Journal of the College of Physicians and Surgeons Pakistan

Clinical Significance of Methyltransferase-like 16 Expression in Epithelial Ovarian Cancer

To detect methyltransferase-like (METTL) 16 expression in epithelial ovarian cancer (EOC) by immunohistochemistry (IHC), and its relationship with clinicohistopathological parameters and prognosis. Observational study. Department of Gynaecology and Pathology, The First Hospital of Wannan Medical College (Yijishan Hospital of Wannan Medical College), from February to June 2022. METTL16 expression in 115 EOC patients was evaluated by IHC. According to the immunoreactive score (IRS), scores <6 represented low expressions and ≥6 high expressions. Clinicopathologic data and follow-up information were collected for statistical evaluation. METTL16 expression decreased in EOC (p = 0.001) and affected the poor prognosis of EOC patients. Low METTL16 patients expression had significantly higher frequencies of advanced FIGO stage, low grade, more lymph node metastasis, high CA125 levels, bilateral disease, distant metastasis, and high frequency of neural/vascular invasion compared to high METTL16 patients (p ≤0.001, <0.001, <0.001, 0.017, 0.027, <0.001, and 0.010, respectively). The survival analysis showed that the overall survival (p <0.0001) as well as the disease-free survival (p <0.0001) were remarkably shorter in low METTL16 patients compared to high METTL16 patients, suggesting worse survival. There was a clear association between the expression of METTL16, poor prognostic factors, and lower survival of EOC patients, suggesting that it might exert a vital effect on the malignant progression / prognosis of EOC. Epithelial ovarian cancer (EOC), METTL16, Immunohistochemistry, Prognosis.

Diagnostic Importance of PAX2, ARID1A, and FOXA1 Biomarkers in Atypical Endometrial Hyperplasia

To evaluate the contribution of PAX2, ARID1A, and FOXA1 biomarkers to diagnosis in cases with atypical endometrial hyperplasia (AEH). Descriptive Study. Place and Duration of the Study: Pathology Department of Umraniye Training and Research Hospital, from January 2018 to December 2020. Curettage materials of 100 patients diagnosed with AEH which stained PAX2, ARID1A, and FOXA1, were evaluated. The staining patterns in the atypical endometrial glandular areas were grouped as slight-no loss, moderate loss, and complete loss / severe loss for all three biomarkers. Complete or/severe loss in AEH was considered helpful in the diagnosis. Complete loss / severe loss rates in curettages were 84% for PAX2, 5% for ARID1A, and 15% for FOXA1, respectively. When used in combination, complete loss / severe loss rates were 85% in at least one of the three markers, 84% in PAX2 and/or ARID1A, 85% in PAX2 and/or FOXA1, and 17% in ARID1A and/or FOXA1. Although all 3 biomarkers showed marked staining loss, PAX2 is the most sensitive biomarker for the diagnosis of AEH in curettage materials. Endometrium, Atypical hyperplasia, PAX2, ARID1A, FOXA1.

Accuracy of Diffusion Weighted Imaging in Assessment of Pelvic Lymphnode Metastasis in Patients with Endometrial Cancer

To evaluate the sensitivity and specificity of diffusion-weighted imaging in determining metastatic pelvic lymph nodes in patients of endometrial cancer and comparing its accuracy with contrast-enhanced sequence of MRI, taking histopathology as gold standard. Retrospective Study. Place and Duration of the Study: Department of Radiology, the Aga Khan University Hospital Karachi, from January to December 2021. Fifty-eight adult females with biopsy proven endometrial carcinoma and complete medical records were included through convenience sampling. Patients who did not have complete medical records were excluded. Studied variables included signal characteristics of lymph nodes and their short axis diameter. The sensitivity and specificity of DWI and contrast-enhanced MRI for evaluation of diseased lymph nodes were calculated using histopathology as the gold standard. Among 58 patients with histopathologically proven endometrial cancer, 14 had metastatic lymphadenopathy. DWI-weighted imaging in the evaluation of metastatic and non-metastatic lymph nodes had sensitivity of 81.1% while specificity, the positive and negative predictive value of 88.8%, 72.2%, and 82.5% and on contrast-enhanced imaging as 66.6%, 58.1%, 35.7%, and 83.3%, respectively. The DWI shows better accuracy in evaluation and discrimination between metastatic and non-metastatic lymph nodes as compared to contrast-enhanced MRI examination for the evaluation of diseased lymph nodes in patients with endometrial cancer. DWI, Contrast-enhanced MRI, Lymph node, Endometrial cancer.

Serum Wnt10B/beta;-Catenin in Early Diagnosis, Lymph Node Metastasis, and Prognosis in Cervical Cancer

To assess the serum levels of Wnt10B and β-catenin for early diagnosis of the cervical cancer and their association with distant lymph node metastasis and prognosis. Observational study. Place and Duration of the Study: Department of Gynaecology, Hunan Provincial People's Hospital, The First Hospital Affiliated with Hunan Normal University, Changsha, Hunan, China, from September 2019 to 2023. The cervical cancer group included 156 patients, while the control group comprised 96 healthy women. Serum samples were collected to compare the levels of β-catenin and Wnt10B. Univariate and multivariate analyses were used to explore the relationship between these biomarkers and clinical characteristics. The receiver Operating Characteristic (ROC) curve analysis was conducted to evaluate their diagnostic value. The cervical cancer group exhibited significantly higher serum levels of β-catenin and Wnt10B compared to the control group (p <0.001). Univariate analysis revealed markedly elevated levels of Wnt10B and β-catenin (p <0.001) in patients with poor prognosis, lymph node metastasis, and advanced stages (III-IV). Multivariate analysis identified prognosis (p = 0.02) and lymph node metastasis (p <0.001) as independent risk factors for elevated Wnt10B and prognosis (p = 0.006) as a risk factor for increased β-catenin. According to ROC curve analysis, serum levels of Wnt10B (AUC = 0.77, p = 0.0003), β-catenin (AUC = 0.73, p = 0.0021), and the combined diagnostic approach (AUC = 0.79, p = 0.0001) could be used to predict the risk of postoperative recurrence. Serum levels of Wnt10B and β-catenin are valuable biomarkers for early cervical cancer diagnosis, lymph node metastasis, and prognosis of cervical cancer. Cervical cancer, Wnt10B, β-catenin, Early diagnosis, Prognostic biomarkers, Prognosis.

Impact of Muscle Mass Depletion on Surgical Outcomes in Patients with Primary High-grade Serous Ovarian Cancer Undergoing CRS and HIPEC

To investigate the effect of sarcopenia on surgical outcomes in patients with primary high-grade serous ovarian cancer undergoing cytoreductive surgery and hyperthermic intraperitoneal chemotherapy (CRS and HIPEC). Descriptive study. Department of Surgical Oncology, Faculty of Medicine, Ankara University Ankara, Turkey,  from January 2013 to January 2020. Forty patients, who underwent CRS and HIPEC with the diagnosis of primary high-grade serous ovarian cancer and peritoneal carcinomatosis were included in the study. Preoperative staging CT images were used to determine total psoas ındex values by measuring psoas muscle area at the level of L3 vertebra. Patients with total psoas ındex values below the cut-off levels were considered sarcopenic. Demographic, clinicopathological and perioperative results were compared between sarcopenic and non-sarcopenic patients. Serious postoperative complications (36.4% vs. 6.9%, p=0.039)  and infective (54.5% vs. 17.2%, p=0.042) and pulmonary (72.7% vs. 34.5%, p=0.040 complications were significantly higher in sarcopenic patients. Hospital stay [20(12-25) vs. 12(9-16.5) days, p=0.017] and ICU stay [4(2-6) vs. 2(1-2.5) days, p=0.013)] were found to be longer in sarcopenic patients. In univariate analysis, advanced age (OR: 1.40 95% CI: 1.07-1.84; p=0.021) and sarcopenia (OR: 7.71% 95 CI: 1.17-51.06; p=0.039) were significantly associated with serious postoperative complications. The presence of sarcopenia (OR: 0.050 95% CI: 0.004-0.675; p=0.024) was found to be independent predictor of serious postoperative complications. Sarcopenia can easily be diagnosed without additional cost or radiation exposure with routine preoperative staging CT images. Identification of sarcopenic ovarian cancer patients in preoperative period may affect patient selection, predictability of possible serious complications, elective operation preparation process with a combination of nutrition and exercise therapy, thus postoperative complication rates may be reduced and short-term results may be improved. Key Words: Cytoreductive surgery, Ovarian cancer, Sarcopenia.

Sclerosing Stromal Tumor and Fibroma Occuring Simultaneously in Both-sided Ovaries:&lt;br /&gt; A Rare Occurrence

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Acute Toxicity and Local Response using Three Fractions of High Dose Rate (HDR) Brachytherapy for Curative Treatment of Carcinoma Cervix

To determine the acute vaginal mucosal toxicity and clinical response of cervical cancer after definitive treatment with external beam radiotherapy (EBRT) and three fractions each of 8 Fray (Gy) high dose rate intracavitary brachytherapy (HDR-BT). Descriptive study. Radiation Oncology Section, Department of Oncology, The Aga Khan University Hospital, Karachi, Pakistan from January 2008 till December 2015. Protocol was formulated for carcinoma cervix to complete treatment in 7 weeks. Patients were treated with chemotherapy and pelvic EBRT to a total dose of 45 Gy/25 fractions, followed by three intracavitary HDR brachytherapy fractions of 8 Gy each. Vaginal toxicity and local clinical response was assessed at the end of treatment, at 4 and 8 weeks. A total of 57 patients were treated with HDR brachytherapy and 49 patients were evaluated for assessment of toxicity and response. According to FIGO staging system, two had stage IB2, one had IIA, thirty-six had IIB, seven had IIIB, one had IVA disease and two had IVB with para aortic nodes. Concurrent gemcitabine and cisplatin were given to 26 (46%); whereas, 28 (49%) received concurrent cisplatin alone. Grade III acute vaginal mucosal toxicity was seen in 52 and Grade IV acute vaginal mucosal toxicity was observed in 08 patients. At completion of treatment, 40 patients had complete clinical response, at 4 weeks follow-up, complete regression of disease was found in 3 more and at 8 weeks none had clinical residual disease. This regimen of HDR brachytherapy treatments is feasible, efficacious, and well-tolerated for carcinoma cervix in a setup with cost constraints. Long term toxicity and disease control remains to be reported with longer follow-up. Key Words: Carcinoma cervix, High dose rate brachytherapy, Acute toxicity, Local response, External beam radiation therapy, Intracavitary brachytherapy.

Acute Side Effects with High Dose Rate Computed Tomography-guided Three-dimensional Brachytherapy in Carcinoma Cervix

To determine the frequency and grades of acute side effects with three-dimensional brachytherapy in carcinoma cervix using RTOG/EORTC acute radiation morbidity scoring criteria. Descriptive study. Department of Radiotherapy, Institute of Nuclear Medicine and Oncology (INMOL), Lahore, Pakistan from July 2016 to September 2017. A total of 55 histologically proven patients of squamous cell carcinoma of the cervix, aged between 16-70 years, were included. Patients with previous radiotherapy in pelvic area, inflammatory bowel diseases and known diabetics, were excluded. All patients were given a radiation dose of 7 Gray in 4 insertions through 3-dimensional conformal brachytherapy planning. Acute vaginal, gastrointestinal, and genitor-urinary side effects of brachytherapy were assessed. Mean age of the patient population was 47.09 ±13.10 years (Range: 21-68). Mean time to presentation was 5.65 ±2.32 months and mean tumor size was 3.67 ±1.47 cm. Majority, i.e. 18 (32.7%) patient presented in stage III. Most of the patients, 26 (47.3%), had ECOG-2 performance status. Grade-1 genitourinary toxicity was significantly high (p <0.001). In lower gastrointestinal toxicity, Grade-1 was the highest being 54.5%. Conversely, vaginal toxicities of grade-2 and 3 were most commonly seen. Stratification of acute side effectswith respect toage, stage and tumor size revealed no significant association except in mucosal membrane toxicity, which was affected by tumor size (p = 0.004). Three-dimensional brachytherapy in carcinoma cervix is a safe and tolerable procedure with minimal acute side effects. Key Words: Cervical cancer, Brachytherapy, Acute toxicities, Computed tomography.

Cervical HSIL Involving the Endometrium and Adenomyosis: A Case Report and Literature Review

Cervical squamous cell carcinoma (SCC) spreading superficially to the inner surface of the uterus and replacing the endometrial lining cells with carcinoma cells is called superficial spreading SCC. We, hereby report a 53-year postmenopausal woman who had a history of cervical SCC in situ/high grade squamous intraepithelial lesion (HSIL). Ultrasonography revealed an enlarged uterus measuring 9.0×6.5×5.0 cm with dilatation of the uterine cavity and the cervical canal. Subsequently, she underwent total abdominal hysterectomy (TAH) and bilateral salpingo-ophorectomy with a diagnosis of cervical HSIL involving the endometrium and adenomyosis. This a very rare phenomenon, as the endometrial involvement may be caused by direct extension of the cervical lesion, and occur mainly in postmenopausal women, and should be deligently searched during pathological examination. Key Words: HSIL, Cervix, Endometrium, Adenomyosis.

Distribution of High-risk Human Papillomavirus Genotypes in Cervical Secretions in Punjab

To determine the high risk-human papillomavirus (HR-HPV) prevalence, genotype distribution, and associated risk factors in women with general gynaecological problems. Descriptive, cross-sectional study. Lady Wallingdon Hospital, Lahore from August 2018 to May 2019. One hundred females with general gynaecological problems constituted the sample. Real-time polymerase chain reaction and liquid base cytology were performed for HR-HPV detection, genotyping, and cytological changes in cervical samples. The overall prevalence of HR-HPV was found to be 57%, with the most frequent HR-HPV genotypes HPV 16 (18%), HPV 18 (6%), and HPV 45 (1%). The total prevalence of single HR-HPV infection was 25%; whereas, multiple co-infection of HR-HPV was seen in 32% of cases. In total, 81% of these women had normal cytology and 19% had cytologic abnormalities. A significant association was observed between HR-HPV infection and general gynaecological complaints and between HR-HPV infection and cytological abnormalities (p < 0.001). The HR-HPV prevalence was 57% with the most prevalent genotypes were HPV 16 and HPV 18. The results will also aid the identification of HR-HPV 51 and 31 genotypes, which should be added in the multi-type HPV vaccines. Key Words: Cancer of cervix, Human papillomavirus, Papanicolaou test, Pakistan.

Time for Reintroducing HPV Vaccine in Pakistan for Primary Prevention of Cervical Cancer

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Factors Associated with Survival Outcomes in Ovarian Cancer Patients in Karachi, Pakistan: Results from a Single-Institution Cancer Registry

To evaluate survival outcomes and identify sociodemographic and clinicopathological factors associated with survival among women diagnosed with ovarian cancer (OC) in Karachi, Pakistan. Retrospective cohort study. Place and Duration of the Study: The Aga Khan University Hospital, Karachi, Pakistan, between 2010 and 2020. A total of 966 women aged 18-91 years with OC were identified from the University Hospital cancer registry. Data on vital status and last contact dates were updated. Sociodemographic characteristics, tumour features, stage, CA125 levels, and treatment modalities were analysed. Survival was assessed as the primary endpoint using Kaplan-Meier survival analysis and Cox proportional hazards models, with hazard ratios (HR) and 95% confidence intervals (CI) reported. Patients who did not undergo cytoreductive surgery exhibited the highest mortality risk (HR: 3.94; CI: 2.69-5.76), followed by those who underwent suboptimal cytoreduction surgery (HR: 2.01; CI: 1.29-3.13) compared to those who underwent optimal cytoreduction surgery. Chemotherapy significantly reduced mortality risk (HR: 0.56; CI: 0.39-0.82). Recurrence was a critical determinant of poor survival, with the highest risk observed in patients who were never disease-free (HR: 10.81; CI: 6.12-19.07) or experienced recurrence (HR: 7.44; CI: 4.31-12.86). Optimal cytoreduction surgery and chemotherapy are essential in improving survival outcomes for OC patients. Recurrence remains a significant determinant of poor prognosis. Enhancing early detection, optimising treatment strategies, and strengthening healthcare infrastructure are critical for improving survival outcomes among OC patients in Karachi. Ovarian cancer, Survival outcomes, Cytoreductive surgery, Chemotherapy, Recurrence.

Impact of Types of Cytoreductive Surgery on Survival and Morbidity in Recurrent Epithelial Ovarian Cancer

Postoperative CA-125 as a Prognostic Marker for Overall Survival in Ovarian Cancer

To investigate the association between postoperative CA-125 levels and overall survival (OS) in patients with ovarian cancer, assessing its potential role as a prognostic biomarker. Observational study. Place and Duration of the Study: Department of Medical Oncology, Faculty of Medicine, Celal Bayar University, Manisa, Turkiye, from February 2012 to November 2024. The medical records of 211 women diagnosed with ovarian cancer were retrospectively reviewed. Descriptive statistical analyses were conducted to investigate the relationship between CA-125 levels and OS. Patients were categorised into high and low perioperative CA-125 groups based on predefined cut-off values: 305 U/mL preoperatively and 30.4 U/mL postoperatively. The predictive performance of preoperative and postoperative CA-125 levels for ovarian cancer recurrence was assessed using receiver operating characteristic (ROC) analysis. The Kaplan-Meier survival curves were employed to estimate OS, and the Cox regression analysis was performed for univariate and multivariate assessments. Significant differences in OS were observed between the patients with low versus high postoperative CA-125 levels: 1-year OS (93.3% vs. 81.8%), 3-year OS (87.8% vs. 48.1%), 5-year OS (73.3% vs. 35.4%), and 10-year OS (52.0% vs. 19.7%) (p <0.001). Furthermore, postoperative CA-125 levels were independent predictors of both OS (univariate: p <0.001; multivariate: p = 0.009) and progression-free survival (PFS) (univariate: p = 0.005; multivariate: p = 0.011). Perioperative CA-125 levels hold significant prognostic value in ovarian cancer management, offering a valuable biomarker for predicting survival outcomes and disease progression. Postoperative CA-125, Tumour marker, Ovarian cancer, Overall survival, Prognostic marker.

Tumour Load in Advanced Ovarian Cancer Patients and Its Validation by Radiological Peritoneal Cancer Index (PCI) Score

To compare the radiological peritoneal cancer index (PCI) score to the surgical PCI score for validating it as a non-invasive method to predict surgical outcomes. A descriptive study. Place and Duration of the Study: Department of Obstetrics and Gynaecology of the Aga Khan University Hospital, Karachi, Pakistan from September 2021 to May 2022. All successive patients diagnosed with advanced-stage ovarian cancer were enrolled in the research. Prior to surgery, the severity of ovarian cancer was evaluated using the Sugarbaker Peritoneal Cancer Index score derived from radiological imaging. The score was compared to the surgical PCI score determined during the surgery. The correlation between the scores and residual tumour status was confirmed. The study included a total of 26 patients. The mean age of patients was 50.17 years, with a standard deviation of 11.04. Five (19.2%) patients underwent surgery first, whereas 21(80.8%) needed interval debulking surgery after receiving chemotherapy in the neoadjuvant setting. The interclass correlation value among radiological and surgical (PCI) was 0.52, with a 95% confidence interval ranging from 0.17 to 0.75. The Bland-Altman plot displays the agreement amongst the PCI scores, indicating a bias of 1.115 with a 95% confidence interval of 4.61. Surgical exploration revealed zero residual disease in 90% of persons with a PCI score 10. Patients with a PCI score below 10 had also fewer complications. PCI is an efficient means for anticipating the success of surgery and the existence of residual disease without invasive measures. This can be very helpful in deciding the best time for surgery. Peritoneal cancer index, Advanced ovarian cancer, Carcinomatosis, Prognosis, Tumour load.

Comparative Analysis of Gene Expression Profiles in Ovarian Clear Cell Carcinoma and High-Grade Serous Ovarian Cancer

To evaluate disparities in gene expression profiles between Ovarian Clear Cell Carcinoma (OCCC) and High-Grade Serous Ovarian Carcinoma (HGSOC). A descriptive study. Place and Duration of the Study: The Second People's Hospital of Jingdezhen, Jiangxi, China, between 31st December 2017 and December 2023. Basic and clinical diagnostic information, along with genetic test reports, were compiled from all patients within the included groups. Differential gene expression between the two cohorts was scrutinised to elucidate its clinical significance. Comparative analysis revealed nine differentially expressed genes in OCCC relative to HGSOC, with six exhibiting significant disparities (p <0.05). These genes are implicated in pivotal cellular processes including the cell cycle, apoptosis, DNA damage repair, and the PI3K pathway. Notably, aberrant expression patterns, such as overexpression of MET and downregulation of PTEN and SMARCA4, correlated with adverse prognosis and survival outcomes in selected patients. Distinctive gene expression profiles between OCCC and HGSOC underscore disparate tumorigenic mechanisms, thereby laying a foundation for the tailored therapeutic interventions. Further elucidation of the identified differentially expressed genes is warranted to delineate their role in OCCC pathogenesis and prognostic significance. Ovarian clear cell carcinoma, High-grade serous ovarian cancer, Gene expression profiles, Homologous recombination repair.

Relationship Between CIP2A and Endometrium Cancer

To determine whether there is a relationship between endometrium cancer and the oncoprotein cancerous inhibitor of protein phosphatase 2A (CIP2A). A descriptive study. Balıkesir University Medical Faculty Hospital, Balıkesir, Turkey, from January 2013 to July 2018. CIP2A was studied immunohistochemically and molecularly in paraffin blocks. The correlation between CIP2A expression and different endometrial pathologies were evaluated. In addition, the relationship between CIP2A expression in tumor tissue and clinicopathological prognostic parameters and also between Ki67, P53, HER2 with CIP2A expression were investigated. A higher expression of CIP2A was found in endometrium cancer tissues compared to normal endometrial tissues. In addition, CIP2A expression according to molecular and immunohistochemical results was associated with significant poor prognostic factors such as FIGO Stage, FIGO Grade, cervical involvement, myometrial invasion and HER2 positivity. CIP2A could be a promising and therapeutic target in endometrium cancer. Invention of the complex connections of CIP2A with other oncoproteins may lead to amazing and interesting developments in both early diagnosis and treatment. Key Words: CIP2A, Endometrium cancer, Expression, Oncoprotein.

Efficacy and Safety of Combined Chemotherapy Regimens with Bevacizumab in Platinum-sensitive Ovarian Cancers

To determine the differences in terms of overall survival in platinum-sensitive ovarian cancer (PSOC) patients undergoing various chemotherapy protocols, and to demonstrate patient tolerance, toxicity, and efficacy data with the use of bevacizumab in different protocols. An observational study. Place and Duration of the Study: Dr. Abdurrahman Yurtaslan Ankara Oncology Training and Research Hospital, Ankara, Turkey, from January 2018 to January 2022. Patients aged 18 and above, who had received treatment for PSOC, were included in the study. Patients with platinum-resistant disease and those for whom bevacizumab usage was contraindicated were not enrolled in the study. For the 95 patients, the median age was 55 (34-78) years. Median follow-up are 39.7 (39.2-47.5) months. Median progression-free survival (PFS) of the patients are 10.8 (7.3-14.0) months for carboplatin-gemcitabine-bevacizumab (CGB), 10.9 (IQR 5.5-14.3) months in the carboplatin-liposomal doxorubicin-bevacizumab (CLdB) arms, and 6.1 (IQR 5.8-14.3) months in the carboplatin-paclitaxel-bevacizumab (CPB) group (p=0.79). The median overall survivals (OS) are 37.9 (IQR 33.3-46.9) months in the CGB arm, 41.0 (IQR 38.0-50.3) months CPB arm, and 41.3 (IQR 38.1-52.3) months in the CLdB arm (p=0.173). There was no difference in terms of overall survival among all three chemotherapy protocols. However, due to the difference in toxicity, the treatment should be selected on a patient-specific basis. Additionally, the use of bevacizumab at a dose of 7.5 mg/kg was demonstrated to be equivalent to using 15 mg/kg in terms of overall survival. This lower dose is also important to avoid financial toxicity. Bevacizumab, Ovarian cancer, Platinum-based chemotherapy, Tolerability, Adverse clinical events.

Association of Polycystic Ovarian Syndrome with Endometrial Carcinoma among Premenopausal Females

To determine the association of polycystic ovarian syndrome (PCOS) with endometrial carcinoma in premenopausal females. Cohort study. Place and Duration of the Study: Department of Obstetrics and Gynaecology, Unit II, Sir Ganga Ram Hospital, Lahore, Pakistan, from July 2020 to January 2021. Females aged between 20-45 years, presenting with irregular uterine bleeding were included. Females with PCOS were considered as the exposed group and females without PCOS were considered as the unexposed group. Dilation and curettage was performed, and histopathology reports were assessed. There were total 70 patients (35 in each group). The mean age was 34.93±8.64 years in the exposed and 30.92±5.98 years in the unexposed group. Frequency percentage of endometrial carcinoma was 34.3% (n=24) in the exposed and 15.7% (n=11) in the unexposed group (OR=10.54). PCOS was found to be one of the risk factors for endometrial carcinoma. Polycystic ovarian syndrome (PCOS), Endometrial carcinoma, Premenopausal pre-menopause.

Outcomes of Mechanical Resection of Endometrial Polyps and Submucosal Fibroids Through TruClear Hysteroscopy

To assess the efficacy of mechanical resection through TruClear™ hysteroscopy in patients with endometrial polyps and submucosal fibroids. Descriptive study. Place and Duration of the Study: Department of Obstetrics and Gynaecology, Shifa International Hospital, Islamabad, Pakistan, from June 2018 to 2022. Patients diagnosed with endometrial polyps and submucosal fibroids confirmed by abdominal or transvaginal ultrasonography were included. Patients having a history of congestive cardiac failure, chronic kidney disease, and bleeding diathesis were excluded from the study. Data about the complete removal of pathology (endometrial polyps and submucosal fibroids), mean operating time, and postoperative complications such as bleeding and perforation were extracted. The follow-up was set up to 6 months after the procedure. The average age of the 45 patients was 35.62 ± 7.46 years. Heavy menstrual bleeding was the most prevalent symptom, seen in 73.3% of cases, followed by irregular vaginal bleeding (IVB) in 11.1% of cases. The most frequent disease identified by sonography was a polyp in 21 (47%) instances, followed by submucosal fibroids in 12 (27%) cases, mixed pathology in 10 (22%), and malignancy in 2 (4%) cases. The overall average operative time was 36.46 ± 24.94 minutes. A hundred percent removal of lesions was observed in this study. Persistent symptoms were observed in 13% of patients after the surgery so they were treated with other interventions. The most common intervention was an intrauterine hormonal device. Intraoperative bleeding was observed in only one patient and was managed by intraoperative intrauterine balloon insertion. The recurrence rate was 8.9% (4/45). TruClear™ hysteroscopy showed a major advantage in the successful and complete removal of the pathology, low operation time, and complications. Fibroids, Hysteroscopy, Polyps, Endometrial resection, Menstrual bleeding.

Isolated Metastasis of Pancreas due to Endometrial Carcinoma

Diffusion-weighted MRI at 3T in Endometrial Cancer: Correlation of Apparent Diffusion Coefficient with Histopathological Prognostic Parameters

To evaluate the value of apparent diffusion coefficient (ADC) for the differentiation of histological subtypes in endometrial cancer, and to assess if ADC values correlate with histopathological parameters. Descriptive study. Department of Radiology, Faculty of Medicine, Ondokuz Mayis University between January 2016 and December 2019. Eighty-three patients (mean age: 60.28 ± 9.07) with endometrial cancer underwent diffusion-weighted imaging (DWI) at 3T before surgery. The mean ADC (ADCmean) and minimum ADC (ADCmin) values of the tumours were assessed to predict histological subtype of endometrial cancer, grade of tumour, presence of myometrial invasion, lower uterine segment involvement, cervical involvement, lymphovascular invasion, and lymph node metastasis. Sixty patients (72.3%) were diagnosed with endometrioid carcinoma, and 23 patients (27.7%) were diagnosed with non-endometrioid carcinoma. The median ADCmean/ADCmin of endometrioid and non-endometrioid tumours were 0.72/0.58 ×10-3 mm2/s and 0.82/0.63 ×10-3 mm2/s, respectively. ADCmean and ADCmin were significantly different between endometrioid and non-endometrioid tumours (p=0.016 and p=0.048). For the endometrioid carcinomas, ADCmean and ADCmin were significantly different between low-grade (G1 and G2) and high-grade (G3) tumours (ADCmean/ADCmin = 0.75/0.65 vs. 0.59/0.49 x10-3 mm2/s, p=0.010 and p=0.013). Myometrial invasion, lymphovascular invasion, cervical involvement, lower uterine involvement, serosal involvement and lymph node metastasis were not significantly associated with ADC values. ADC measurements were useful for differentiating endometrioid and non-endometrioid carcinomas. High-grade endometrioid carcinomas had significantly lower ADC values compared to low-grade ones. Key Words: Endometrial cancer, Diffusion-weighted MRI, Apparent diffusion coefficient, Prognostic factors, Histological grade.

Atypical Polypoid Adenomyoma (APAM)

Atypical polypoid adenomyoma (APAM) is a rare polypoidal benign tumor of uterus, which usually presents with irregular vaginal bleeding in women of reproductive age. It has the potential of malignant transformation but does not metastasise. It may coexist with endometrial hyperplasia and adenocarcinoma; and so, is usually misdiagnosed. It is composed of atypical endometrial glands along with bundles of smooth muscle fibres. It has a high incidence of recurrence. We describe a case of APAM, which was managed at a tertiary care hospital. A 25-year woman with irregular vaginal bleeding and abdominal mass had total abdominal hysterectomy (TAH) on suspicion of endometrial sarcoma.  Histopathology specimen revealed APAM. On follow-up so far, she is in stable condition and asymptomatic. Key Words: Atypical polypoid adenomyosis, Adenosarcoma, Endometrial carcinoma.

Detection of Serous Tubal Intraepithelial Carcinoma along with High Grade Serous Carcinoma of Both Ovaries

High-grade serous carcinoma (HGSC) of ovary is the commonest of all ovarian malignant tumours and is associated with high mortality rate. Serous tubal intraepithelial carcinoma (STIC) is believed to be the precursor lesion. In literature, only 40-50% of HGSC shows concurrent STIC, even after thorough sampling. We, herein, present a case of a 40-year female, who underwent staging laparotomy for bilateral ovarian carcinoma. She was diagnosed as HGSC of both ovaries. Left ovary capsule was focally ruptured. Peritoneal washings showed metastatic carcinoma. Provisional FIGO stage was IC. During sampling, concurrent finding of STIC was documented in right fallopian tube. No invasive carcinoma was present in both entirely submitted fallopian tubes. Key Words: High grade serous carcinoma, Ovary, Serous tubal intraepithelial carcinoma, TP53.

Diagnostic Efficacy of Serum PDCD4 and HSP70 Levels for Lymph Node Metastasis in Early Cervical Cancer

To investigate the diagnostic value of serum programmed cell death protein 4 (PDCD4) and heat shock protein 70 (HSP70) levels in detecting lymph node metastasis (LNM) in patients with early-stage cervical cancer (International Federation of Gynaecology and Obstetrics [FIGO] stages I to IIA). A comparative study. Place and Duration of the Study: Department of Gynaecology, Urumqi Maternal and Child Health Hospital, Xinjiang, China, from January 2021 to December 2023. One hundred and thirty-two early-stage cervical cancer patients were divided into two subgroups: the LNM subgroup (25 cases) and the Non-LNM subgroup (107 cases). Additionally, 60 healthy women were included as the Control group. Serum PDCD4 and HSP70 levels were measured using enzyme-linked immunosorbent assay (ELISA). Multivariate logistic regression analysis was conducted to identify risk factors for LNM. Serum PDCD4 levels were significantly lower in the Cervical cancer group compared to the Control group (1.31 ng/mL vs. 3.27 ng/Ml; p <0.001), and HSP70 levels were significantly higher (85.20 ± 14.88 ng/mL vs. 39.22 ± 10.03 ng/Ml; p <0.001). The incidence of LNM among the 132 early-stage cervical cancer cases was 18.94% (25/132). The LNM subgroup exhibited lower serum PDCD4 levels (1.31 ng/mL, IQR 0.59-2.14) and higher HSP70 levels (85.20 ± 14.88 ng/mL) compared to the Non-LNM subgroup (PDCD4: 3.27 ng/mL, IQR 1.78-5.37; HSP70: 39.22 ± 10.03 ng/mL; both p <0.05). The multivariate logistic regression analysis identified advanced stromal infiltration depth (≥1/2 cervical muscle wall, OR 4.288, 95% CI: 1.155-15.922) and elevated serum HSP70 levels (OR 1.093, 95% CI 1.031-1.158) as independent risk factors for LNM, while elevated serum PDCD4 levels were found to be an independent protective factor (OR 0.245, 95% CI: 0.091-0.656). The combined detection of serum PDCD4 and HSP70 demonstrated a sensitivity of 88.00%, specificity of 84.11%, and a Youden index of 0.721 (AUC 0.926, 95% CI: 0.867-0.964). Reduced serum PDCD4 levels and elevated HSP70 levels were significantly correlated with LNM in early-stage cervical cancer. The combination of serum PDCD4 and HSP70 levels demonstrated high diagnostic efficacy for LNM in early- stage cervical cancer. Early-stage cervical cancer, Programmed cell death protein 4, Heat shock protein 70, Lymph node metastasis, Diagnostic efficiency.

Assessing the Efficacy of High-Intensity Focused Ultrasound for Uterine Fibroids Using Dynamic Contrast-Enhanced-Magnetic Resonance Imaging

To evaluate the efficacy of high-intensity focused ultrasound (HIFU) the treatment of uterine fibroids using dynamic contrast-enhanced-magnetic resonance imaging (DCE-MRI). Descriptive study. Place and Duration of the Study: Department of Radiology, Liuzhou Hospital of Guangzhou Women and Children's Medical Centre, Liuzhou, China, from November 2019 to November 2022. A total of 52 patients with 66 uterine fibroids were selected using random sampling to test treatment differences. The treatment effect was evaluated by analysing preoperative and postoperative T1WI, T2WI, and T1WI contrast-enhanced scans, comparing fibroid size, signal changes, and the degree of enhancement before and after treatment. The signal intensity ratio (SIR) was analysed using the Wilcoxon and paired t-test, while the non-perfused volume ratio (NPVR) was assessed using the Shapiro-Wilk test and the Kruskal-Wallis test. The NPVR of the low-enhancement group was 35.99 cm3, the equal-enhancement group was 82.87 cm3, and the high-enhancement group was 96.00 cm3. The NPVR values for the low-, equal-, and high-enhancement were 86.19, 78.17, and 64.60, respectively. The NPVR was significantly higher in the low-enhancement group than in the other two groups, with a significant difference of p <0.05. The postoperative NPVR was significantly correlated with varying degrees of enhancement (p <0.05). The NPVR was the highest in the low-enhancement group (86.19%), followed by the equal-enhancement group (78.17%), and the lowest in the high-enhancement group (64.60%). DCE-MRI plays a crucial role in assessing HIFU treatment efficacy for uterine fibroids. The degree of enhancement in uterine fibroids inversely correlates with ablation effectiveness, and DCE-MRI, utilising a high-concentration gadolinium-based contrast agent, provides a clearer depiction of the enhancement features of these fibroids. Uterine fibroids, Dynamic contrast-enhanced-MRI, High-intensity focused ultrasound, Non-perfused volume ratio.

Comment on: Effect of Pap Smear Cytology, HPV Genotyping On the Concordance of Colposcopy and Conization Results

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Management of Borderline Ovarian Tumours: Tertiary Centre Experience from Turkey

This study aimed to analyse the management protocols, surgical approaches, and outcomes of the women with Borderline ovarian tumours (BOT) at Ankara Etlik Zubeyde Hanım Women's Health Training and Research Hospital, Ankara, Turkey. One hundred and seventy-seven patients diagnosed with serous and mucinous BOT were enrolled in the study. Demographic, clinical, and pathological data were reviewed retrospectively from the medical records. The patients were divided into two groups according to surgical interventions: Laparoscopy group (n=50) and Laparotomy group (n=127). Treatment was conservative in 107 (60.5%) patients. Mean age at diagnosis (48.69 ± 12.52 vs. 41.1±11.66 years, p<0.001), tumour size (84.13 ± 51.85 mm vs. 67.1 ± 34.78 mm, p = 0.013), and number of postmenopausal patients (n = 55 vs. 9, p = 0.002) were significantly higher in the Laparotomy group. There were no significant differences in the rates of intraoperative cyst rupture (22% vs. 18%, p = 0.120) and recurrence (2.25% vs. 5.05%, p = 0.760). There was no difference between radical vs. conservative surgery and laparotomy vs. laparoscopy in terms of recurrences. In appropriate cases, the conservative treatment and laparoscopy may be preferred. Key Words: Borderline ovarian tumour, Laparoscopy, Laparotomy.

HIPEC in Ovarian Cancer: When and to Whom?

To evaluate the optimal candidates for hyperthermic intraperitoneal chemotherapy (HIPEC) and cytoreductive surgery (CRS) in ovarian cancer. Descriptive study. Place and Duration of the Study: Health Sciences University, Dr. Abdurrahman Yurtasian Ankara Oncology Training and Research Hospital, Ankara, Turkey, between 2013 and 2021. Ovarian cancer patients who underwent HIPEC and CRS for peritoneal involvement were included in this study. Thermosolutions were prepared as a closed system by using HT 2000 hyperthermic perfusion device. Then, cisplatin was applied at 100 mg/m2 at 42-42.5 °C for 60 minutes after CRS. A total of 47 patients were enrolled. The median age was 54 years (27-80) at the time of diagnosis. Forty (85.1%) patients had high grade serous carcinoma and 22 (46.7%) patients had clinical stage 3C disease. The median peritoneal cancer index (PCI) was 13 (3-24) in the whole population. HIPEC was applied as first-line treatment in 25 (51%) patients. Eleven (23.4%) patients had HIPEC in the post-neoadjuvant interval whereas 10 (21.3%) patients had it in platinum sensitive relapse. Median progression free survival (PFS) was 31(95% CI:11-50), 33 (95% CI:1-67), and 18 (95% CI:8-27) months in the primary, post-neoadjuvant interval, and platinum-sensitive relapse HIPEC groups, respectively. The patients with lower PCI (PCI13, 145 months versus 42 months, p=0.034). HIPEC with CRS should be considered in selected serous carcinoma patients with peritoneal involvement, especially for the patients with primary ovarian cancer with lower PCI (PCI<13). Ovarian cancer, HIPEC, Peritoneal cancer index.

Clinicopathological and Survival Characteristics of Mismatch Repair Status and PD-1 Expression in Serous Ovarian Cancer

To evaluate the clinicopathological characteristics of mismatch repair (MMR) deficiency and its clinical outcomes by performing immunohistochemistry (IHC) for MMR genes in the serous ovarian cancer (SOC) tumour sections. A retrospective case-control study. Place and Duration of the Study: Gynecology Department of Kanuni Sultan Süleyman Training and Research Hospital, and Department of Medical Oncology of Medipol University, between March 2001 and January 2020. IHC was carried out for MLH1, MSH2, MSH6, and PMS2 on full-section slides from 127 SOCs to evaluate the MMR status. MMR-negative and MMR-low groups together were defined as MMR deficient and called microsatellite instability-high (MSI-H). The MSI status and expression of programmed cell death-1 (PD-1) were compared in SOCs with different MMR statuses. A significantly higher frequency of MMR-deficient SOCs was diagnosed at early stages compared with the patients in the MSS group (38.6% and 20.6%, respectively, p=0.022). The frequency of cases with PD-1 expression was significantly higher in the MSI-H group (76.2%) than in the MSS counterparts (58.8%, p=0.028). Patients in the MSI-H group had significantly longer DFS (25.6 months) and OS (not reached) than those in the MSS group (16 months and 48.9 months, p=0.039 and p=0.026, respectively). MSI-H SOCs were diagnosed at an earlier stage as compared to MMR proficient cases. The presence of PD-1 expression was significantly higher in cases presenting MMR deficiency compared with MMR-proficient cases. MSI status was significantly associated with DFS and OS. Serous ovarian cancer, Microsatellite instability, Mismatch repair deficiency.

Initial Ca 125 Value as a Predictive Marker for High-grade Serous Ovarian Cancer

To determine the relevance between the cut-off level of cancer antigen 125 (CA 125) level and long-term prognosis in high-grade serous ovarian cancer (HGSCs). Observational study. Departments of Oncology, Medeniyet University Goztepe Education and Research Hospital, and Kartal Lutfi Kirdar Education and Research Hospital, Istanbul, Turkey, from January 2017 to June 2019. Medical records of 230 women with HGSC were reviewed randomly from two Oncology Clinics. Descriptive analysis and CA 125 marker levels were evaluated with five years of disease-free survival rate (DFS) and overall survival rate (OS). Patients were divided into groups of high and low initial CA 125 levels (cut-off ≥385U/ml). The ability of initial serum CA 125 levels in predicting the presence of marker-recurrence of ovarian cancer were analysed using ROC (Receiver operating characteristics) curve analysis. Statistically significant predictive value of initial CA 125 level was calculated as 385U/ml (p=0.008). The 5-year DFS of high and low CA 125 levels for all stages in HGSC was statistically significant (p<0.001). The sub-group analysis demonstrated that the significant survival difference was especially in FIGO stage III. Patients with HGSC <385 U/ml had a significantly improved 5-year DFS and OS rates within stage III disease: 5-year DFS (p = 0.008) and 5-year OS (p = 0.004) according to the stratification of CA 125 level. Initial CA 125 level appeared to be of beneficial clinical predictive value for HGSC. Key Words: Initial CA 125, Tumor marker, High-grade serous ovarian cancer, Disease-free survival, Overall survival, Predictive value.

High-risk Human Papillomavirus Infection in Putian, China: A Cross-sectional Analysis of 98085 Women

To assess high-risk human papillomavirus (hrHPV) infection among women undergoing cervical cancer screening in Putian for establishing an optimal cervical cancer screening mode and preventive vaccination strategy for HPV. Cross-sectional study. Place and Duration of the Study: The Affiliated Hospital of Putian University for cervical cancer screening period, from August 2020 to December 2022. Cervical cell specimens were obtained using 'two cancer screening platforms'. qRT-PCR and flow-FISH were used for hrHPV typing. The pathological diagnostic test was performed for the hrHPV-positive samples. The results concerning the relationships between hrHPV infection at different age groups and pathological diagnosis were analysed retrospectively. A total of 98085 hrHPV preliminary screening results in the Putian region and 9036 hrHPV-positive samples were included. The infection rate of hrHPV for the three infection modes increased with age. The 41-50 age group is the highest incidence which the phase from cervical intraepithelial neoplasia to cervical cancer. The top three hrHPV subtypes were HPV52, HPV58, and HPV16. The positive rate of HPV16 was positively correlated with the progression of cervical intraepithelial neoplasia. Effective screening, vaccination, and education must be provided because HPV infections are district-specific and age-specific. HPV16 is correlated with cervical cancer progression. Pathological diagnosis and prevention of cervical cancer infected with HPV16 must be conducted. hrHPV, Cervical cancer, Pathological diagnosis.