International Journal of Gynecological Cancer, 2006
The objective of this study was to evaluate size, bilaterality, histopathologic origin, and the s... more The objective of this study was to evaluate size, bilaterality, histopathologic origin, and the serum levels of some tumor markers in patients with mature cystic teratomas (MCTs) of the ovary. Retrospective study of 80 patients operated at Department of Obstetrics and Gynecology, Gulhane Military Medical Academy, Turkey, between the years 1998 and 2003 was performed. The mean age was 33.1 AE 11.3 years (median 34; range 15-69). The mean tumor diameter was 7.2 AE 4.5 cm (median 5; range 3-20). The mean serum CA19-9 level was 101.2 AE 179.7 IU/mL (range 1-841, normal value ,37), the mean serum CA125 level was 32.0 AE 37.8 U/mL (range 2.2-205, normal value ,35), the mean carcino-embryogenic antigen (CEA) level was 1.46 AE 1.20 ng/mL (range 0.2-4.8, normal value 3.4), and the mean serum alpha-fetoprotein (AFP) level was 2.7 AE 3.0 ng/mL (range 0.1-10.5, normal value ,8.1). The elevated rate of CA19-9, CA125, CEA, and AFP was 38.8% (31/80), 25% (18/72), 9.1% (4/44), and 8.7% (4/46), respectively. The bilaterality rate was 27.5% (22/80). Patients with an elevated serum CA19-9 level showed significantly higher bilaterality rate (51.6% versus 12.2%, P , 0.05) than the patients with low levels. Likelihood ratio for bilaterality was 2.8 for CA19-9 and 4.6 for CA125. Bilateral teratomas showed a significantly higher rate of ectodermal component than the unilateral ones (100% versus 74.3%, P , 0.05). Ovarian MCTs were diagnosed especially during the reproductive period. CA19-9 may be the only important marker in the diagnosis of MCTs. Elevated levels of CA19-9 and CA125 may be an indicator of bilaterality. Since levels of CA19-9 and CA125 may be elevated in both benign and malignant conditions, interpretation of these findings must be made in light of the clinical condition of the patient.
OBJECTIVE To detect whether the localisation of the tumour has an impact on the dissemination of ... more OBJECTIVE To detect whether the localisation of the tumour has an impact on the dissemination of the tumour and whether or not surgical procedures should be individualized according to the localisation of the tumour. MATERIAL METHOD 106 clinically surgically stage I endometrial endometrioid carcinoma cases treated multi-institutionally at Gulhane Military Medical Academy (GATA) and Dr. Zekai Tahir Burak (ZTB) Women's Health Education and Research Hospital Gynecologic Oncology Units in the last five years were evaluated retrospectively. The tumours localised near the internal cervical os and not invading the cervical canal were accepted as lower uterine segment (LUS) localisation and the corporal location as upper uterine segment (UUS) localisation. RESULTS Tumour localisation was more frequent in the upper segment than LUS (85.9% vs 14.1%). There was no statistically significant difference between only endometrial and only serous invasion rates. Myometrial invasion less than one...
To compare the clinical and laboratory findings between adjuvant therapy performed and not perfor... more To compare the clinical and laboratory findings between adjuvant therapy performed and not performed on peritoneal cytology-positive patients with cytology-negative cases of surgical-pathologic Stage I endometrial cancer. Twelve peritoneal cytology-positive and 12 negative surgical-pathologic Stage I endometrial cancer cases were used in the study. Adjuvant radiotherapy was performed for six cytology-positive patients (group I); no adjuvant therapy was performed for six cytology-positive (group II) and 12 cytology-negative patients (control group). Pelvic examination, vaginal cytology, serum CA125 levels and routine blood tests were checked at two-month intervals for two years and at six-month intervals for the third year. Abdominopelvic computerized tomography was planned annually. There was no statistically significant difference among the three groups and no recurrence in any group. We do not recommend adjuvant therapy for cytology-positive patients if the tumor is confined to the uterus.
Villoglandular papillary adenocarcinoma (VPA) of cervix is rare but a well recognized variant of ... more Villoglandular papillary adenocarcinoma (VPA) of cervix is rare but a well recognized variant of cervical adenocarcinoma with favorable prognosis occurring in younger age group. A 28-year-old white woman, gravida 3, para 2 was admitted for abnormal vaginal bleeding, when she was pregnant at 8th weeks of gestation. Physical examination revealed about 2.5 cm polipoid lesion of the cervix protruding into vagina. Histopathological findings were consistent with cervical VPA. After termination of pregnancy, radical hysterectomy type III was performed. The patient underwent second, third and fourth laparotomies because of recurrent pelvic masses. At the end of five years follow-up period, she died because of the complication of recurrent tumor. VPA is not an innocent tumor, and can be complicated by recurrence and metastasis. More radical surgical and medical attempts should be planned.
A 45-year-old patient presented with complaints of vaginal bleeding and pelvic pain. Fractioned p... more A 45-year-old patient presented with complaints of vaginal bleeding and pelvic pain. Fractioned probe curettage was performed and reported as Stage IIa, grade 3, squamous cell carcinoma of the uterine cervix. The patient underwent radical hysterectomy type III, bilateral salpingo-oophorectomy, omentectomy, appendectomy, and pelvic para-aortic lymph node dissection according to our clinical protocol. Adjuvant radiation therapy was planned. A splenic mass of 8 cm in diameter was revealed on computed tomography at the end of the third year of the disease-free follow-up period. Fine needle aspiration biopsy was performed and reported as metastatic carcinoma correlated to the previous cervical cancer. Debulking surgery was performed. The patient died one year after the second surgical operation. Spleen metastasis in patients with squamous cell carcinoma of the uterine cervix is exceedingly rare. Nonetheless we recommend screening of all intra-abdominal organs including the spleen as a rare metastastic site in follow-up examination protocols.
The authors aimed to detect immediate risk of having high grade squamous lesions (HSIL) in atypic... more The authors aimed to detect immediate risk of having high grade squamous lesions (HSIL) in atypical squamous cells of uncertain significance(AS-CUS) and concomitant high-risk human papillomavirus (HrHPV) testing as negative [HrHPV(negative)AS-CUS]. The authors performed immediate/baseline colposcopy on concomitant HrHPV (negative)AS-CUS cases. Pap tests were evaluated with liquid-based cytology (LBC) and HrHPV detection was performed in LBC material with PCR. Colposcopic diagnoses and biopsy results were compared with Pap test and HrHPV test results. There were 104 patients over a one-year period. In all, 84 cases were included. Colposcopic biopsies revealed low grade squamous intraepithelial lesion (LSIL) in 19 cases (23%) and HSIL in three cases (4%). Intrauterine device use and smoking were significantly correlated with presence of HSIL (p = 0.005 and p = 0.007 respectively). Similar data in literature, 4% of ASC-US-HrHPV (negative) cases are expected to have HSIL in follow-up pe...
Turkish journal of obstetrics and gynecology, 2017
Anemia in the first trimester of pregnancy is the situation as described by the World Health Orga... more Anemia in the first trimester of pregnancy is the situation as described by the World Health Organization when the level of hemoglobin (Hb) is less than 11 g in 100 cc of blood. The prevalence of this problem is 18% in developed countries, whereas it is between 35-75% in developing countries. In this study, we aimed to determine the prevalence of anemia at the time of pregnancy detection. A retrospective cross-sectional study was designed to determine the prevalence of anemia. A total of 5228 first trimester pregnant women were admitted to the study between 2012 and 2014. Hb levels of 11 to 9.5 g/dL, 9.5 to 8 g/dL, and less than 8 g/dL were considered as mild, moderate, and severe anemia, respectively. We detected mild, modarate, and severe anemia at rates of 16.64%, 3.07%, and 0.28%, respectively, in our population. The overall prevalence of anemia at the time of detection of pregnancy was 20.0%. Anemia is a significant risk factor for maternal mortality in developing countries. Th...
Introduction: The use of robotics for benign etiology in gynecology has not proven to be more ben... more Introduction: The use of robotics for benign etiology in gynecology has not proven to be more beneficial when compared to traditional laparoscopy. The major concern regarding robotic hysterectomy stems from its high cost. Aim: To evaluate the clinical utility and effectiveness of one-arm reduced robotic-assisted laparoscopic hysterectomy as a cost-effective surgical option for total robotic hysterectomy. Material and methods: A sample population of 54 women who underwent robotic-assisted laparoscopic surgery for benign gynecologic indications was evaluated, and two groups were identified: (1) the two-armed robotic-assisted laparoscopic surgery group (n = 38 patients), and (2) the three-armed robotic-assisted laparoscopic surgery group (n = 16 patients). Results: An increased cost was observed when three-armed robotic surgery was employed for benign gynecologic surgery (p < 0.001). The cost reduction observed in the study group was primarily derived from one robotic arm reduction and vaginal closure of the cuff. This cost reduction was achieved without an increase in complication rates or undesirable postoperative outcomes. An estimated profit between $399.5 and $421.5 was made for each patient depending on the suture material chosen for cuff closure. Two-armed surgery resulted in an 18.6% reduction in procedure-specific costs for robotic hysterectomy. Conclusions: Two-armed robotic-assisted laparoscopic hysterectomy appears to be a cost-effective solution for robotic gynecologic surgery. This surgical solution can be performed as effectively as classical three-armed robotic hysterectomies for benign indications without the risk of increased surgical-related morbidities. This approach has the potential to be a widely preferred surgical approach in medical communities where cost reduction is one of the primary determinants of surgery type.
Acta Obstetricia Et Gynecologica Scandinavica, Feb 1, 2007
To investigate the effect of determination of human papillomavirus (HPV) subtype on the success o... more To investigate the effect of determination of human papillomavirus (HPV) subtype on the success of imiquimod therapy in women with vulvar condylomata acuminata. A total of 132 women with biopsy-proven vulvar condylomata acuminata were enrolled in this prospective study. HPV DNA detection and determination of genotype were made through polymerase chain reaction (PCR) technique. The women were treated with imiquimod cream 5% in the area of the visible lesions, three times a week at night for 16 weeks. Twelve of the 132 women (9.1%) failed to detect any improvement with this therapy during the 16-week period. However, 80 women (60.6%) experienced total clearance of the lesions, and 20 women (15.2%) observed a partial response. The complete response rates were 76.2% for HPV-6, 66.7% for HPV-11, 35% for HPV-6 plus 11, and 6.3% for unclassified HPV subtypes (other HPV subtypes than HPV 6 and -11). Topical imiquimod 5% cream is an appropriate treatment modality for HPV-6 or -11 positive vulvar warts.
International Journal of Gynecological Cancer, 2006
The objective of this study was to evaluate size, bilaterality, histopathologic origin, and the s... more The objective of this study was to evaluate size, bilaterality, histopathologic origin, and the serum levels of some tumor markers in patients with mature cystic teratomas (MCTs) of the ovary. Retrospective study of 80 patients operated at Department of Obstetrics and Gynecology, Gulhane Military Medical Academy, Turkey, between the years 1998 and 2003 was performed. The mean age was 33.1 AE 11.3 years (median 34; range 15-69). The mean tumor diameter was 7.2 AE 4.5 cm (median 5; range 3-20). The mean serum CA19-9 level was 101.2 AE 179.7 IU/mL (range 1-841, normal value ,37), the mean serum CA125 level was 32.0 AE 37.8 U/mL (range 2.2-205, normal value ,35), the mean carcino-embryogenic antigen (CEA) level was 1.46 AE 1.20 ng/mL (range 0.2-4.8, normal value 3.4), and the mean serum alpha-fetoprotein (AFP) level was 2.7 AE 3.0 ng/mL (range 0.1-10.5, normal value ,8.1). The elevated rate of CA19-9, CA125, CEA, and AFP was 38.8% (31/80), 25% (18/72), 9.1% (4/44), and 8.7% (4/46), respectively. The bilaterality rate was 27.5% (22/80). Patients with an elevated serum CA19-9 level showed significantly higher bilaterality rate (51.6% versus 12.2%, P , 0.05) than the patients with low levels. Likelihood ratio for bilaterality was 2.8 for CA19-9 and 4.6 for CA125. Bilateral teratomas showed a significantly higher rate of ectodermal component than the unilateral ones (100% versus 74.3%, P , 0.05). Ovarian MCTs were diagnosed especially during the reproductive period. CA19-9 may be the only important marker in the diagnosis of MCTs. Elevated levels of CA19-9 and CA125 may be an indicator of bilaterality. Since levels of CA19-9 and CA125 may be elevated in both benign and malignant conditions, interpretation of these findings must be made in light of the clinical condition of the patient.
OBJECTIVE To detect whether the localisation of the tumour has an impact on the dissemination of ... more OBJECTIVE To detect whether the localisation of the tumour has an impact on the dissemination of the tumour and whether or not surgical procedures should be individualized according to the localisation of the tumour. MATERIAL METHOD 106 clinically surgically stage I endometrial endometrioid carcinoma cases treated multi-institutionally at Gulhane Military Medical Academy (GATA) and Dr. Zekai Tahir Burak (ZTB) Women's Health Education and Research Hospital Gynecologic Oncology Units in the last five years were evaluated retrospectively. The tumours localised near the internal cervical os and not invading the cervical canal were accepted as lower uterine segment (LUS) localisation and the corporal location as upper uterine segment (UUS) localisation. RESULTS Tumour localisation was more frequent in the upper segment than LUS (85.9% vs 14.1%). There was no statistically significant difference between only endometrial and only serous invasion rates. Myometrial invasion less than one...
To compare the clinical and laboratory findings between adjuvant therapy performed and not perfor... more To compare the clinical and laboratory findings between adjuvant therapy performed and not performed on peritoneal cytology-positive patients with cytology-negative cases of surgical-pathologic Stage I endometrial cancer. Twelve peritoneal cytology-positive and 12 negative surgical-pathologic Stage I endometrial cancer cases were used in the study. Adjuvant radiotherapy was performed for six cytology-positive patients (group I); no adjuvant therapy was performed for six cytology-positive (group II) and 12 cytology-negative patients (control group). Pelvic examination, vaginal cytology, serum CA125 levels and routine blood tests were checked at two-month intervals for two years and at six-month intervals for the third year. Abdominopelvic computerized tomography was planned annually. There was no statistically significant difference among the three groups and no recurrence in any group. We do not recommend adjuvant therapy for cytology-positive patients if the tumor is confined to the uterus.
Villoglandular papillary adenocarcinoma (VPA) of cervix is rare but a well recognized variant of ... more Villoglandular papillary adenocarcinoma (VPA) of cervix is rare but a well recognized variant of cervical adenocarcinoma with favorable prognosis occurring in younger age group. A 28-year-old white woman, gravida 3, para 2 was admitted for abnormal vaginal bleeding, when she was pregnant at 8th weeks of gestation. Physical examination revealed about 2.5 cm polipoid lesion of the cervix protruding into vagina. Histopathological findings were consistent with cervical VPA. After termination of pregnancy, radical hysterectomy type III was performed. The patient underwent second, third and fourth laparotomies because of recurrent pelvic masses. At the end of five years follow-up period, she died because of the complication of recurrent tumor. VPA is not an innocent tumor, and can be complicated by recurrence and metastasis. More radical surgical and medical attempts should be planned.
A 45-year-old patient presented with complaints of vaginal bleeding and pelvic pain. Fractioned p... more A 45-year-old patient presented with complaints of vaginal bleeding and pelvic pain. Fractioned probe curettage was performed and reported as Stage IIa, grade 3, squamous cell carcinoma of the uterine cervix. The patient underwent radical hysterectomy type III, bilateral salpingo-oophorectomy, omentectomy, appendectomy, and pelvic para-aortic lymph node dissection according to our clinical protocol. Adjuvant radiation therapy was planned. A splenic mass of 8 cm in diameter was revealed on computed tomography at the end of the third year of the disease-free follow-up period. Fine needle aspiration biopsy was performed and reported as metastatic carcinoma correlated to the previous cervical cancer. Debulking surgery was performed. The patient died one year after the second surgical operation. Spleen metastasis in patients with squamous cell carcinoma of the uterine cervix is exceedingly rare. Nonetheless we recommend screening of all intra-abdominal organs including the spleen as a rare metastastic site in follow-up examination protocols.
The authors aimed to detect immediate risk of having high grade squamous lesions (HSIL) in atypic... more The authors aimed to detect immediate risk of having high grade squamous lesions (HSIL) in atypical squamous cells of uncertain significance(AS-CUS) and concomitant high-risk human papillomavirus (HrHPV) testing as negative [HrHPV(negative)AS-CUS]. The authors performed immediate/baseline colposcopy on concomitant HrHPV (negative)AS-CUS cases. Pap tests were evaluated with liquid-based cytology (LBC) and HrHPV detection was performed in LBC material with PCR. Colposcopic diagnoses and biopsy results were compared with Pap test and HrHPV test results. There were 104 patients over a one-year period. In all, 84 cases were included. Colposcopic biopsies revealed low grade squamous intraepithelial lesion (LSIL) in 19 cases (23%) and HSIL in three cases (4%). Intrauterine device use and smoking were significantly correlated with presence of HSIL (p = 0.005 and p = 0.007 respectively). Similar data in literature, 4% of ASC-US-HrHPV (negative) cases are expected to have HSIL in follow-up pe...
Turkish journal of obstetrics and gynecology, 2017
Anemia in the first trimester of pregnancy is the situation as described by the World Health Orga... more Anemia in the first trimester of pregnancy is the situation as described by the World Health Organization when the level of hemoglobin (Hb) is less than 11 g in 100 cc of blood. The prevalence of this problem is 18% in developed countries, whereas it is between 35-75% in developing countries. In this study, we aimed to determine the prevalence of anemia at the time of pregnancy detection. A retrospective cross-sectional study was designed to determine the prevalence of anemia. A total of 5228 first trimester pregnant women were admitted to the study between 2012 and 2014. Hb levels of 11 to 9.5 g/dL, 9.5 to 8 g/dL, and less than 8 g/dL were considered as mild, moderate, and severe anemia, respectively. We detected mild, modarate, and severe anemia at rates of 16.64%, 3.07%, and 0.28%, respectively, in our population. The overall prevalence of anemia at the time of detection of pregnancy was 20.0%. Anemia is a significant risk factor for maternal mortality in developing countries. Th...
Introduction: The use of robotics for benign etiology in gynecology has not proven to be more ben... more Introduction: The use of robotics for benign etiology in gynecology has not proven to be more beneficial when compared to traditional laparoscopy. The major concern regarding robotic hysterectomy stems from its high cost. Aim: To evaluate the clinical utility and effectiveness of one-arm reduced robotic-assisted laparoscopic hysterectomy as a cost-effective surgical option for total robotic hysterectomy. Material and methods: A sample population of 54 women who underwent robotic-assisted laparoscopic surgery for benign gynecologic indications was evaluated, and two groups were identified: (1) the two-armed robotic-assisted laparoscopic surgery group (n = 38 patients), and (2) the three-armed robotic-assisted laparoscopic surgery group (n = 16 patients). Results: An increased cost was observed when three-armed robotic surgery was employed for benign gynecologic surgery (p < 0.001). The cost reduction observed in the study group was primarily derived from one robotic arm reduction and vaginal closure of the cuff. This cost reduction was achieved without an increase in complication rates or undesirable postoperative outcomes. An estimated profit between $399.5 and $421.5 was made for each patient depending on the suture material chosen for cuff closure. Two-armed surgery resulted in an 18.6% reduction in procedure-specific costs for robotic hysterectomy. Conclusions: Two-armed robotic-assisted laparoscopic hysterectomy appears to be a cost-effective solution for robotic gynecologic surgery. This surgical solution can be performed as effectively as classical three-armed robotic hysterectomies for benign indications without the risk of increased surgical-related morbidities. This approach has the potential to be a widely preferred surgical approach in medical communities where cost reduction is one of the primary determinants of surgery type.
Acta Obstetricia Et Gynecologica Scandinavica, Feb 1, 2007
To investigate the effect of determination of human papillomavirus (HPV) subtype on the success o... more To investigate the effect of determination of human papillomavirus (HPV) subtype on the success of imiquimod therapy in women with vulvar condylomata acuminata. A total of 132 women with biopsy-proven vulvar condylomata acuminata were enrolled in this prospective study. HPV DNA detection and determination of genotype were made through polymerase chain reaction (PCR) technique. The women were treated with imiquimod cream 5% in the area of the visible lesions, three times a week at night for 16 weeks. Twelve of the 132 women (9.1%) failed to detect any improvement with this therapy during the 16-week period. However, 80 women (60.6%) experienced total clearance of the lesions, and 20 women (15.2%) observed a partial response. The complete response rates were 76.2% for HPV-6, 66.7% for HPV-11, 35% for HPV-6 plus 11, and 6.3% for unclassified HPV subtypes (other HPV subtypes than HPV 6 and -11). Topical imiquimod 5% cream is an appropriate treatment modality for HPV-6 or -11 positive vulvar warts.
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Papers by M. Yenen