Endocervical polyps in high risk human papillomavirus infections

Objectives: Human papillomavirus (HPV) positive patients with and without endocervical polyps is compared with respect to HPV genotypes and presence of pre-invasive diseases. To our knowledge, this is the first and largest report in the literature examining the endocervical polyps in HPV positive cases. Material and methods: Clinicopathological data for the first one million screening patients (n = 1 060 992) from around the entire country during 2015 and 2016 were targeted for this research. Colposcopy, colposcopic surgical diagnostic procedures and final pathology results of 3499 patients with high-risk (HR) HPV-positive were obtained from reference colposcopy centers. Patients with endocervical polyps (n = 243 [6.9 %]) were accepted as experimental arm while patients without any endocervical polyp (n = 3256 [93.1%]) were regarded as the control group. Age, HPV genotype, Pap smear abnormality, and final pathological results were compared between two groups using Student’s t-test and cross-tabulation chi-square test. Results: The incidence of endocervical polyp was found to be 6.9 % in HR HPV-positive women. The most common HPV genotypes observed in both groups were HPV 16 or 18. Abnormal cytology reports (≥ ASC-US) were not significantly different between both groups. However, with respect to final pathological diagnosis, patients with endocervical polyp had significantly lower numbers of pre-invasive diseases (31.3% vs 44.2%; p < 0.10). Conclusions: Endocervical polyps may be more common in patients with HR HPV infections. HPV 18 is observed significantly more, in the HR HPV positive endocervical polyp group. Patients with endocervical polyps do not have increased risk for preinvasive cervical diseases

Widespread Recurrence 7 Years After Radical Abdominal Trachelectomy For Early Cervical Adenocarcinoma

Cervical cancer is the third most common female cancer worldwide and the use of routine screening resulted in earlier stage and younger age at diagnosis. Fertility preservation via radical trachelectomy comes up as an option in such patients. Recent literature reviews confirm the safety of this operation with excellent oncologic outcomes in appropriately chosen patients. However, recurrent disease is likely and a strict follow-up is recommended to detect recurrences at an early stage following radical trachelectomy. In this report, a case who underwent radical trachelectomy and developed widespread recurrences 7 years after initial surgery possibly due to the lack of oncologic follow-up is discussed

Treatment Of Rectovaginal Fistula Using Sphincteroplasty And Fistulectomy

Aim To assess the results of the treatment of rectovaginal fistulas with incontinence and impaired anal tonus. Materials and Methods This study comprised three rectovaginal fistula groups that were treated using sphincteroplasty and fistulectomy: group 1: eight women with simple rectovaginal fistula due to birth trauma; group 2: six rectovaginal fistula cases that were associated with chronic inflammatory diseases; and group 3: five cases with at least one failed repair attempt. In the second step, operations that took place before the year 2000 were compared to the operations that took place after the year 2000 in terms of demographic and clinical characteristics. Results All of the simple rectovaginal fistula cases healed after the operation. Five of the group 2 patients healed after the operation. However, 1 patient with Crohn's disease needed to undergo reoperation, but successfully healed after 6 months. On the contrary, 3 patients in group 3 healed (60%) whereas 2 of them failed to heal. Clinical characteristics of the patients were different between the groups (before and after the year 2000). Conclusion The choice of operation must be done according to the patient's underlying pathology. Proper management of associated inflammatory diseases and systemic disorders is recommended for necessary complex cases.PubMedScopu

Repair of Diaphragmatic Injury and Placement of Tube Thoracostomy During Right Upper Quadrant Peritonectomy

Objective Patients with advanced or recurrent ovarian cancer often have metastatic disease in the upper abdominal region, especially to the right hemidiaphragm, which requires diaphragmatic resection in order to achieve optimal cytoreduction. The aim of this surgical video is to demonstrate repair of a diaphragmatic injury and placement of tube thoracostomy during right upper quadrant peritonectomy in a patient with recurrent ovarian cancer. Methods This is the case of a 45-year-old woman presented with platinum sensitive recurrent ovarian cancer. Abdomen computed tomography also confirmed peritoneal carcinomatosis and pelvic recurrent mass. HIPEC was administered after complete cytoreduction including bilateral upper quadrant peritonectomy, during which diaphragmatic injury occurred near the central tendon and pleural cavity was entered. We inserted a chest tube through the 6th intercostal space in the anterior axillary line in order to prevent postoperative massive pleural effusion. Diaphragmatic defect was closed primarily after the tube placement. The chest tube was withdrawn on the third postoperative day and the patient was discharged on postoperative day 25 without any complications. Results The central tendon of diaphragm is the most vulnerable part for lacerations. Diaphragmatic repairs could be performed by various techniques; interrupted or continuous, locking or non-locking sutures, with either permanent or absorbable materials. In our view, all of the techniques provide similar results and surgeons can choose any of them as long as they are comfortable with the procedure. Conclusion In most cases, these lacerations can be repaired primarily without necessitating tube thoracostomy. However, performance of HIPEC can cause massive pleural effusions which can lead to significant pulmonary morbidity. Therefore, retrograde placement of the chest tube under direct vision is quite straightforward when the diaphragm is opened

Endometriosis In Cesarean Scar: A Case Report

A patient with surgical scar endometriosis, a rare condition, was presented. The patient was 30 years old, gave birth twice by cesarean section, her last delivery was seven years ago. She appealed to the outpatients' clinic because of the complaints of pain, swelling and redness on the scar site, her complaints began one year after the last delivery and continued. The complaints did not alter by menstrual cycle. On the examination, there was a painful hyperemic lesion 2x2crn in size which was raised from the skin, located at the right of the scar, assumed to be associated with the fixed fascia and another lesion 2x2crn in size which could not be noticed by inspection but be palpated was found. The lesions described were totally excised. The result of paraffin block examination of the material was reported as endometriosis. Pain on the scar site with menstrual period, enlargement and discoloration of the lesions are classical signs of scar endometriosis. But the patients do not always present these findings. Endometriosis should also be remembered along with other reasons when lesions occur on the scar site after surgery

Clinical And Pathological Characteristics Related To Parametrial Involvement In Clinical Early-Stage Cervical Cancer

Objectives: Since parametrial involvement is believed to be a crucial factor in the management of cervical cancer, our study was designed to investigate the clinical and pathological features which predicted parametrial involvement in patients with clinical early-stage cervical cancer. Material and methods: The study included patients with clinical early-stage cervical cancer who underwent radical hysterectomy with pelvic and para-aortic lymphadenectomy between December 2001 and August 2014, at the Hacettepe University Hospital. The clinical and pathological characteristics of the affected patients were evaluated, including age, histologic subtype, tumor size, depth of cervical stromal invasion, lympho-vascular space invasion (LVSI), and lymph node metastasis. Univariate and multivariate analyses were performed to reveal factors associated with parametrial involvement. Results: The study group consisted of 126 patients (mean age: 52.7 years; range: 29-83), including 101 (80.2%) with squamous, 19 (15.1%) with adenocarcinoma, and 6 (4.8%) with adenosquamous histological subtype of cervical cancer. Parametrial involvement and lymph node metastasis were detected in 41 (32.5%) and 46 (36.5%) women, respectively. Univariate analysis showed that deep cervical stromal invasion, LVSI, tumor size > 2 cm and lymph node metastasis were associated with parametrial involvement. Multivariate logistic regression analysis identified the independent risk factors associated with parametrial involvement as LVSI (OR 8.93, 95% CI 1.1-73.5, p = 0.042) and lymph node metastasis (OR 8.8, 95% CI 1.5-9.3, p = 0.004). Conclusions: LVSI, deep cervical stromal invasion, lymph node metastasis and tumor size are significantly associated with parametrial involvement in patients with clinical early-stage cervical cancer.WoSScopu

Impact Of Adjuvant Treatment On Oncologic Outcomes In Patients With Stage I Leiomyosarcoma Of The Uterus

Background/aim: This study aimed to evaluate the role of adjuvant therapy for stage I uterine leiomyosarcoma (LMS). Materials and methods: Clinicopathological data of cases of stage I uterine LMS from 1998 to 2015 were retrieved from the computerized database of Hacettepe University Hospital. The Kaplan-Meier method was used to estimate survival and progression-free survival, and survival differences were analyzed by log-rank test. Cox regression analysis was performed to account for the potential influence of confounding factors. Results: We evaluated the outcomes of 35 patients with histologically proven stage I LMS. The median age at diagnosis was 50 years. All patients underwent surgical treatment and 20 patients (57.1%) received adjuvant therapy. Twelve of these patients (34.3%) received adjuvant chemotherapy, 3 (8.6%) received adjuvant pelvic irradiation, and 5 (14.2%) received adjuvant chemotherapy with pelvic irradiation. The median follow-up duration was 34 months (range: 3-231 months). Twenty-three (65.7%) patients had a recurrence during follow-up. Adjuvant therapy did not significantly improve median progression-free survival or median overall survival. Cox regression analysis did not demonstrate any significant impact of the factors studied, including age, menopausal status, tumor size, mitotic count, staging surgery, or adjuvant therapy. Conclusion: Adjuvant therapy for surgically treated stage I uterine LMS did not improve oncologic outcomes.WoSScopu

Does Preoperative Diagnosis of Endometrial Hyperplasia Necessitate Intraoperative Frozen Section Consultation?

Background: In women with endometrial hyperplasia, there is a risk for co-existent endometrial cancer when patients are subjected to immediate surgical treatment. Aims: The aim of this study was to investigate the frequency of endometrial cancer and the accuracy of frozen section analysis at the time of hysterectomy among patients with endometrial hyperplasia, to reveal whether or not a preoperative diagnosis of endometrial hyperplasia necessitates frozen section consultation. Study Design: Retrospective cross-sectional study. Methods: A department database review was performed to identify patients who were subjected to hysterectomy with a preoperative diagnosis of endometrial hyperplasia, during the period from 2007 to 2014. Results: The study group included 189 cases. The final pathological examination revealed endometrial cancer in 16 women (8.4%). The risk of cancer in patients with endometrial hyperplasia was 1 of 125 (0.8%) in simple hyperplasia without atypia, 1 of 21 (4.8%) in complex hyperplasia without atypia and 14 of 43 (32.5%) in atypical hyperplasia. Of women with cancer, 2 of 16 (12.5%) had high-risk features. Frozen section analysis was requested in 46 cases. Frozen sections helped to identify six out of 11 cases of endometrial cancer (54.5%). The sensitivity, specificity and positive and negative predictive values of frozen section analysis for the detection of endometrial cancer among women with endometrial hyperplasia were 54.4%, 97.2%, 85.7% and 87.5%, respectively. Conclusion: Although a significant proportion of patients with atypical endometrial hyperplasia are diagnosed with endometrial cancer following hysterectomy, most of these cases have low-risk features and do not require surgical staging. Additionally, intraoperative frozen section analysis if not helpful for diagnosing concurrent endometrial cancer in patients with endometrial hyperplasia. Therefore, it seems that patients with endometrial hyperplasia can be operated upon in settings with no available method for obtaining frozen sections intraoperatively.WoSScopu

Evaluation of colposcopy after the addition of human papillomavirus testing to the Turkish cervical cancer screening program

Abstract Objective To evaluate colposcopy performance following the human papillomavirus (HPV) DNA screening program in Turkey. Methods Women aged 30–65 years are screened for cervical cancer every 5 years, with individuals positive for HPV 16 and/or 18 or other high‐risk HPV types with abnormal cytology referred for colposcopy. Both HPV test and cytology are obtained at the same visit. If HPV is negative, cytology will not be assessed. However, if HPV is positive, both cytology and HPV genotyping will be performed. Colposcopy‐require was defined as HPV 16/18 positivity or abnormal smear results with any hrHPV positivity, and the remaining patients (normal smear with hrHPV positivity other than HPV 16/18) were grouped as colposcopy non‐required. National data on colposcopy outcomes and unnecessary performance rates in February 2018–2019 were evaluated via a questionnaire. Results A total of 9808 patients were included, divided based on colposcopy requirement: 5751 (58.6%) patients required colposcopy and 4057 (41.4%) did not. Unnecessary colposcopy was performed on 90.1% of the non‐required group (3657 of 4057 patients). In the colposcopy‐required group, 4455 patients (79.9%) underwent punch biopsy; 3194 (57.1%), endocervical curettage (ECC); and 421 (7.5%), “see and treat” in the non‐required group, the results were 2790 (76.3%), 1957 (53.2%), and 211 (5.7%), respectively. A total of 746 cervical intraepithelial neoplasia (CIN)‐3 isolates were detected, including 702 using existing screening and triage with 94.1% sensitivity (702/746). Multiple biopsies were taken in 69.8% (n = 3110) of patients from the colposcopy‐required group and 63.7% (n = 1777) from the non‐required group. The ECC samples included 19 cervical cancers and 212 ≥CIN‐3 lesions in the colposcopy‐required group, and four cancers and 41 ≥CIN‐3 lesions in the non‐required group. The proportion of ≥CIN‐3 lesions detected by ECC only was 4.7% (35 of 746 ≥CIN‐3 lesions). Conclusion Our results showed high rates of unnecessary colposcopies, and a high percentage of multiple and random punch biopsies and ECC

Staining characteristics of p16INK4a: Is there a correlation with lesion grade or high-risk human papilloma virus positivity?

Usubutun, Alp/0000-0001-9572-7875;WOS: 000259270800015PubMed: 18958930Aim: The aims of this study were to evaluate the efficiency of p16INK4a in showing cervical lesions and to determine any relationship between lesion grade and high-risk human papilloma virus (HR-HPV) infection and p16INK4a staining characteristics. Methods: Immunohistochemical analysis of p16INK4a was performed on 13 low-grade squamous intraepithelial lesions (LSIL), 22 high-grade squamous intraepithelial lesions (HSIL), 23 squamous cell carcinoma (SCC) and 25 normal tissue samples. The distribution, staining pattern and intensity of p16INK4a expression were assessed and correlated with HR-HPV positivity determined by real-time polymerase chain reaction. Results: All HSIL and SCC cases, but only 46.2% of LSIL cases, were positive for p16INK4a. Although positive staining of p16INK4a in showing HR-HPV-positive lesions was statistically significant (P = 0.000), we could not find a significant correlation for distribution (P = 0.319), staining pattern (P = 0.057) or intensity (P = 0.057) of p16INK4a in showing HR-HPV in cervical epithelium. These parameters were correlated only with the increasing grade of the lesion (P = 0.000). Conclusions: p16INK4a is a highly sensitive marker of cervical intraepithelial neoplasia and cervical cancer. There is a good correlation between p16INK4a expression and cervical lesion grade and HR-HPV positivity. The distribution, staining pattern and intensity of this marker are significantly correlated with the increasing grade of cervical lesions, suggesting that diffuse distribution, full thickness staining pattern and strong intensity of this marker are highly supportive of HSIL and cervical cancer, while focal distribution, scattered/basal staining pattern and weak intensity suggest LSIL. However, these parameters are not correlated with HR-HPV status in cervical lesions