“Three-Step Approach” Versus “See-and-Treat Procedure” in women with “High Grade Squamous Intraepithelial Lesion” (HSIL) or “Atypical Squamous Cells cannot exclude HSIL” (ASC-H) Cytology

Objective: The purpose of this study was to examine the correlation between histological findings in women with HSIL or ASC-H who have undergone loop electrosurgical excisional procedure with “Three-Step Approach” and “See-and-Treat Procedure". Study Design: A retrospective review was performed in 171 women with cytologically detected HSIL or ASC-H. Sixty five women with HSIL cytology and 35 women with ASC-H cytology were managed by “Three-Step Approach”, 35 women with ASC-H and 36 women with HSIL cytology were managed by "See-and-Treat Procedure”. Rates of histopathological findings were compared in two strategies with respect to previous cytology. Results: Fifteen women with ASC-H (42.9%), and 24 women with HSIL (68.5%) had CIN 2-3 at loop electrosurgical excisional procedure specimens in the “See-and-Treat” group whereas 14 women with ASC-H (38.8%), and 43 women with HSIL (66.2%) had CIN 2-3 at loop electrosurgical excisional procedure specimens in the “Three-Step Approach” group. There was no significant difference in the rate of CIN 2+ lesions when two strategies were compared in women with HSIL and ASC-H (p=0.71 and p=0.72, respectively). The overtreatment rates were 22.9% and 48.6% for HSIL and ASC-H cytology, respectively in the “See and Treat” group. Conclusion: In the ASC-H group, the rate of CIN 2+ lesions is significantly high (51.4%). It seems rational to perform “See-and-Treat procedure” in the setting of ASC-H smears although the overtreatment rate seems to be high. Because of the rate of overtreatment, the “Three-Step Approach” seems to be more reasonable in women with ASC-H cytology who also have fertility concerns. After a cytological diagnosis of HSIL, “see and treat” approach seems to be a safe and time saving strategy

Intrauterine Contraceptive Device Migration to the Sigmoid Colon: A Case Report

The Copper T intrauterine device (IUDs) are a commonly used method of contraception for women, but have been associated with serious complications such as bleeding, perforation and migration to adjacent organs or omentum. Although perforation of the uterus by an IUD is not uncommon, migration to the sigmoid colon is extremely rare. Here, we report a case of 37-year-old female with an IUD migrating through the uterus into the peritoneal cavity and subsequently invading into the sigmoid colon. [Med-Science 2015; 4(2.000): 2257-62

A case report of complete mole with co-existent exaggerated placental site reaction and review of the literature

Exaggerated placental site (EPS) is defined as a non-neoplastic trophoblastic lesion, which intermediate trophoblasts infiltrate exaggeratedly into endometrium and myometrium. These lesions may occur following normal pregnancy, ectopic pregnancy, abortus or molar pregnancy. Herein we share a case of EPS detected after evacuation due to molar pregnancy. We also review the related literature, where only a few reports exist describing the clinical course, histopathology and differential diagnosis of EPS

Mature Cystic Teratoma of the Fallopian Tube in a Postmenopausal Woman: A Case Report and Review of the Literature

Background. Mature cystic teratomas of the fallopian tube are extremely rare and only 54 cases have been reported in the literature. In this paper, we report a mature cystic teratoma of the fallopian tube in a postmenopausal woman and we report the review of literature of tubal cystic teratomas. Case. A 62-year-old, gravida 4 postmenopausal woman presented with pain in the right lower abdominal region for a long time. An 88 × 72 × 95 mm heterogeneous mass which contained calcifications and lipoid components was detected in the right adnexal region by transvaginal ultrasonogram (TV-USG). Serum tumour markers, namely, CA125, CA15-3, and CA19-9, were within normal range. A laparotomy revealed a 9 × 10 cm cystic mass within the fimbrial region in the right fallopian tube, and right salpingoopherectomy was performed consequently. Microscopic examination revealed squamous epithelium with sebaceous glands and hair follicles, and pseudostratified ciliated respiratory epithelium with cartilage and mucous glands. Because the frozen section resulted in a benign dermoid cyst, no further operative procedure was performed. The postoperative follow-up was uneventful and the patient was discharged on the second postoperative day. Conclusion. In cases of undetermined pelvic or abdominal masses, a teratoma of the fallopian tube should be considered

Termination of a Pregnancy for the Third Time due to Meckel-Gruber Syndrome: Case Report and Review of Literature

Meckel-Gruber Syndrome (MGS) is a rare autosomal recessive disorder that is characterized by typical ultrasonographical (USG) findings including encephalocele, polydactyly and cystic dysplastic kidneys. In this article we report an antenatally detected MGS with a review of the literature. A 28 year-old multigravida (G7P3L3) presented with 14 weeks of gestation for routine antenatal examination. The mother had had a second degree intermarriage, and two previous pregnancies were learned to be terminated due to MGS. The USG showed occipital encephalocele, polydactyly, oligohydramnios and bilateral renal cystic dysplasia. After detecting the fetal karyotype as 46,XY, termination of pregnancy was performed. In the histopathological examination, encephalocele, polydactyly and bilateral dysplastic kidneys were observed and diagnosis of MGS was confirmed. In cases with MGS, parents should be informed about the fetal prognosis and the recurrence risk for the next pregnancies. [Med-Science 2015; 4(2.000): 2236-43

Spectrum of Vulvar Lesions in an Obstetrics and Gynecology Outpatient Clinic

Wide range lesions may occur in the vulvar region. The aim of the present study is to have an insight into the diverse morphologic spectrum of vulvar lesions. Total of 263 patients with primary vulvar complaints seen in Ankara Numune Training and Research Hospital Gynecology and Obstetrics Outpatient Clinic were recruited into study. The present retrospective study was carried out by compiling the data from archival records from January 2010 to May 2014. The vulvar biopsies specimens were studied for histomorphological features. The lesions were categorized as non-neoplastic, neoplastic and inconclusive; neoplastic ones were further divided into benign, malignant and premalignant.The age of the women ranged from 11 to 85 years (mean 46.27±14.32) with the maximum number of patients between 41 to 50 years of age. Most common clinical presentation was itching (126 cases; 47.9%). The commonest site of vulvar lesions was labia majora (145 cases, 55.1%). Non neoplastic lesions were more common (n = 172; 65.4%) than the neoplastic lesions (n =91; 34.6%). There were 81 (30.8%) benign lesions while 10 cases (3,8%) were malignant or premalignant ones. Amongst the non-neoplastic lesions, the most common histopathologic diagnosis was of lichen sclerosus et atrophicus (46 cases; 17,5%). Early recognition of vulvar lesions and a prompt biopsy diagnosis for all lesions with suspicious changes is of great significance. [Med-Science 2015; 4(1.000): 1876-84

Oncological Outcomes of Stage IIIA Endometrioid Type Endometrial Cancer: A Multicenter Study

The objective of this retrospective study was to evaluate Stage IIIA endometrioid type endometrial carcinomas (ECCs) and to analyze clinical and pathological determinants of prognosis in three tertiary hospitals between January 2007 and January 2017. Forty-seven patients with a median age of 61 (range: 31 to 76) years were diagnosed with Stage IIIA disease. Median follow-up was 45 (range: 6 to 116) months. The five-year disease-free survival (DFS) rate was 57.2%, and the overall survival (OS) rate was 59.7%. In the univariate analysis, age and grade of the disease (1-2 versus 3) disease were found to be significant factors for DFS. Univariate analysis also revealed the presence of cervical stromal involvement and grade of the disease were associated with decreased OS. In the multivariate analysis, however, only patients with an advanced histological grade had a reduced risk for OS (hazard ratio [FIR] 2.9; 95% confidence interval [CI] 1.020-8.615; p= 0.040). In conclusion, histological grade seems to be an independent prognostic factor for OS in patients with Stage IIIA ECCs