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    Advanced stage juvenile granulosa cell tumor of the ovary detected shortly after term pregnancy
    (Kare Publ, 2010) Aybatli, Aysun; Balkanli Kaplan, Petek
    Granulosa cell tumors (GCTs) constitute 70% of all sex-cord stromal tumors of the ovary and 1-2% of all ovarian cancers. A 19-year-old gravida 1, para 1 woman was admitted to our institution with abdominal distension. No ovarian mass had been detected during routine ultrasonographic examinations in our institution throughout her pregnancy, and one year had passed since her delivery by cesarean section. On admission, a painless ovarian mass was detected in the left ovary measuring 7x7x5 cm. Left salpingo-oophorectomy was performed during staging surgery. The case was stage-IIIB according to the FIGO staging system. Pathological examination revealed the diagnosis of juvenile GCT. We report this rare case with the aim of pointing out the possibility of unexpected aggressive behavior of juvenile GCT of the ovary over an approximately one-year period.
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    Assessment of CA-125 area under the curve as a prognostic factor in patients with ovarian cancer
    (Humana Press Inc, 2013) Uzunoglu, Sernaz; Aybatli, Aysun; Kaplan, Petek Balkanli; Cicin, Irfan; Sut, Necdet; Sayin, Cenk; Varol, Fusun
    The goal of this study was to evaluate the efficacy of CA-125 area under the curve (CA-125 AUC) as a prognostic factor following surgical treatment for ovarian cancer patients. A retrospective analysis was conducted on ninety-five patients with ovarian cancer who had primary treatment in a tertiary center between 2000 and 2010. After either optimal or cytoreductive surgery, all patients underwent adjuvant chemotherapy. CA-125 AUC was calculated for each patient that had a minimum of three CA-125 serum measurements during the treatment period. The mean age at diagnosis and mean survival were 53.9 years (range, 16-75 years) and 35.6 +/- 22.9 months (range, 3.1-95.4 months), respectively. The mean (and median) CA-125 AUC of patients of FIGO stages I, II, III, and IV was 53.0 (42.5), 58.06 (58.06), 97.8 (54.6), and 405.2 (149.3) IU/ml day, respectively (p = 0.004). The mean CA-125 AUC was 57.7, 410.1, and 636.3 IU/ml day for patients with a complete response, partial response, and no response/progressive disease to first-line chemotherapy, respectively (p < 0.001). The CA-125 AUC cut-off level for an overall survival of >= 5 years was 99.75 IU/ml day with a sensitivity of 90.9 % (95 % CI, 70.8-98.6) with 1.27 as positive likelihood ratio. Patients who suffer from ovarian cancer, with a lower CA125 AUC, have a better overall survival than those with a higher CA125 AUC. CA-125 AUC could be used as an independent factor for evaluating the treatment efficacy and chemotherapy response.
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    Delayed-interval delivery of an in vitro-fertilized triplet pregnancy with premature rupture of membranes in the second trimester
    (Springer Heidelberg, 2010) Yuce, Mehmet Ali; Aybatli, Aysun; Kaplan, Petek Balkanli
    The incidence of multiple pregnancies is increasing with the availability of assisted reproductive techniques. Preterm labor and preterm rupture of membranes are major complications in such pregnancies. Preterm delivery of the first fetus is often followed by delivery of the remaining fetuses. However, conservative management in such circumstances might allow for fetal lung maturity in the remaining fetuses. We present a case of conservative management of an in vitro-fertilized triplet pregnancy with early loss of the leading triplet. A 33-year-old woman in the 21st week of a triplet pregnancy delivered her one of the fetuses, 4 days after the preterm rupture of membranes. To save the surviving fetuses, ligation of the umbilical cord at the cervical level was performed. Patient received antibiotics, tocolytics and corticosteroids after then. The second and the third fetuses were successfully delivered by cesarean section in the 28th week of pregnancy, 43 days after the first fetus was born. We can improve the life expectancy of the retained fetuses by conservative management using tocolytics, antenatal steroids to stimulate lung maturation and antibiotics following the delivery of the first fetus.
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    Huge solitary primary pelvic hydatid cyst presenting as an ovarian malignancy: case report
    (Galenos Yayincilik, 2009) Aybatli, Aysun; Kaplan, Petek Balkanli; Yuce, Mehmet Ali; Yalcin, Omer
    Hydatid disease is a zoonotic parasitic infection caused by Echinococcus granulosus. Echinococcus cysts are found mostly in the liver (60%) and lung (15%), but they can be located in any part of the body. However pelvic echinococcosis as the primary site is rarely seen. We report the case of a large echinococcal cyst localized in the lower pelvis. A 76-year-old woman was admitted to an emergency department with urinary retention for ten days. Ultrasonography and other imaging modalities revealed a mass with solid and cystic components in pelvic localization. This unusual presentation in an elderly postmenopausal woman was initially considered as an ovarian malignancy until surgical exploration and microscopic studies confirmed the diagnosis of echinococcosis. Antihelminthics were administered postoperatively and the patient is now being closely followed up. Gynecologists should be aware of the possibility of a primary hydatid cyst of the pelvic cavity and should be considered in the differential diagnosis of cystic pelvic masses, especially in areas where the disease is endemic.
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    The investigation of tumoral angiogenesis with HIF-1 alpha and microvessel density in women with endometrium cancer
    (Galenos Yayincilik, 2012) Aybatli, Aysun; Sayin, Cenk; Kaplan, Petek Balkanli; Varol, Fusun; Altaner, Semsi; Sut, Necdet
    Objective: Hypoxia inducible factor 1 alpha (HIF-1 alpha) is a nuclear protein upregulated in response to reduced cellular oxygen concentration which therefore acts as a marker for hypoxia. The aim of this study was to determine tumoral angiogenesis with immunohistochemical markers in endometrium cancer and its relation with stage, grade, survival rates and other prognostic factors. Material and Methods: Using the database in our Gynecologic Oncology clinic, we selected 94 patients who were diagnosed with endometrial cancer and underwent primary surgery at our institution between 2001 and 2010. Tissue microarrays believed to demonstrate the optimum part of the tumor were reprepared from the paraffin blocks. Angiogenesis and microvessel density (MVD) were investigated with the aid of HIF-1 alpha and CD34 antibodies. Results: High expression of HIF-1 alpha was significantly more frequent in advanced grade endometrial cancers (p=0.044). HIF-1 alpha expression was highly correlated with CD34 expression in the tumor cells (p<0.001). However lack of relation among stage, overall survival rates and histological types were analyzed with HIF-1 alpha. When we compared HIF-1 alpha positive and negative cases with cervical, adnexial, lymphovascular and myometrial invasion, there was no difference between these groups. MVD was evaluated with CD34 and it was remarkable and significantly different on advanced grade tumors (r=0.268; p=0.009). A similar significant difference was observed between the high expression of CD34 and type II endometrial cancer histology (p<0.001). However, there was no relationship between the MVD and stage or survival rates. Conclusion: High expression of HIF-1 alpha is associated with tumoral angiogenesis in endometrial adenocarcinomas. Further studies targeting HIF-1 alpha for disrupting mechanisms essential for tumor growth in endometrium cancer will be significant investigations in the future.
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    Neuromuscular Morphometry of the Vaginal Wall in Women With Anterior Vaginal Wall Prolapse
    (Wiley-Blackwell, 2010) Inal, Masan Ali; Kaplan, Petek Balkanli; Usta, Ufuk; Tastekin, Ebru; Aybatli, Aysun; Tokuc, Burcu
    Introduction and Hypothesis: The aim of this study was to compare the changes in hystomorphometry and innervation of the anterior vaginal wall in women with and without anterior vaginal wall prolapse. Methods: Eighty-nine biopsy specimens were obtained from the anterior vaginal wall of women having a cystocele repaired (stage >= II; prolapse group, 49) and the same location in patients with no prolapse (stage
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    Single Dose Methotrexate in Treatment of Ectopic Pregnancy: Review of 32 Case
    (Galenos Publ House, 2011) Aybatli, Aysun; Kaplan, Petek Balkanli; Alicik, Mehmet; Sayin, Niyazi Cenk; Yuce, Mehmet Ali
    Objective: To evaluate the efficacy of single dose intramuscular methotrexate in the treatment of ectopic pregnancy. Material and Methods: 32 patients who matched the inclusion criteria were enrolled. Success of treatment was defined as a resolution of ectopic pregnancy without performing surgical intervention. The cases in whom the treatment was successful and those that were not were compared for beta-hCG values and clinical features. Results: beta-hCG at diagnosis averaged 1293.9 mlU/ml. Of the 32 patients who received methotrexate, 26 were successfully treated. 23 patients (71.8%) received a single dose of methotrexate, 3 patients (9.3%) received an additional dose of methotrexate, 6 patients (18.7%) who had failed methotrexate required surgery for cure. The success rate of single-dose methotrexate was 79.3%. Conclusion: Our study shows that single dose systemic methotrexate treatment can be used as an option in unruptured pregnancies.