Granüloza hücreli over tümörlerinin yönetimi: Tersiyer bir merkeze ait 10 yıllık deneyim

Objective: Granulosa cell tumors (GCT) arise from the mesenchymal cells and sex cords of the ovaries and can be observed in women of all age groups. This study presented our 10 year-long gynecology oncology experience on the clinical course and outcome of GCT cases. Methods: Thirty-one patients who were operated due to suspicious adnexal masses in our hospital between January 2011 and January 2018 and whose final pathology report confirmed the diagnosis of GCT was included in the study. The data of the patients were evaluated. Preoperative ultrasound findings and serum tumor marker results are noted. Results: Twenty-nine (94%) patients were diagnosed with AGCS and only two (6%) patients were diagnosed with JGCS. The mean age of the study population was 47.74 14.47 years and the mean body mass index was 32.51 7.1. Most patients presented with heavy menstrual bleeding (29%). 48.4% of the patients underwent hysterectomy with bilateral salpingo-oophorectomy, and complete lymph-node dissection, whereas 22.6% of them had hysterectomy with bilateral salpingo-oophorectomy, and 29% of them had oophorectomy only. Three patients (9.3%) had a disease recurrence. The overall survival was 54.4 29.3 months and disease free survival was 49.6 24.2 months. Conclusion: The most important predictor of survival among patients with GCT is a disease stage at the time of initial diagnosis. Long-term surveillance, including routine clinical follow-up and evaluation of tumor markers is mandatory.Amaç: Granüloza hücreli tümörler (GCT) yumurtalıkların mezenkimal hücrelerinden ve cinsiyet kordonlarından ortaya çıkar ve her yaş grubundaki kadınlarda görülebilir. Bu çalışma, GCT olgularının klinik seyri ve sonuçları hakkında 10 yıllık jinekoloji onkoloji deneyimimizi sunmayı amaçladı. Yöntem: Ocak 2011-Ocak 2018 tarihleri arasında hastanemizde şüpheli adneksiyal kitle nedeniyle ameliyat edilen ve son patoloji raporu GHT tanısı ile doğrulanan 31 hasta çalışmaya dahil edildi. Hastaların verileri değerlendirildi. Preoperatif ultrason bulguları ve serum tümör belirteç sonuçları not edildi. Bulgular: Yirmi dokuz (%94) hastaya AGCS tanısı kondu ve sadece iki (%6) hastaya JGCS tanısı kondu. Çalışma popülasyonunun ortalama yaşı 47,74 14,47 yıl ve ortalama vücut kitle indeksi: 32,51 7,1 idi. Hastaların çoğu ağır adet kanaması (%29) ile başvurdu. Hastaların %48,4’üne bilateral salpingo-ooferektomi ve tam lenf nodu diseksiyonu ile histerektomi, %22,6’sına bilateral salpingo-ooferektomi ile histerektomi, %29’una sadece ooferektomi yapıldı. Üç hastada (%9,3) hastalık nüksü vardı. Genel sağkalım 54,4 29,3 aydı ve hastalıksız sağkalım 49,6 24,2 aydı. Sonuç: GCT’li hastalar arasında sağkalımın en önemli prediktörü, ilk tanı anındaki hastalık evresidir. Tümör belirteçlerinin rutin klinik takibi ve değerlendirmesini içeren uzun vadeli sürveyans zorunludur

Histerektomide robotik veya laparoskopik yaklaşım: Operatif sonuçlar ve maliyet karşılaştırılması

Purpose: The present study aimed to compare surgical outcomes and cost analysis of robotic-assisted surgery (RAS) and conventional laparoscopic surgery (CLS) hysterectomy procedures. Materials and Methods: The patients who underwent total robotic hysterectomy or total conventional laparoscopic hysterectomy with or without bilateral salpingo-oophorectomy due to benign gynecological disorders such as uterine fibroid, abnormal uterine bleeding, endometrial hyperplasia, adenomyosis, persistent ovarian cysts, chronic pelvic pain were retrospectively evaluated. Results: A total of 80 women underwent RAS or CLS hysterectomy during the study period. The mean total operative time was 187 +/- 10 min. in RAS and 133 +/- 24 min. in CLS groups, respectively. The mean total cost of the RAS hysterectomy group was 17.710 TL, and CLS hysterectomy group was 7000 TL. Conclusion: Both CLS and RAS hysterectomies for benign gynecological indications are safe surgical procedures with negligible complication rates. RAS is a more expensive procedure compared to CLS.Amaç: Bu çalışma, robotik yardımlı cerrahi (RAC) ve geleneksel laparoskopik cerrahi (GLC) histerektomi prosedürlerinin cerrahi sonuçlarını ve maliyet analizini karşılaştırmayı amaçlamaktadır. Gereç ve Yöntem: Uterin fibroid, anormal uterin kanama, endometrial hiperplazi, adenomiyozis, persiste eden over kistleri, kronik pelvik ağrı gibi benign jinekolojik bozukluklar nedeniyle bilateral salpingo-ooferektomi ile birlikte veya salpingo-ooferektomi olmaksızın total robotik histerektomi veya total konvansiyonel laparoskopik histerektomi uygulanan hastalar geriye dönük olarak değerlendirildi. Bulgular: Çalışma dönemi sırasında toplam 80 kadına RAC veya GLC histerektomi yapıldı. Ortalama toplam ameliyat süresi RAC ve GLC gruplarında sırasıyla 187 ± 10 dk. ve 133 ± 24 dk. idi . RAC histerektomi grubunun ortalama toplam maliyeti 17.710 TL ve GLC histerektomi grubunun 7000 TL idi. Sonuç: İyi huylu jinekolojik endikasyonlar için hem GLC hem de RAC histerektomiler ihmal edilebilir komplikasyon oranları ile güvenli cerrahi prosedürlerdir. Maliyetlerle ilgili olarak, RAC, GLC 'ye göre daha pahalı bir prosedürdür

The association between the preoperative prognostic nutritional index and the controlling nutritional status score on tumor stage, chemotherapeutic response and overall survival in ovarian cancer

Objective: This study aimed to investigate the association between preoperative prognostic nutritional index (PNI) and controlling nutritional status (CONUT) scores on the stage of ovarian cancer (OC), chemotherapeutic response, and overall survival (OS) in patients with OC. Methods: The data of the patients who operated due to OC between January 2015 and January 2020 in a tertiary referral hospital were recorded. The patients' basic characteristics, preoperative total cholesterol, albumin, lymphocyte count, tumor markers, disease stage, grade, chemotherapeutic response, OS, and progression-free survival were recorded. The PNI and the CONUT score were calculated. Results: The mean PNI level was considerably higher in the early-stage group than the advanced-stage group (50.02 +/- 6.8 vs. 46.3 +/- 7.4, p = 0.005). The AUC was 63% for the cutoff point 45.98 of PNI, whereas the AUC was 42% for the cutoff point 1.5 of CONUT score in predicting early-stage disease. The PFS and OS were significantly higher in the high PNI group than the low PNI group (p = 0.01, p = 0.002, respectively). Conclusion: The patients with early-stage OC had significantly higher PNI levels and lower CONUT scores in our study population

Performing gynecologic cancer surgery during the COVID-19 pandemic in Turkey: A multicenter retrospective observational study

Objective To report the perioperative outcomes of 200 patients with gynecologic cancer who underwent surgery during the Novel Coronavirus Disease (COVID-19) pandemic and the safety of surgical approach. Methods Data of patients operated between March 10 and May 20, 2020, were collected retrospectively. Data were statistically analyzed using IBM Statistical Package for the Social Sciences (SPSS) Statistics for Windows v. SP21.0. Results Data of 200 patients were included. Their mean age was 56 years. Of the patients, 54% (n=108), 27.5% (n=55), 12.5% (n=25), and 2% (n=4) were diagnosed as having endometrial, ovarian, cervical, and vulvar cancer, respectively. Of them, 98% underwent non-emergent surgery. A minimally invasive surgical approach was used in 18%. Stage 1 cancer was found in 68% of patients. Surgeons reported COVID-related changes in 10% of the cases. The rate of postoperative complications was 12%. Only two patients had cough and suspected pneumonic lesions on thoracic computed tomography postoperatively, but neither was positive for COVID-19 on polymerase chain reaction testing. Conclusion Based on the present findings, it is thought that gynecologic cancer surgery should continue during the COVID-19 pandemic while adhering to the measures. Postponement or non-surgical management should only be considered in patients with documented infection. Gynecologic cancer surgery should continue during the COVID-19 pandemic while adhering to measures. Only 1% of patients developed COVID-19-related symptoms during the postoperative follow-up period

Steroid hormone profiles and molecular diagnostic tools in pediatric patients with non-CAH primary adrenal insufficiency

CONTEXT: There is a significant challenge of attributing specific diagnoses to patients with primary adrenal insufficiency of unknown etiology other than congenital adrenal hyperplasia (non-CAH PAI). Specific diagnoses per se may guide personalized treatment or may illuminate pathophysiology. OBJECTIVE: This work aimed to investigate the efficacy of steroid hormone profiles and high-throughput sequencing methods in establishing the etiology in non-CAH PAI of unknown origin. METHODS: Pediatric patients with non-CAH PAI whose etiology could not be established by clinical and biochemical characteristics were enrolled. Genetic analysis was performed using targeted-gene panel sequencing (TPS) and whole-exome sequencing (WES). Plasma adrenal steroids were quantified by liquid chromatography-mass spectrometry and compared to that of controls. This study comprised 18 pediatric endocrinology clinics with 41 patients (17 girls, median age: 3 mo, range: 0-8 y) with non-CAH PAI of unknown etiology. RESULTS: A genetic diagnosis was obtained in 29 (70.7%) patients by TPS. Further molecular diagnosis could not be achieved by WES. Compared to a healthy control group, patients showed lower steroid concentrations, most statistically significantly in cortisone, cortisol, and corticosterone (P < .0001, area under the receiver operating characteristic curve: .96, .88, and .87, respectively). Plasma cortisol of less than 4 ng/mL, cortisone of less than 11 ng/mL, and corticosterone of less than 0.11 ng/mL had a greater than 95% specificity to ensure the diagnosis of non-CAH PAI of unknown etiology. CONCLUSION: Steroid hormone profiles are highly sensitive for the diagnosis of non-CAH PAI of unknown etiology, but they are unlikely to point to a specific molecular diagnosis. TPS is an optimal approach in the molecular diagnosis of these patients with high efficacy, whereas little additional benefit is expected from WES

Post-recurrence survival analysis of patients with pulmonary recurrence from gynaecologic cancers: a multi-institutional analysis of 122 patients

In this retrospective study, patients with epithelial gynaecologic cancer with pulmonary recurrence (PR) were evaluated from five national gynaecologic oncology clinics. Patients with a diagnosis of primary endometrial, ovarian/fallopian tube/peritoneal, cervical or vaginal/vulvar tumours who developed an initial PR were included in the study A total of 122 patients were included in the study. The median follow-up time after recurrence was 7.5 (range, 1–84) months. The 2-year PRS was 48% in the main cohort. The risk of death was more than seven times higher in patients who did not receive salvage chemotherapy compared with those who did (hazard ratio: 7.6, 95% CI: 3.0–18.9; p < .001). When squamous cell carcinoma was compared with the other tumour types, the risk of death increased more than three times (hazard ratio: 3.7, 95% CI: 1.4–9.6; p = .007).IMPACT STATEMENT What is already known on this subject? Pulmonary recurrence (PR) from gynaecologic malignancies is rare and can cause major clinical problem. Therefore, defining the clinical and pathologic characteristics and recurrence patterns are essential. What the results of this study add? This study demonstrates non-squamous subtype and salvage chemotherapy at PR were associated with improved survival. What of these findings for clinical practice and/or further research? To the best of our knowledge, our study is the largest study to investigate the clinico-pathologic characteristics, recurrence patterns, treatment options, and post-recurrence survival (PRS) in patients with PR from epithelial gynaecologic cancers. Future research should examine the underlying causes of these findings