PCOS) and healthy controls matched for age and body mass index (BMI), and to investigate the association between androgen levels, insulin resistance and fat distribution.

MATERIALS AND METHODS

Thirty-one PCOS women and 29 age- and BMI-matched healthy control women were evaluated in terms of subcutaneous adipose tissue thickness determined with a skinfold caliper and body composition analyzed by bioelectrical impedance analysis. Blood samples were obtained for determination of follicle-stimulating hormone, luteinizing hormone, 17beta-estradiol, 17-hydroxyprogesterone, basal prolactin, testosterone, dehydroepiandrosterone sulfate, sex hormone-binding globulin (SHBG), androstenedione, insulin and glucose levels. Insulin sensitivity was estimated by fasting glucose/insulin ratio and free androgen index (FAI) was calculated as 100 x testosterone/SHBG. Differences between means were analyzed by Student's t test or the Mann-Whitney U test according to distribution of the data. Correlation analysis was performed between the body fat distribution and parameters concerning insulin resistance and androgens.

RESULTS

FAI was significantly higher in patients with PCOS compared with the control group (p = 0.001). Fasting insulin was significantly higher and fasting glucose/insulin ratio was significantly lower in the PCOS group vs. controls (p = 0.03 and 0.001, respectively). There was significantly less subcutaneous adipose tissue in the controls than the PCOS women at the triceps (p = 0.04) and subscapular region (p = 0.04). Waist-to-hip ratio of PCOS women was significantly higher than that of control subjects (p = 0.04).

CONCLUSION

Upper-half type body fat distribution is linked with PCOS, high free testosterone levels and insulin resistance.

Insulin sensitivity does not differentiate by hirsutism in non-obese women with polycystic ovary syndrome

OBJECTIVE

Hirsutism is one of the component of polycystic ovary syndrome. According to the Rotterdam Consensus has concluded that principially obese women with polycystic ovary syndrome (PCOS) should be evaluated for the metabolic syndrome. The aim of the present study was to investigate the insulin sensitivity in PCOS women with and without hirsutism regardless of obesity.

MATERIAL AND METHODS

Clinical characteristics, sex hormones and fasting glucose and insulin levels of fifty-eight women with PCOS were analyzed. Hirsutism has been evaluated through the Ferriman-Gallwey (FG) map scoring system.

RESULTS

Twenty-two women (38%) were hirsute. They were not any significant difference between hirsute and nonhirsute women for their sex steroids and insulin sensitivity (P>0.05). There were no correlation among sex steroids, WHR and insulin sensitivity in relation to FG score in the subgroup with hirsutism (P>0.05).

CONCLUSION

Our study suggests that normal weight and overweight women with hirsutism can have normal insulin sensitivity and normal levels of circulating androgens in PCOS women.

Effect of Aerodiol administration on ocular arteries in postmenopausal women

OBJECTIVE

The aim of the present study was to evaluate the alteration of ocular blood hemodynamics after intranasal administration of 17beta-estradiol, through measurement of the ophthalmic artery (OA) and the central retinal artery (CRA) using color duplex sonography.

METHODS

Thirty healthy women who had been naturally postmenopausal for at least 1 year were enrolled in the study. A randomized, placebo-controlled, crossover, double-blinded study was conducted of the acute effect of 17beta-estradiol (Aerodiol; Servier, Chambrayles-Tours, France) on OA and CRA blood flow using color duplex sonography.

RESULTS

The peak systolic and end diastolic velocities of the CRA were increased significantly after 17beta-estradiol administration compared with placebo. A significant decrease was also found in the pulsatility and resistive indices of the CRA. However, there were no statistically significant differences in OA flow velocities or pulsatility and resistive indices.

CONCLUSIONS

Nasal 17beta-estradiol administration in postmenopausal women causes an improvement in the ocular vascular Doppler indices. These results suggest that there could be a positive effect of Aerodiol on middle-sized arteries and arterioles.

Squamous cell carcinoma arising in a mature cystic teratoma of the ovary in young patient with elevated carbohydrate antigen 19-9

Squamous cell carcinoma is the most common type of malignant transformation in mature cystic teratomas. It mainly effects postmenopausal women but is rarely seen in young patients. Carbohydrate antigen 19-9 (CA19-9) tumor marker is a high-molecular-weight glycoprotein, frequently elevated in gastrointestinal adenocarcinomas. CA19-9 levels can increase in both dermoid cysts and in malignant transformation of dermoid cysts. Herein we report a case of squamous cell carcinoma originating from a dermoid cyst in a 31-year-old, gravida 0, para 0, single woman with high levels of CA19-9 and normal levels of CEA. Preoperative CA19-9 was 1000 U/ml (normal range below 27 U/ml). The patient underwent unilateral salpingo-oophorectomy, omentectomy, appendectomy, pelvic and paraaortic lymphadenectomy. After the pathologic analysis of the material, the patient was categorized as FIGO Stage IIa due to metastasis to the left tube. She received six cycles of cisplatin and paclitaxel at 21-day intervals. The postoperative first day, second month, and sixth month CA19-9 values were 602 U/ml, 33.5 U/ml and 22.3 U/ml, respectively. She is now doing well without recurrence of disease six months after the surgery. Squamous cell carcinomas originating from dermoid cysts are rare tumors especially seen in elderly patients with high levels of tumor markers (like CEA, SCCA). Every case may not have the same characteristics and management should be individualized.