Shotgun Proteomics Identifies Serum Fibronectin as a Candidate Diagnostic Biomarker for Inclusion in Future Multiplex Tests for Ectopic Pregnancy

Ectopic pregnancy (EP) is difficult to diagnose early and accurately. Women often present at emergency departments in early pregnancy with a 'pregnancy of unknown location' (PUL), and diagnosis and exclusion of EP is challenging due to a lack of reliable biomarkers. The objective of this study was to identify novel diagnostic biomarkers for EP. Shotgun proteomics, incorporating combinatorial-ligand library pre-fractionation, was used to interrogate pooled sera (n = 40) from women undergoing surgery for EP, termination of viable intrauterine pregnancy and management of non-viable intrauterine pregnancy. Western blot was used to validate results in individual sera. ELISAs were developed to interrogate sera from women with PUL (n = 120). Sera were collected at time of first symptomatic presentation and categorized according to pregnancy outcome. The main outcome measures were differences between groups and area under the receiver operating curve (ROC). Proteomics identified six biomarker candidates. Western blot detected significant differences in levels of two of these candidates. ELISA of sera from second cohort revealed that these differences were only significant for one of these candidates, fibronectin. ROC analysis of ability of fibronectin to discriminate EP from other pregnancy outcomes suggested that fibronectin has diagnostic potential (ROC 0.6439; 95% CI 0.5090 to 0.7788; P>0.05), becoming significant when 'ambiguous' medically managed PUL excluded from analysis (ROC 0.6538; 95% CI 0.5158 to 0.7918; P<0.05). Fibronectin may make a useful adjunct to future multiplex EP diagnostic tests

Placental site trophoblastic tumor: Report of a tertiary center experience

PubMedID: 26775357Objective: To analyze the clinical and pathological characteristics of placental site trophoblastic tumor (PSTT) cases and to discuss the diagnosis, treatment, and prognosis of PSTT. Materials and Methods: The clinical and pathological data of eight patients with PSTT at Istanbul Medical Faculty Hospital from 1988 to 2010 were analyzed retrospectively. Results: The mean age of the patients was 31 years. The antecedent pregnancy was full-term delivery in most of the patients (6/8, 75%). The mean interval from last pregnancy to diagnosis of PSTT was 35 months (range, six to 192). Serum human chorionic gonadotropin (hCG) levels at the time of diagnosis ranged from 0.1 to 2280 mIU/ml (mean, 614). All patients had Stage 1 disease and ultimately underwent hysterectomy. None of the patients received adjuvant chemotherapy. One patient died of an unknown reason, one month after the surgery. The rest of the patients were alive and without evidence of disease after an average of 3.5 years (range, one to 11) of follow-up. Conclusion: Hysterectomy alone can provide long-term survival in early-stage disease

Placental site trophoblastic tumor: report of a tertiary center experience

Objective: To analyze the clinical and pathological characteristics of placental site trophoblastic tumor (PSTT) cases and to discuss the diagnosis, treatment, and prognosis of PSTT. Materials and Methods: The clinical and pathological data of eight patients with PSTT at Istanbul Medical Faculty Hospital from 1988 to 2010 were analyzed retrospectively. Results: The mean age of the patients was 31 years. The antecedent pregnancy was full-term delivery in most of the patients (6/8, 75%). The mean interval from last pregnancy to diagnosis of Pm was 35 months (range, six to 192). Serum human chorionic gonadotropin (hCG) levels at the time of diagnosis ranged from 0.1 to 2280 mIU/ml (mean, 614). All patients had Stage 1 disease and ultimately underwent hysterectomy. None of the patients received adjuvant chemotherapy. One patient died of an unknown reason, one month after the surgery. The rest of the patients were alive and without evidence of disease after an average of 3.5 years (range, one to 11) of follow-up. Conclusion: Hysterectomy alone can provide long-term survival in early-stage disease

Conservative management of a patient with endometrial carcinoma desiring fertility: how to inform?

Conservative management of patients with endometrial cancer who desire fertility is becoming widespread in certain circumstances. A 36-year-old women desiring fertility with early-stage endometroid type adenocarcinoma of the endometrium was treated with 160 mg/d megestrol acetate for six months. After confirmation of a normal endometrial biopsy she became pregnant spontaneously. Following an uneventful pregnancy a healthy baby at term was delivered by cesarean section. Definitive surgery was Performed. The risks and benefits of this thereupeutic approach are discussed and informing style of the patients emphasized

Analysis of vaginal recurrences in Stage I endometrial adenocarcinoma

Objective: To determine the risk of vaginal recurrence in Stage I endometrial cancer and treatment morbidity associated with different therapeutic approache

Analysis of vaginal recurrences in Stage I endometrial adenocarcinoma

Objective: To determine the risk of vaginal recurrence in Stage I endometrial cancer and treatment morbidity associated with different therapeutic approache

Groin recurrence following Stage IA squamous cell carcinoma of the vulva with negative nodes on superficial inguinal lymphadenectomy

Purpose of Investigation: Stage IA vulvar cancer with a depth of stromal invasion less than 1 mm is generally managed by wide local excision alone since there is less than 1% risk of lymph node involvement. Case: A 62-year-old patient was admitted to a university hospital with a suspicious vulvar lesion. Results: We present the first case of inguinal node and a possible contralateral pubic minus recurrence following bilateral superficial inguinal lymphadenectomy and wide local resection for Stage IA vulvar cancer. Conclusion: There is no evidence that extended radical surgery provides a better overall survival or reduces recurrence rate in Stage IA vulvar carcinomas. Conservative vulvar resection and sentinel node dissection seem to be a rational choice. Nevertheless the disease may recur in the inguinal areas and frequently be lethal, therefore close surveillance and early attempts to treat the recurrent disease before infection and inflammation ensues should be the aim of current treatment strategies