Şener Gezer

The impact of mismatch repair (MMR), p53, and LCAM-1 immunohistochemical expression on prognosis in low-risk endometrial cancer

To investigate the relationship between mismatch repair (MMR) deficiency, TP53, and L1 cell adhesion molecule (L1CAM) immunohistochemical staining and their impact on progression-free survival (PFS) and overall survival (OS) in low-risk endometrial cancer. A total of 253 low-risk endometrial cancer patients were retrospectively screened. Immunohistochemical stains were applied to tumor tissue samples to assess MMR deficiency, TP53, and L1CAM expression, and survival analysis were performed. The expected PFS time was 78.6 months for the MMR-proficient group and 70.3 months for the MMR-deficient group (p = 0.011). OS was 71.6 months for the MMR-proficient group and 68.2 months for the MMR-deficient group (p = 0.755). L1CAM overexpression was associated with a poorer PFS, 62.7 months compared to 77.7 months (p = 0.039). However, there was no statistically significant difference in OS, 58.5 months versus 72.1 months, respectively (p = 0.242). p53 abnormal (p53-abn) staining was associated with a worse prognosis in terms of PFS, 62.8 months versus 77.7 months (p = 0.035), and OS, 43.4 months versus 73 months, respectively (p < 0.001), compared to patients with wild-type staining. No significant statistical relationship was observed in survival times concerning tumor diameter, grade, and lymphadenectomy status. In a multivariate analysis, MMR deficiency emerged as an independent poor prognostic factor for PFS, while p53-abn was identified as an independent poor prognostic factor for OS. p53-abn staining was associated with a poor prognosis for both PFS and OS in low-risk endometrial cancer patients. Meanwhile, MMR deficiency and L1CAM positivity were found to be associated solely with a poorer prognosis for PFS.

Application of thrombin gel matrix for the prevention of lymphocele in patients with endometrial cancer: A prospective randomized trial

To evaluate a thrombin gel matrix (TGM), Floseal, for the prevention of lymphocele in patients with endometrial cancer who underwent pelvic lymphadenectomy. A total of 79 consecutive patients with endometrial cancer were randomly allocated to one of two groups: the TGM group and control group. After completion of the lymphadenectomy, 5 mL of Floseal was applied to the bilateral pelvic sidewalls, especially the femoral canal, obturator, and common iliac vessels areas. Computed tomography scans were obtained for lymphocele evaluation 2 months after the surgery. Three patients from the TGM group, and four patients from the control group were lost during follow-up, and data from 36 participants from each group were analyzed. As the primary outcome, lymphocele developed in 12 patients in both groups (33 %). There was no significant difference between the groups in terms of lymphocele and symptomatic lymphocele development. Lymphocele localization was also not different between the two groups, but the diameter of the lymphoceles detected in the TGM group was significantly greater (p = 0.021). The mean drainage days was significantly shorter in the TGM group (p = 0.015). The amount of drainage was also less in the TGM group, but the difference was not statistically significant. Thrombin gel matrix applied to the pelvic sidewalls does not reduce the incidence of symptomatic or asymptomatic lymphoceles after pelvic lymphadenectomy in endometrial cancer. However, it can reduce the amount of drainage and the number of drainage days so it can help to shorten hospitalization.

Cervical versus endometrial injection for sentinel lymph node detection in endometrial cancer: a randomized clinical trial

To evaluate the relationship between pelvic/para-aortic sentinel lymph node status and two different injection sites of 99m-technetium ( This was a randomized controlled trial involving 81 patients with endometrial cancer. In the cervical group (n=40), injections of The rate of detection of at least one sentinel lymph node, sensitivity, and the negative predictive value was 80%, 66.6%, 96.6% for the cervical group and 85%, 66.6%, 96.9% for the endometrial group, respectively. False-negative sentinel lymph nodes were detected in one patient from each group . There was no significant difference between the groups in terms of total sentinel lymph node count, sentinel pelvic lymph node count, and pelvic bilaterality, but the para-aortic sentinel lymph node count was significantly higher in the endometrial group (p<0.001). Ultra-staging examination of the pelvic sentinel lymph nodes revealed isolated tumor cells in one patient from each group. Transcervical endometrial tracer injection in endometrial cancer revealed similar pelvic but significantly higher para-aortic sentinel lymph node detection.

Extremely high anti‐Mullerian hormone levels detected during infertility workup revealing sex cord tumor with annular tubules and underlying Peutz–Jeghers syndrome: A case report

AbstractWe report an infertile, but otherwise asymptomatic woman, whose extremely high anti‐Mullerian hormone (AMH) level detected during infertility investigation led to the diagnosis of sex cord tumor with annular tubules (SCTAT) which is a very rare sex cord‐stromal tumor (SCST) and eventually revealed a previously undiagnosed hereditary cancer syndrome, Peutz–Jeghers syndrome (PJS). A 33‐year‐old woman attended Kocaeli University ART Clinic for infertility evaluation. Her AMH level was 319.63 ng/ml. Detection of bilateral ovarian cysts required surgical evaluation. The histopathological examination of ovaries revealed SCTAT. The strong association of SCTAT with PJS raised the suspicion of this syndrome. Whole STK11 gene sequencing confirmed PJS diagnosis. AMH has become a widely used tool in the evaluation of infertile women. Clinicians dealing with infertility should be familiar with the utility of AMH measurement besides being a marker of ovarian reserve. Detection of high AMH concentrations should raise the suspicion of an SCST.