Cytohistological discrepancies of cervico-vaginal smears and HPV status

Objectives: Discrepancies between abnormal cervical cytology or high-risk human papillomavirus (HR-HPV) status (cytolo-gy negative/HPV positive) and subsequent histological findings are a common occurrence. After using co-testing, the dis­crepancies between the HR-HPV status and cervical cytology have become an issue. In this study, we aimed to determine the characteristics of women with a discrepancy between histology and cytology/HR-HPV status, in terms of diagnosis, review and identification. Material and methods: A total of 52 women, patients of the University Hospital between 2013–2015, with cytohistologi­cal or HR-HPV status discrepancy were recruited for the study and retrospectively analyzed. The cytological samples were liquid-based Pap smears, classified according to the 2001 Bethesda system. The HR-HPV status was identified using the Hybrid Capture 2 HR-HPV DNA assay. The histological samples were obtained by cervical biopsy as well as large loop exci­sion of the transformation zone (LLETZ). Results: A cytohistological discrepancy was demonstrated in patients with (-)cytology/HR-HPV(+), ASCUS, LSIL, ASC-H, HSIL, AGC-NOS: 17.3%, 23.07%, 26.9%, 9.5%, 17.3% and 5.7%, respectively. When the degree of atypia in cytology increases, the concurrency of cervical cytology with biopsy also increases. A positive HR-HPV co-test result (19/24, 79.1%) was observed in nearly all CIN2 ≥ (+) cases. Our study emphasizes the significance of HR-HPV testing to determine CIN2 ≥ (+) cases, even in the presence of a normal cytological result. Conclusions: In case of cytohistological or HR-HPV discrepancies, a careful review of the HR-HPV status and the degree of cytological atypia should be performed before further intervention

Yarı dolu mesane ile yapılan vajinal histerektomi

Yarı dolu mesane ile yapılan vajinal histerektom

A New Etiologic Factor for Adnexal Torsion: Congenital Omental Fenestrum

Torsion seen in ovary, fallopian tube or in both organs is one of the gynecologic emergency pathologies in patients suffering from acute lower abdominal pain, and it constitutes approximately 2.7% of gynecologic emergencies. Delays in diagnosis and treatment can cause ischemic damage, in that way can cause the risk of ovary, fallopian tube or both organs loss. Thus, it can result in fertility problems in people who are desiring future fertility. Although the etiology is not totally known, it has been thought that torsion risk has been increasing in benign cystic teratomas and ovarian tumors. It can be also seen in congenital situations such as vitellointestinal duct anomaly and people who have undergone pelvic surgery. In this article, a case for adnexal torsion developed in congenital omental fenestrum which is considered as a new factor for torsion etiology, was explained

A Rare Cause of Intrauterine Plagiocephaly within Twin Pregnancy: A Case Report

The word plagiocephaly is occurred from Greek for “slanted” (plagio) and “head” (kephale). Plagiocephaly describes a planar or multiplanar cranial asymmetry which can be occurred in prenatal or postnatal period. In prenatal period, the most reason for associated plagiocephaly is intrauterine pressure (multiple birth infants (especially dizygotic twins), amount of amniotic, small pelvis and uterine tumors etc.). It has been demonstrated in recent studies that the location of the fetuses within uterus, importantly their position and orientation in the uterus and also the number of fetuses play crucial roles in the development of plagiocephaly during pregnancy. In this report, it was reported that in the case of the dizygotic twin- pregnancy due to the location of the babies in the uterus, they are prone to develop plagiocephaly

Successful Management of a Cystic Lesion Which Had Been Caused by Menstrual Blood Above the Dehiscence of Cesarean Incision Scar: Case Report

Cesarean scar dehicence has the incidence of 1.2% after base transverse incisions. Beside causing a situation increasing morbidity and mortility for baby and mother and needing acute intervention in antenatal or intrapartum period by causing uterine rupture, it is an important complication that can cause sudden bleeding, infection and even uterine fistules in postpartum period. In our case, we will mention about the successful management of cyst caused by menstrual blood that develops dehiscence of cesarean scar. A female patient with the age of 40 (Gravida:2, parity:2 (2 C/S) applied to our policlinic because of amenorrhoea. A cystic mass, probably originated from cesarean incision scar, with intense content, smooth borders and the dimensions of 66x24 mm was observed by the help of transvaginal ultrasonography. The evacuation of the cyst content had been decided by performing vacuum aspiration from cervical ostium. Transabdominal ultrasonography guided karman cannula was placed into the cyst from cervical ostium. The content of the cyst had been aspired by negative pressure. Most of the complications after cesarean can be diagnosed by easy ultrasonographic observations and physical examinations, some needs expensive radiologic observations such as magnetic resonance imaging, computerized tomography, while for some of them, second- look procedures can be necessary that increase mortality and morbidity of the patient. The most important thing is how to treat these complications. Some of them can be treated by conservative approaches; while some of them needs severe surgical operations even histerectomy. As in our case, the cyst caused by menstrual blood after causing dehiscence of cesarean scar, was vacuum aspirated easily and treated by conservative approach

An Appendix Origin Burkitt’s Lymphoma Spreading into Genital Tract

Burkitt’s lymphoma (BL) occurs commonly in children and young adults, whereas bilateral ovarian involvement is extremely rare. We report a patient with unusual symptoms for BL, mimicking an ovarian neoplasm. Here, our aim was also to point out that BL can spread into the genital tract. A 60-year-old woman presented with the complaint of abdominal pain for a few months. Abdominal distension and sensibility were observed upon physical examination of the patient, but no common “B” symptoms associated with lymphoma were noted. Our imaging studies revealed bilateral adnexal masses suggesting an ovarian tumour with positive laboratory findings. We performed an exploratory laparotomy and a total hysterectomy, bilateral salpingo-oophorectomy and right hemicolectomy with appendectomy. The hemicolectomy process was needed to reduce the tumour burden and because of the risk of intestinal obstruction risk that could arise from the tumour mass in the ileocecal valve. Observation of a frozen specimen indicated BL, so the surgery was ended. Although BL involving the genital tract is a rare condition in patients who have pelvic masses, BL can be one of the diseases that should be considered for specific diagnosis

A Giant Parasitic Leiomyoma with Blood Supply from Omental Branches: A Case Report

A female patient with the age of 33 having gravida: 3, parity: 2 and D&C: 1, applied to our clinics by pelvic mass that she had. It had been comprehended from the anamnesis of the patient that she applied to a gynecologist because of ongoing inguinal pain and abdominal distension for about 4 months. In the physical examination, a mass that can be palpated in suprapubic region was observed. In transvaginal ultrasonographic examination, a giant leiomyom was determined having the dimensions of 9.5cm x 8.5 cm that was located at fundal uterus with subserous component and enlarged the uterus. Pfannenstiel incision was performed. In intraoperative examination, a fundal subserous located parasitic leiomyoma with around 10 cm diameter, supplied by a vascular structure about 30 cm in length from omentum was diagnosed.It was diagnosed that omentum adhered to leiomyoma partially. Firstly, omentum with its vascular structure was excised. Partial omentectomy was performed. Then, leiomyoma was excised by performing dissection and operation was ended up. Parasitic myomas are indicated as rarely seen myomas in literature. It is crucial to maintain specific diagnosis, careful imaging and serious planning in preoperative preparations.Although parasitic leiomyomas are rarely seen cases, because of abnormal vascularization and adhesion to other organs, one should be careful in preoperative examinations and sufficient blood supply should be maintained in case of bleeding. Additionally, surgical information has to be had for surgical exploration and pelvic anatomy