Synchronous tumors of the female genital tract: A 20-year experience in a single center

Objective: To evaluate the clinicopathological characteristics and the clinical outcome of synchronous malignant neoplasms of the female reproductive tract. Material and Methods: Patients who were operated and diagnosed with synchronous malignant tumor of the genital system (n=25) at the Dokuz Eylul University Department of Obstetrics and Gynecology, Gynecologic Oncology Unit between 1992 and 2012 were included into this study. Recurrent, metastatic and metachronously detected tumors were not included. Age at diagnosis, parity, menopausal status, hormone use, presenting sign or symptoms and the clinical outcomes were evaluated. Results: 20 of 25 patients had endometrial-ovarian cancer. The mean age at diagnosis was 53,6 years. The most common presenting symptom was abnormal uterine bleeding. The median follow-up duration for all patients was 69 months. Overall survival for all patients was 87 months and 81 months for patients with endometrial-ovarian cancer. 5-year survival rate was 73% for all patients and 68% for patients with endometrial-ovarian cancer. Conclusions: Endometrial-ovarian cancer togetherness is the most common in synchronous gynecologic malignancies. They occur at a younger age and have more favorable prognosis than metastatic primary gynecologic tumors

Serviksin sarkomatöz gelişim gösteren Müllerian adenosarkomunda over metastazı

The aim of this study is to present a rare case of M;uuml;llerian adenosarcoma of the cervix with ovarian metastasis and sarcomatous overgrowth. A gravida 2, para 2 woman aged 32 years with vaginal bleeding was admitted to the gynecology department. A 3-4 cm polypoid mass protruding from the cervix was detected in a pelvic examination. Total abdominal hysterectomy and bilateral salpingoopherectomy was performed because of metastatic implants on the right ovary. The pathologic evaluation revealed M;uuml;llerian adenosarcoma of the cervix with sarcomatous overgrowth and ovarian metastasis. After surgery, the patient was planned to undergo chemo- and radiotherapy. This is the first cervical M;uuml;llerian adenosarcoma case mentioned in the literature with metastasis to the ovary in a young woman. There is no optimal management option for cervical adenosarcomas due to the rarity of this phenomenon. Nevertheless, even if the patient is young and imaging techniques do not elucidate metastatic disease, surgeons should evaluate the ovaries for the spread of tumor, especially if histology reveals sarcomatous overgrowth.Bu çalışmanın amacı, nadir görülen ve over metastazı ile birlikte olan sarkomatöz gelişim gösteren serviks adenosarkom olgusunu sunmaktır. Otuz iki yaşında gravida 2, para 2 olan olgu, vajinal kanama yakınması ile jinekoloji bölümüne başvurmuştur. Pelvik bakıda, serviksten vajene protrüde olmuş 3-4 cm polipoid yapıda kitle izlenmiştir. Total abdominal histerektomi ve over üzerindeki metastatik odaklar nedeniyle de bilateral salpingo-ooferektomi uygulanmıştır. Patolojik değerlendirme, over metastazının eşlik ettiği serviksin sarkomatöz gelişim gösteren Müllerian adenosarkomu olarak raporlanmıştır. Operasyon sonrası hastaya kemoterapi ve radyoterapi planlanmıştır. Bu olgu, literatürde genç hastada overe metastaz yaptığı gösterilmiş ilk serviksin Müllerian adenosarkom olgusudur. Olgunun nadir görülmesinden dolayı, uygun tedavi yaklaşımı ile ilgili yeterli bilgi yoktur. Ancak olgu genç ve görüntüleme yöntemlerinin sonucunda overlerin normal dahi olduğu belirtilse, sarkomatöz gelişim gösterdiği bildirilen olgularda, cerrah over metastazı riskini göz önünde bulundurmalıdır

The alteration of apoptosis-related genes in female pelvic supportive tissues with regard to menopausal status

PurposeWe aimed to compare the expression levels of anti-apoptotic and proapoptotic genes in the parametrium, sacrouterine and round ligaments with respect to menopausal status in women presenting without any indication of pelvic organ prolapse (POP). We hypothesized that apoptosis related gene expressions in female pelvic tissues may be altered during menopause.MethodsThe study groups consisted of pre-menopausal (n = 10) and menopausal (n = 10) females who did not have POP symptoms. Three different types of tissue samples (Parametrium, Round Ligament and Sacrouterine Ligament) were obtained and RNA was isolated from these tissues. After purifying and quantifying RNA samples, qPCR was used to determine the expression levels of anti-apoptotic and pro-apoptotic genes.ResultsBCL-2 gene expression levels were significantly lower in all the tissues of menopausal patients compared to those of premenopausal patients. In comparison to premenopausal patients, the sacrouterine ligament tissue BAD expression level was significantly high (p = 0.035), and the BCL-2/BAD ratio was significantly lower in menopausal patients (p = 0.006).ConclusionApoptosis-related protein levels change during menopause; pro-apoptotic gene expressions decrease and anti-apoptotic gene expressions increase. The significant alteration of BCL-2 and BAD expression in sacrouterine ligament with respect to menopausal status was observed and this suggested that when compared to other pelvic tissues, the sacrouterine ligament, which plays a crucial role for genital organs in restoring normal pelvic anatomy and providing support, could be affected more by menopause

Post - Coital Vaginal Evisceration Following 8 Years in a Patient was Operated for Endometrium Cancer: Report of a Case and Review of the Literature

Intestinal prolapse through vagina following hysterectomy secondary coitus is rare. It is generally seen in postmenopausal women after vaginal hysterectomy or multiple surgeries performed for pelvic floor disorders. However, in English literature, there are only a few cases of vaginal evisceration after radical hysterectomy and pelvic lymphadenectomy, but all of these cases were cervical cancer. We report a case of a 49-year old woman presenting with evisceration of the small bowel from the vagina eight years after total abdominal hysterectomy (TAH), bilateral salpingoopherectomy (BSO) and pelvic-paraaortic lymphadenectomy for stage Ib endometrioid type endometrial cancer