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Öğe Clinicopathological and immunohistochemical analysis of sclerosing stromal tumours of the ovary(Springer Heidelberg, 2010) Zekioglu, Osman; Ozdemir, N.; Terek, C.; Ozsaran, A.; Dikmen, Y.Sclerosing stromal tumours (SST) of the ovary are rare, benign tumours. SSTs are usually hormone inactive and tend to occur in the second and third decades of life. The most common clinical symptom is menstrual irregularity. Fourteen women diagnosed with SST of the ovary were included in this study. Tumour samples were collected, embedded in paraffin and stained with haematoxylin and eosin, periodic acid-Schiff (PAS), and PAS with digestion, as well as immunohistochemically for vimentin, smooth muscle actin, desmin, CD 99, inhibin-alpha and the oestrogen and progesterone receptor. The age of the patients ranged from 16 to 54 years (mean age 25.2 years). The tumours ranged in size from 6 to 21 cm (mean 10.5 cm). Macroscopically, eight tumours were solid and six were solid and cystic. All SSTs were well circumscribed with pseudolobule formation. Spindle-shaped fibroblast-like cells and vacuolated theca-like cells were prominent. Blood vessels exhibited a hemangiopericytomatous pattern and boomerang-like features. Immunohistochemical results were as follows: vimentin, 14/14 cases positive; smooth muscle actin, 14/14 cases positive; desmin, 14/14 cases positive; CD 99, 4/14 cases positive; inhibin-alpha, 14/14 cases positive; oestrogen receptor, 0/14 cases positive; progesterone receptor, 2/14 cases positive. The characteristic histopathological features we observed in our study are usually adequate for the diagnosis of SSTs. Although inhibin-alpha, CD 99 and desmin staining may be a useful and reliable tool for SST diagnosis in problematic cases, an immunohistochemical panel will not discriminate from other tumours in the sex cord-stromal group.Öğe Evaluation of treatment results and prognostic factors in early-stage cervical carcinoma patients treated with postoperative radiotherapy or radiochemotherapy(I R O G Canada, Inc, 2012) Demirci, S.; Ozsaran, Z.; Ozsaran, A.; Yavas, F.; Demircioglu, B.; Hanhan, M.; Dikmen, Y.; Aras, A. B.Purpose: To investigate the clinical features, prognostic factors, and treatment outcome in early-stage cervical carcinoma patients treated with postoperative radiotherapy (RT)/radiochemotherapy (RCT). Methods: The records of 256 Stage IB and 11 cervical cancer patients treated with postoperative RT/RCT from 1992-2007 were retrospectively reviewed. Median age of the patients was 47 (range: 25-78). Two hundred one (78.6%) patients had squamous cell carcinoma and 29(11.3%) had adenocarcinoma. One hundred and eighty-seven (73.0%) had FIGO Stage IB and 69 (27%) had Stage II disease. Concomitant cisplatin-based chemotherapy was administered to 47 (18.4%) patients. Metastatic lymph node ratio (MLNR), defined as number of metastatic lymph nodes divided by the number of dissected lymph nodes, was 0 in 142 (55.5%) patients, from 1% to 10% in 27 (10.5%) and > 10% in 31(12.1%) patients. Results: Median follow-up duration was 60.5 months (range: 6-202 months). Five-year locoregional control (LRC), disease-free survival (DFS), disease specific survival (DSS) and overall survival (OS) rates were 90.8%, 83.4%, 91.2%, and 85%, respectively. In multivariate analysis; bulky tumor (> 4 cm) was shown as an important prognostic factor for LRC, DFS and DSS. Pretreatment hemoglobin level (< 10 g/dl) was associated with lower OS rate. Endometrial involvement was associated with lower LRC and DFS. Treatment break > 14 days showed significance for DFS and DSS. MLNR was found as a valuable prognostic factor for all endpoints (LRC, DFS, DSS and OS). The rate of grade 3-4 late toxicity was 3.6% and 2%, respectively. Conclusion: Postoperative RT/RCT is an effective treatment modality for early-stage cervical cancer patients with unfavorable features and provides satisfactory local control and survival rates with low morbidity.Öğe MMAC tumor supressor gene expression in ovarian endometriosis and ovarian adenocarcinoma(I R O G Canada, Inc, 2007) Cirpan, T.; Aygul, S.; Terek, M. C.; Kazandi, M.; Dikmen, Y.; Zekioglu, O.; Sagol, S.Objective: The aim of this study was to investigate the role of MMAC1 protein in the relationship between ovarian endometriosis and clear cell and endometrioid-type ovarian adenocarcinomas. Methods: A total of 63 subjects who underwent surgery for a pelvic tumoral mass, 30 of whom were diagnosed with grade 1 to 3 ovarian adenocarcinoma and 33 of whom were diagnosed with grade 1 to 4 endometriosis during histopathological examination were included in this study. The mean age for subjects with ovarian endometrioid type adenocarcinoma was 51.8 +/- 12.4, whereas the mean age for subjects with ovarian clear cell type adenocarcinoma was 59.5 +/- 13.7. Ovarian carcinomas were graded in accordance with the FIGO 1989 grading system. The mean age for subjects with endometriosis was 37 +/- 11.9. New sections were obtained from paraffin blocks in the archives of Ege University, School of Medicine, Department of Pathology onto lysinated slides and immunohistochemical staining by using mouse monoclonal antibody (MMAC1, 28H6 clone, Novocastra, UK) as MMAC antibody was applied in order to determine MMAC1 protein. Brown staining on the nucleus was considered as positive immunoreactivity. Immunoreactive staining was evaluated as percentage staining over the whole preparative. Results: Of the 63 subjects included in the immunohistochemical study, ovarian endometrioid adenocarcinoma was identified in 18 subjects, while 12 subjects were diagnosed with ovarian clear cell adenocarcinoma and 33 subjects with ovarian endometriosis. No significant relationships were observed between age and MMAC immune staining in the ovarian endometrioid adenocarcinoma (r = -0.41, p = 0.08) and ovarian endometriosis (r = 0.12, p = 0.50) groups, whereas a significant relationship was observed in the ovarian clear cell adenocarcinoma group (r = 0.631, p = 0.02). No significant relationships were observed between CA125 levels and MMAC immune staining in the ovarian endometrioide adenocarcinoma (r = 0.056, p = 0.82), ovarian endometriosis (r = 0.21, p = 0.36) and ovarian clear cell adenocarcinoma (r=0.363, p=0.24) groups. No correlations were observed between endometriosis stages and the MMAC immune staining (r = -0. 17, p = 0.92). There was no correlation between mean diameter of endometrioma and MMAC immune staining (r = -0.230, p = 198). Mean endometrioma diameter was 5.7 +/- 3.5 (1-15.5). No correlations were detected between MMAC immune staining and ovarian endometrioide adenocarcinoma or ovarian clear cell adenocarcinoma stage (r = -0.22, p = 0.37; r = 0.44, p = 0.14, respectively). No significant relationships with respect to MMAC immune staining were detected between the endometriosis and ovarian clear cell adenocarcinoma groups (p = 0.05) and between the ovarian clear cell adenocarcinoma and ovarian endometrioid adenocarcinoma groups (p = 0.27). A significant relationship with respect to MMAC immune staining was observed between ovarian endometrioide adenocarcinoma and endometriosis groups (p = 0.001). Conclusion: Immunohistochemical determination of MMAC defective protein expressions could be considered for utilization as a new, simple and useful technique in determination of endometriosis patients with increased risk of malignant transformation, patients where early surgical treatment would be necessary and patients that should be subjected to follow-up controls with a higher frequency.Öğe Postoperative radiotherapy in intermediate and high-risk Stage I endometrial cancer: analysis of prognostic factors and survival(I R O G Canada, Inc, 2008) Bolukbasi, Y.; Demirci, S.; Ozsaran, Z.; Yalman, D.; Hanhan, M.; Ozsaran, A.; Dikmen, Y.; Aras, A.Purpose: Patients with Stage IA Grade (G) III, Stage IB GII-III and Stage IC GI-II-III endometrial cancer who received postoperative adjuvant radiotherapy were evaluated in terms of local control, disease-free and overall survival rates and prognostic factors. Materials and Methods: Four hundred and three patients with Stage I endometrial cancer treated with radiotherapy from January 1990 to December 2003 at Ege University Faculty of Medicine Department of Radiation Oncology were reviewed retrospectively. According to our radiotherapy protocol patients with Stage IB G2 disease (149 patients) received only external radiotherapy and the remaining (254 patients) received both external radiotherapy and intracavitary brachytherapy. Results: Median age of the patients was 58 (range: 37-83). Nine patients (2.2%) had Stage IA, 196 (48.6%) had Stage IB and 198 (49.1%) had Stage IC disease. Histologic grade was 1 in 52 (12.9%) patients, 2 in 268 (66.5%) patients and 3 in 83 (20.6%) patients. Seventy-one (17.7%) patients had lymphovascular space invasion. Five-year locoregional relapse-free, distant-free, disease-free survival (DFS) and overall survival (OS) were 98.2%, 92.8%, 91.8% and 87.7%, respectively. In multivariate analysis, myometrial invasion and lymphovascular invasion were predictive factors for DFS and for OS prognostic factors were histologic type, myometrial invasion, and histologic grade. During radiotherapy 47.9% of the patients developed acute morbidity and 26.3% developed late morbidity, vaginal stenosis being the most frequent late morbidity. Conclusion: Postoperative adjuvant radiotherapy provides high locoregional control rates with acceptable toxicity in selected patients with Stage I endometrial carcinoma.Öğe PROGNOSTIC PREDICTORS AND SPREAD PATTERNS IN ADULT OVARIAN GRANULOSA CELL TUMORS: MULTICENTER LONG TERM FOLLOW-UP STUDY OF 108 PATIENTS(Lippincott Williams & Wilkins, 2013) Ertas, I. E.; Taskin, S.; Akman, L.; Gungorduk, K.; Goklu, R.; Terek, C.; Ozsaran, A.; Yildirim, Y.; Dikmen, Y.; Ortac, F.Öğe Reproductive outcomes after progestin therapy in infertile women with endometrial atypical hyperplasia(Oxford Univ Press, 2012) Akman, L.; Akdogan, A.; Sahin, G.; Terek, C.; Ozsaran, A.; Dikmen, Y.; Goker, E. N. T.; Tavmergen, E.Öğe THE ROLE OF PREOPERATIVE SERUM VASCULAR ENDOTHELIAL GROWTH FACTOR AND MIGRATION INHIBITOR FACTOR IN THE DIFFERENTIATION OF BENIGN AND MALIGNANT ADNEXIAL MASSES(Lippincott Williams & Wilkins, 2013) Yildirim, N.; Dikmen, Y.; Terek, M. C.; Akman, L.; Yildirim, A. G. Sahingoz; Selvi, N.; Aktan, C.; Gunduz, C.
