Risk of HSIL (CIN 2-3) on colposcopic biopsy is minimal in postmenopausal women with LSIL on cytology and a negative HRHPV test

BackgroundCurrent cervical cancer screening guidelines recommend a 1-year follow-up period for patients with a postmenopausal low-grade squamous intraepithelial lesion (LSIL) who are test negative for high-risk human papillomavirus (HrHPV). The aim of this study was to assess whether such patients had an increased immediate risk of high-grade squamous intraepithelial lesion. MethodsWe assessed 54 HrHPV-negative women with postmenopausal LSIL in the Department of Obstetrics and Gynecology of our hospital between 2012 and 2013. All patients underwent liquid-based cytology and reflex HrHPV testing (for human papillomavirus [HPV] types 16, 18, 31, 33, 35, 39, 45, 51, 52, 56, 58, 59, 66, and 68). Colposcopic examination and guided biopsy were performed by the same gynecologist (MO). ResultsThe average age of the patients was 53.13.2 years. There were 33 patients (61%) with cervical intraepithelial neoplasia (CIN) grade 1 and 21 who were non-dysplastic. None of the patients was positive for CIN 2 or any other lesions. ConclusionsIf the HPV test is negative, repeat cytology after 12 months is recommended by the American Society for Colposcopy and Cervical Pathology for cases of HrHPV-negative postmenopausal LSIL. We recommend reflex HPV testing as the best choice for patients who test positive for postmenopausal LSIL by Pap smear, in line with the literature. Diagn. Cytopathol. 2016;44:969-974. (c) 2016 Wiley Periodicals, Inc

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

Štetni učinci pušenja tijekom trudnoće na DNA i razine reaktivnih oblika kisika (ROS) u krvi majke i novorođenčeta

Some of the genotoxic/carcinogenic substances or metabolites in cigarette smoke are capable of passing through the placenta and harming a newborn’s health. Smoking is also known as a factor in the formation of oxidative damage and the main mechanism involved in the carcinogenic process. Predetermining this genotoxic risk can be successfully achieved by measuring certain parameters of oxidative stress. The comet assay is considered an important biomarker for the evaluation of genotoxic substances and is effective for detecting DNA damage caused by smoking. This study examined third trimester bloods and the cord blood of 28 actively smoking and 22 non-smoking mothers in terms of DNA damage and oxidative stress parameters. Cu/Zn superoxide dismutase (CuZn-SOD), malondialdehyde (MDA), catalase (CAT), plasma nitrite/nitrates (NO2•/NO3•), selenium-dependent glutathione peroxidase (Se-GPx), Cu, and Zn levels were measured as indicators of oxidative damage. There were no significant increases in DNA damage of the actively smoking pregnant group in comparison with the non-smoking pregnant group, either in the third trimester or cord blood. Oxidative stress parameters of smoker and non-smoker groups were statistically different for MDA (p<0.05), CuZn-SOD (p<0.01), Se-GPx (p<0.05) values while the difference was not significant for NO2•/NO3•, CAT, Zn, and Cu values. The same values were also investigated in cord blood, and only NO2•/NO3• (p<0.01), Se-GPx (p<0.01 and CAT (p<0.001) values were found statistically different. Smoking mothers may have been exposed to more oxidative stress than non-smoking mothers.Pojedine genotoksične/kancerogene supstancije ili metaboliti u cigaretnom dimu mogu proći kroz posteljicu i naštetiti zdravlju novorođenčeta. Pušenje je također poznato kao čimbenik pri nastanku oksidacijskog oštećenja DNA i u procesu kancerogeneze. Ovaj genotoksični rizik može se uspješno odrediti mjerenjem određenih parametara oksidacijskog stresa. Komet-test smatra se važnim biološkim biljegom pri evaluaciji genotoksičnih supstancija i iznimno učinkovitim sredstvom pronalaženja oštećenja DNA uzrokovanih pušenjem. Ova studija proučava krv trudnica u trećem tromjesečju trudnoće i fetalnu krv 28 majki aktivnih pušačica te 22-ju majki nepušačica vezano za oksidacijska oštećenja DNA i parametre oksidacijskog stresa. Razine Cu/Zn superoksidne dismutaze (CuZn-SOD), malondialdehida (MDA), katalaze (CAT), nitrita/nitrata u plazmi (NO2-/NO3-), selenijeve glutation peroksidaze (Se-GPx), Cu i Zn mjerene su kao pokazatelji oksidacijskog oštećenja. Nije bilo značajnih povećanja oštećenja DNA u skupini trudnica aktivnih pušačica u usporedbi sa skupinom trudnica nepušačica, ni u krvi iz trećeg tromjesečja ni u fetalnoj krvi. Parametri oksidacijskog stresa pušačke i nepušačke skupine bili su statistički različiti za vrijednosti MDA (p<0,05), CuZn-SOD (p<0,01), Se-GPx (P<0,05), dok razlika nije bila značajna za vrijednosti NO2-/NO3-, CAT, Zn i Cu. Iste su vrijednosti ispitane i u fetalnoj krvi, a jedino su vrijednosti NO2-/NO3- (p<0,01), Se-GPx (p<0,01) i CAT (p<0,001) bile statistički različite. Vjerojatno je da su majke pušačice bile izložene većem oksidacijskom stresu od majki nepušačica

Tumor markers in gynecologic oncology: A literature review

Jinekolojik kanserler; ovaryan, servikal, endometriyal, vulvar kanserler olup kadınlardaki yıllık 5,1 milyon yeni kanserin %19’unu oluşturmaktadır. Serum tümör belirteçleri hastalığın taramasında, tespit edilmesinde, tedavinin monitorizasyonunda ve takip programında, özellikle rekürrensin prediksiyonunda önemli rol oynamaktadır. Bu derlemede jinekolojik kanserlerde tümör belirteçlerinin rolü tartışılmıştır.5,1 million women getting diagnosed as cancer every year and gynecological cancers (including ovarian, cervical, endometrial and vulvar cancers) constitutes 19% of all new cancers. Serum tumor markers have an important role in scanning and determining of disease, monitoring and follow up program of therapy and particularly prediction of recurrence. In this review, role of the tumor markers in gynecological cancers were discussed

Aynı overin multipl matür rekürrent kistik teratomu: Vaka sunumu ve literatürün gözden geçirilmesi

In this case report, we emphasize the recurrence and multilocularity properties of mature cystic teratomas. A 26 year old G0 woman complaining of stomachache and abdominal distention attended to the gynecology outpatient clinic. Transvaginal ultrasound revealed a 9 cm right ovarian mass with echogenecities suggesting sebaceous material within multiple dermoid cyst loci. A diagnostic laparoscopy was planned; seven separate loci of the dermoid cysts ranging between 2 - 5 cm with a total diameter of approximately 9 cm, were located on the right ovary. The patient was discharged on the second day after the operation without any complication. This patient is the only case having the properties of both recurrence and multilocularity in the Medline database search. Especially, the regular follow-up of the young patients has a clinical importance in early detection of the recurrent masses and during the surgeries of the recurrent cases, the surgeon should be careful about the bilaterality or multilocularity of the tumor.Bu olgu sunumunda, olgun kistik teratomların nüks ve multilokülerite özelliklerini vurguladık. 26 yaşında G0 kadın mide ağrısı ve abdominal distansiyon yakınmalarıyla jinekoloji polikliniğine başvurdu. Transvaginal ultrasonda sağ overde mutipl dermoid kist lokusları içinde ekojenik yağ materyali düşündüren 9cm kitle gözlendi. Sağ overe yerleşmiş totalde yaklaşık 9cm çaplı 2 ile 5 cm arasında değişen dermoid kistin 7 ayrı lokasyonuna tanısal laparoskopi planlandı. Hasta 2. günde komplikasyonsuz bir operasyon sonrası taburcu edildi. Bu hasta, Medline veritabanında rekürren ve multiloküler özelliğe sahip tek olgudur. Özellikle genç hastaların düzenli izlemi tümörün multilokülaritesi ve bilateralitesi hakkında cerrahın dikkatli olmasında, nüks vakaların cerrahisinde ve nüks kitlelerin erken tespitinde klinik öneme sahiptir

Death of the Spouse During Pregnancy Giving the Bad News and the Management

Pregnancy is a vulnerable time for receiving bad news. Death may occur anytime, and some women will experience this during their pregnancy. In our practice we have seen the dispair of the pregnant women after the unexpected death of the spouse. The pregnant women in most cultures are accepted and treated as more vulnerable individuals. Some believe that the sudden emotional changes may influence the course of the pregnancy. Immediate adverse outcome to a pregnancy after hearing the bad news has not been mentioned on the literature. There seems to be no scientific evidence of doing a pregnancy check up on a normally progressing pregnancy before giving the bad news, as well as no acute measures to be taken to avoid an adverse outcome. We reviewed the unexpected death of the loved one during pregnancy, giving the bad news, understanding the needs and expectations of the pregnant women, and about the ways of professional help to ease the pai

A Case of Asymptomatic Postmenopausal Hematometra Mimicking Endometrial Carcinoma

Hematometra in a postmenopausal woman is a rare condition and the possible association of endometrial and cervical carcinoma should be excluded for such cases. We report the case of a 66-year-old multiparous postmenopausal woman who presented as an asymptomatical hematometra mimicking endometrial carcinoma. In this case, hematometra was demonstrated by sonography and well defined by computed tomography and MRI and suggested the possible diagnosis of endometrial cancer. Endometrial sampling revealed only the diagnosis of blood clots and scanty endometrial strands. A total hysterectomy with bilateral salpingo-oophorectomy were done. Pathologic evaluation excluded the diagnosis of endometrial carcinoma and revealed senile cervical stenosis possibly due to hypoestrogenic state. The successful management of this rare condition was discussed

Suggested Office Hysteroscopy Holding Technique to Minimize Delicate Instrument Bending

OBJECTIVE: Office hysteroscopy is valuable in diagnosing and treating intrauterine pathologies. But the expensive instruments used for operative office hysteroscopy are delicate and prone to be damaged by bending. We are suggesting a method to increase the life time of the equipment and decrease the expenses. STUDY DESIGN: 43 patients undergoing office hysteroscopy for endometrial polyps and submucous myomas in Gülhane Military Medical Academy in January 2008 - April 2008 are included in this study and applied the new holding technique suggested by Dr. Emre Karaşahin. Departmentally available instruments are used. RESULTS: All the office procedures were successfully completed, without a single defect on the scissors and forcepses used for the operative office procedures. CONCLUSION: The technique explained in the text increases the life time of the equipment, and therefore decreases the costs of operations