Esra Keles

Endometrial Clear Cell Carcinoma with Non-Gestational Uterine Choriocarcinoma Differentiation

Choriocarcinoma is a rare and highly malignant tumor that primarily occurs in women of reproductive age. Choriocarcinoma can be classified as gestational or nongestational, based on its pathogenetic origin. Although primary nongestational choriocarcinoma has been described in the ovaries, it is very rare in the uterus, especially in postmenopausal women. It is crucial to differentiate between gestational and non-gestational choriocarcinoma, as it affects the choice of treatment and prognosis. Endometrial clear cell carcinoma is an aggressive subtype of endometrial cancer, accounting for less than 10% of all uterine carcinomas. Trophoblastic differentiation in uterine cancer is unusual and very rare, with only three examples of the subtype of clear cell endometrial cancer with gestational choriocarcinoma reported in the literature, including only one with nongestational choriocarcinoma. Here, we present an example of clear cell carcinoma with nongestational uterine choriocarcinoma differentiation in a postmenopausal woman.

The persistence of HPV type‐specific infections in patients following colposcopic examination: An observational study

AbstractAimHigh‐risk HPV infection is a necessary but not sufficient factor for the development of precancerous lesions and cervical cancer. Beyond mere HPV positivity, the persistence of infection over time plays a crucial role. This study aims to evaluate the clearance and persistence rates of HPV 16 and 18 genotypes.MethodsThe cervical cytology results were reported using the 2014 Bethesda System classification. The cervical cytology samples were analyzed using the Roche Cobas® 4800 HPV tests. Patients with any HPV genotype other than 16 or 18, those with missing data, those who were lost to follow‐up, those who underwent excisional procedures or hysterectomy, and those with high‐grade cervical dysplasia were excluded from this study.ResultsAmong 191 patients (mean age: 41.2 ± 0.6 years, 16.8% postmenopausal), the mean follow‐up was 21.6 ± 0.7 months. No significant differences were found between the clearance and persistence groups in age, follow‐up duration, cervical biopsy, or endocervical curettage results. However, HPV 16 had a higher persistence rate (28.2%), and abnormal cytology was more frequent in the persistence group (p = 0.038).ConclusionsAround 25% of patients had persistent HPV infection. Close monitoring is essential for those with CIN 1 on initial colposcopy, as they may have a higher risk of progressing to high‐grade dysplasia compared to those without dysplasia.

The meaning of high‐risk HPV other than type 16/18 in women with negative cytology: Is it really safe to wait for 1 year?

AbstractBackgroundHuman papillomavirus (HPV) is a primary risk factor for cervical cancer. HPV 16 and 18 are the two most carcinogenic genotypes and have been reported in the majority of cervical cancer. High‐risk HPVs (hrHPVs) other than HPV 16/18 cause approximately a quarter of cervical cancers. We aimed to present the colposcopy‐guided biopsy results of non‐16/18 hrHPV‐infected women with negative cytology.MethodsThis is a retrospective cohort study conducted on 752 patients between the ages of 30‐65 years with non‐16/18 hrHPV and negative cytology undergoing colposcopy‐guided biopsy at a tertiary gynecological cancer center between January‐2016 and January‐2019.ResultsThe mean age of the women was 42.35±9.41 years. Cervical intraepithelial neoplasia (CIN) 2+ lesion was detected in 49 (6.5%) women with negative cytology. The rate of CIN 2+ lesions in women with abnormal cytology was 12.8%. Patients with abnormal cytology had about 2.1 and 2.4 times increased the odds of CIN 2+ lesion in cervical biopsy and endocervical curettage specimens, respectively. CIN 3+ lesion was detected in 20 (2.7%) women with negative cytology. One (0.1%) of the patients with HPV 39 and negative cytology had invasive cervical cancer. The two most common HPV subtypes were HPV 31 and HPV 51.ConclusionsThe risk of cervical preinvasive lesions still can be detected and cannot be completely eliminated among hrHPV other than 16/18‐infected women with negative cytology. Based on the results of this study, referral of non‐16/18 hrHPV‐infected women with negative cytology to colposcopy is supported as a credible and feasible strategy.

Comparison of laparoscopy and vNOTES in early‐stage endometrial cancer

Abstract Aim To compare the demographic, clinical, surgical, histopathological, and oncological outcomes of vNOTES and conventional laparoscopy (CL)for early‐stage endometrial cancer. Methods A retrospective study was carried out in the Gynecologic Clinic of a tertiary hospital from January 2019 to November 2020. Patient demographic characteristics, surgical outcomes, histopathological characteristics, visual analog scale (VAS) pain scores at postoperative 6th, 12th, and 24th, intra‐ and postoperative complications, and follow‐up results were noted. Results A total of 45 patients enrolled, of which 16 underwent CL and 29 were vNOTES. The operative time and decrease in hemoglobin levels were similar for both groups ( p  = 0.202, p  = 0.699). Postoperative hospital stay did not differ between the vNOTES group and the CL group ( p  = 0.549). VAS pain scores at postoperative 6th, 12th, and 24th h were significantly lower in vNOTES group than in the CL group ( p  < 0.001). The requirement for additional opioid/narcotic analgesic was lower in the vNOTES group than in the CL group ( p  = 0.037). Conclusion vNOTES may be a safe and feasible option in early‐stage endometrial cancer, having less postoperative pain and less requirement of opioid/narcotic analgesic compared with laparoscopy.