Browsing by Author "Haberal, Asuman Nihan"

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Bilateral synchronous ovarian tumours: an uncommon case and review of the literature
(2018) Tohma, Yusuf Aytac; Gunabakan, Emre; Haberal, Asuman Nihan; Ayhan, Ali; 30150919
Synchronous ovarian tumours are rare. Management of these patients can differ from that of patients with uniform tumours. We present a case of synchronous epithelial ovarian cancer and malignant mixed Mullerian tumour in different ovaries, its follow-up and management until death. To our knowledge this is the second case in the English literature to date. A 61-year-old woman with bilateral adnexal masses underwent complete debulking surgery for ovarian cancer. The final pathology was reported as malignant mixed Mullerian tumour in the right ovary with intact borders and stage 2 grade 3 serous carcinoma in the left ovary. She had a 17-month disease-free interval after 6 cycles of paclitaxel and carboplatin. Recurrence of malignant mixed Mullerian tumour was reported in the pathology after secondary debulking including a partial ileal resection. After 6 cycles of gemcitabine and cisplatin she had a widespread recurrence in the thorax and abdomen. The patient died of disease recurrence at the 25th month after diagnosis. Coexistence of serous and malignant mixed Mullerian tumour in different ovaries is very rare. The main treatment is complete cytoreduction followed with chemotherapy. Platinum-taxane based chemotherapy resulted in an acceptable disease-free interval in our case, but it is not standard yet. A management protocol may be developed with the increasing number of similar cases in the literature.
Clear Cell Carcinoma of the Uterine Cervix; An Unusual HPV-Independent Tumor: Clinicopathological Features, PD-L1 Expression, and Mismatch Repair Protein Deficiency Status of 16 Cases
(TURKISH JOURNAL OF OBSTETRICS AND GYNECOLOGY, 2023) Bulutay, Pinar; Eren, Ozgur Can; Ozen, Ozlem; Haberal, Asuman Nihan; Kapucuoglu, Nilgun
Objective: Endocervical clear cell carcinoma (c-CCC) is a rare and HPV-independent adenocarcinoma type of cervix. Being usually resistant to conventional chemotherapy. Immunotherapy has recently been added as a preferred regimen as a second-line treatment option for programed cell death-ligand 1 (PD L1)-positive or mismatch repair (MMR) deficient cervical carcinomas. In this study, clinicopathological features, PD-L1 expression, and MMR deficiency status of c-CCCs were investigated. Materials and Methods: Sixteen c-CCC diagnosed cases were included in this study. PD-L1 expression was evaluated using two different PD-L1 clones (22C3 and SP263). MMR deficiency status of the cases was evaluated using four MMR proteins (MLH1, PMS2, MSH2, and MSH6). Results: Most of the c-CCC cases were presented as FIGO Stage I (68.75%). PD-L1 expression in either tumoral or tumor-infiltrating immune cells (TILs) was present in 62.5% (10/16) and 69% (11/16) of the 22C3 and SP263 clones, respectively. Most of the cases with high TIL density were also positive for PD-L1. The PD-L1 expression rate was less than 50% in most of the cases and 12.5% of the cases shared extensive PD-L1 staining. Overall, MMR deficiency was observed in 31.25% of the cases. Most of the MMR-deficient cases (80%) were PD-L1 positive. Conclusion: Although our study cohort is limited, we have shown that PD-L1 expression and MMR deficiency can be found in c-CCCs in variable degrees. These findings suggest that accompanying TIL density and MMR deficiency could be used as candidates for predicting PD-L1 positivity for c-CCCs. However, to indicate the clinical importance of these findings, objective treatment outcomes of cases treated with immunotherapy should be seen.
Clinical Outcomes of Patients with High-Grade Ovarian Carcinoma Arising in Endometriosis Compared to Ovarian High-Grade Serous Carcinoma
(2021) Yalcin, Ibrahim; Sahin, Hanifi; Sari, Mustafa Erkan; Haberal, Asuman Nihan; Sahin, Eda Adeviye; Celik, Husnu; Meydanli, Mehmet Mutlu; Ayhan, Ali; 0000-0003-1185-9227
Purpose To compare the prognoses of women with high-grade ovarian carcinoma arising in endometriosis (OCAE) to those of women with ovarian high-grade serous carcinoma (HGSC) Material and Methods This multicenter, retrospective, case-control study included patients with OCAE at two gynecologic oncology centers in Turkey between January 2006 and December 2016. Of a total of 202 women with a diagnosis of OCAE, 70 women with high-grade OCAE were included. Each case high-grade OCAE was attributed to two women with ovarian HGSC. Survival analysis was performed using the Kaplan-Meier method. Results Eleven patients with high-grade OCAE had recurrent disease (15.7%) when compared to 47 patients (33.6%) with HGSC (p = 0.008). The 5-year disease-free survival (DFS) rate of the patients having high-grade OCAE was significantly higher than the women with HGSC (78.3% vs. 56.2%; p = 0.007, respectively). According to the 5-year overall survival (OS) rates, there was no significant difference between high-grade OCAE and HGSC (79.5% vs. 70.1%; p = 0.210, respectively). Conclusion Although this retrospective study demonstrated a significant decrease in recurrence rate and an increase in the 5-year DFS rate in patients with high-grade OCAE, OS rates of the patients with HGSC and high-grade OCAE seem to be similar.
Cloacogenic Adenocarcinoma of the Vulva: A Case Report and Review of the Literature
(2018) Tepeoglu, Merih; Uner, Halit; Haberal, Asuman Nihan; Ozen, Ozlem; Kuscu, Esra; 28272666
Primary adenocarcinoma of the vulva, unrelated to the native glands of perineum is an extremely rare neoplasm. Despite awareness of this lesion for over 40 years, the origin is not beyond speculation. The most reasonable hypothesis is based on the remnants of cloacal differentiation during early days of life. Here we report the case of a 60-year-old patient with a vulvar mass, who underwent partial vulvectomy and bilateral regional lymph node dissection. The tumor was composed of papillary and complex glandular structures and exhibited diffuse positivity for cytokeratin 20 and polyclonal CEA, CDX2, and focal positivity with cytokeratin 7. Unlike the indolent behavior of this malignant neoplasm according to the literature, we found two metastatic inguinal lymph nodes. She did not receive adjuvant therapy and is still alive, free of disease 38 months after surgery. We present different aspects of vulvar adenocarcinomas with a case report.
Does Polyp-Originated Growing have Prognostic Significance for Stage 1 Endometrioid-Type Endometrial Cancer?
(2020) Kucukyildiz, Irem Alyazici; Gunakan, Emre; Akilli, Huseyin; Haberal, Asuman Nihan; Kuscu, Esra; Haberal, Ali; Ayhan, Ali; 0000-0002-5240-8441; 0000-0002-0992-6980; 0000-0001-9852-9911; 0000-0002-1486-7209; AAX-3230-2020; AAI-8792-2021; AAK-4587-2021; AAI-9331-2021
Purpose Endometrioid-type endometrial cancer is usually diagnosed in the early stages and has a good prognosis. Patients with stage 1 disease have survival rates over 95%. Tumor factors affect survival in these patients, but polyp-originated growing has not been sufficiently discussed in the literature. This study aimed to determine the effect of polyp-originated growing in stage 1 endometrioid-type endometrial cancer and to provide a review of the literature. Methods This study includes 318 stage 1 endometrioid-type endometrial cancer patients. The patients were divided into two groups based on the tumor origin. Group I included patients with polyp-originated growing tumors, and Group II included patients with endometrial surface-originated growing tumors. Results Groups I and II included 39 and 279 patients, respectively. The general properties of the patients were similar; there were no significant differences. The univariate survival analyses showed that overall survival for Groups I and II was 65.5 and 83.6 months, respectively; this difference was statistically significant (p = 0.002). The multivariate analysis of age, maximum tumor diameter, tumor origin, lymphovascular space involvement, myometrial invasion depth and tumor grade showed that polyp-originated growing was independently and significantly associated with overall survival (HR 4.05; 95% CI 1.2-13.5; p = 0.023). Conclusion Polyp-originated growing may be a prognostic factor for early stage endometrioid-type endometrial cancer. The prognostic effect of polyp-originated growing is not well known, and further investigation is necessary.
Incidence and outcome of occult uterine sarcoma: A multi-centre study of 18604 operations performed for presumed uterine leiomyoma
(2020) Yorganci, Aycag; Meydanli, Mehmet Mutlu; Kadioglu, Nezaket; Taskin, Salih; Kayikcioglu, Fulya; Altin, Duygu; Atasoy, Latife; Haberal, Asuman Nihan; Kinay, Tugba; Akgul, Mehmet Akif; Tapisiz, Omer Lutfi; Evliyaoglu, Ozlem; Tekin, Ozlem Moraloglu; Ortac, U. Firat; Ayhan, Ali; 0000-0001-9852-9911; 0000-0001-7369-5470; 31499285; AAJ-5802-2021; AAK-4587-2021; AAI-8793-2021
Is The Presence of Endometriosis Associated with A Survival Benefit in Pure Ovarian Clear Cell Carcinoma?
(2018) Sahin, Hanifi; Sari, Mustafa Erkan; Cuylan, Zeliha Firat; Haberal, Asuman Nihan; Sirvan, Levent; Coban, Gonca; Yalcin, Ibrahim; Gungor, Tayfun; Celik, Husnu; Meydanli, Mehmet Mutlu; Ayhan, Ali; https://orcid.org/0000-0001-9852-9911; https://orcid.org/0000-0002-3285-5519; AAJ-5802-2021; 29383437; AAK-4587-2021; AAI-9974-2021; AAL-1923-2021
The purpose of this study was to compare the prognoses of women with pure ovarian clear cell carcinoma (OCCC) arising from endometriosis to those of women with pure OCCC not arising from endometriosis treated in the same manner. A dual-institutional, retrospective database review was performed to identify patients with pure OCCC who were treated with maximal or optimal cytoreductive surgery (CRS) followed by paclitaxel/carboplatin chemotherapy between January 2006 and December 2016. Patients were divided into two groups according to the detection of cancer arising in endometriosis or not, on the basis of pathological findings. Demographic, clinicopathological, and survival data were collected, and prognosis was compared between the two groups. Ninety-three women who met the inclusion criteria were included. Of these patients, 48 (51.6%) were diagnosed with OCCC arising in endometriosis, while 45 (48.4%) had no concomitant endometriosis. OCCC arising in endometriosis was found more frequently in younger women and had a higher incidence of early stage disease when compared to OCCC patients without endometriosis. The 5-year overall survival (OS) rate of the patients with OCCC arising in endometriosis was found to be significantly longer than that of women who had OCCC without endometriosis (74.1 vs. 46.4%; p = 0.003). Although univariate analysis revealed the absence of endometriosis (p = 0.003) as a prognostic factor for decreased OS, the extent of CRS was identified as an independent prognostic factor for both recurrence-free survival (hazard ratio (HR) 8.7, 95% confidence interval (CI) 3.15-24.38; p < 0.001) and OS (HR 11.7, 95% CI 3.68-33.71; p < 0.001) on multivariate analysis. Our results suggest that endometriosis per se does not seem to affect the prognosis of pure OCCC.
A novel prediction method for lymph node involvement in endometrial cancer: machine learning
(2019) Gunakan, Emre; Atan, Suat; Haberal, Asuman Nihan; Kucukyildiz, Irem Alyazici; Gokce, Ehad; Ayhan, Ali; 30718313
Objective The necessity of lymphadenectomy and the prediction of lymph node involvement (LNI) in endometrial cancer (EC) have been hotly-debated questions in recent years. Machine learning is a broad field that can produce results and estimations. In this study we constructed prediction models for EC patients using the Naive Bayes machine learning algorithm for LNI prediction. Methods The study assessed 762 patients with EC. Algorithm models were based on the following histopathological factors: V1: final histology; V2: presence of lymphovascular space invasion (LVSI); V3: grade; V4: tumor diameter; V5: depth of myometrial invasion (MI); V6: cervical glandular stromal invasion (CGSI); V7: tubal or ovarian involvement; and V8: pelvic LNI. Logistic regression analysis was also used to evaluate the independent factors affecting LNI. Results The mean age of patients was 59.1 years. LNI was detected in 102 (13.4%) patients. Para-aortic LNI (PaLNI) was detected in 54 (7.1%) patients, of which four patients had isolated PaLNI. The accuracy rate of the algorithm models was found to be between 84.2% and 88.9% and 85.0% and 97.6% for LNI and PaLNI, respectively. In multivariate analysis, the histologic type, LVSI, depth of MI, and CGSI were independently and significantly associated with LNI (p<0.001 for all). Conclusions Machine learning may have a place in the decision tree for the management of EC. This is a preliminary report about the use of a new statistical technique. Larger studies with the addition of sentinel lymph node status, laboratory findings, or imaging results with machine learning algorithms may herald a new era in the management of EC.
Oncologic outcomes in patients undergoing maximal or optimal cytoreductive surgery for Stage 3C serous ovarian, tubal or peritoneal carcinomas
(2019) Gurkan, Damla; Akin, Aylin Ceren; Sahin, Hanifi; Tohma, Yusuf Aytac; Sahin, Eda Adeviye; Gunakan, Emre; Iflazoglu, Nidal; Haberal, Asuman Nihan; Ayhan, Ali; 0000-0001-9418-4733; 31482736
The aim of this study was to evaluate overall survival (OS) and disease-free survival (DFS) of patients with Stage 3C serous ovarian, tubal and peritoneal carcinomas. A retrospective analysis of 111 patients who underwent maximal or optimal cytoreductive surgery was performed. Patients were divided into three groups as ovarian cancer (n = 47), tubal cancer (n = 24) and peritoneal cancer (n = 40). Median follow-up was 30 months. There was no significant difference in DFS and OS among the groups. Complete cytoreduction was an independent prognostic factor for DFS in all groups (HR 2.3, 95% CI 1.14-4.93; p=.020). Positive peritoneal cytology (HR 2.2, 95% CI 1.02-4.78; p=.044), and retroperitoneal lymph node involvement (HR 2.3, 95% CI1.11-4.89; p=.025) were independent risk factors for decreased OS, and extended cytoreduction (HR 2.7, 95% CI 1.05-6.99; p=.039) were independent risk factors for increased OS. In conclusion, these malignancies should be considered a single entity during treatment.IMPACT STATEMENT What is already known on this subject? Epithelial ovarian cancer is the second most common gynaecological cancer in women worldwide. There are different histological types including ovarian, tubal and peritoneal carcinomas in which malignant cells form in the tissue covering the ovary or lining the fallopian tube of peritoneum. Recent data have supported the view that these malignancies should be considered a single entity and should be treated the same way. What the results of this study add? In the present study, we evaluated overall survival and disease-free survival of patients with Stage 3C ovarian, tubal and peritoneal cancer undergoing maximal or optimal cytoreductive surgery. We found similar oncologic outcomes in all patient groups. To the best of our knowledge, this is the first study to compare oncologic outcomes of these similar and often confused malignancies in the literature. We, therefore, believe that the present study provides additional information to the body of knowledge on this topic. s are of these findings for clinical practice and/or further research? This study is important, as it indicates similar oncologic outcomes in patients undergoing maximal or optimal cytoreductive surgery for Stage 3C ovarian, tubal and peritoneal cancer. Based on these findings, clinicians should keep in mind that these malignancies should be considered a single clinical entity and be treated the same way. We believe that our study would pave the way for further studies regarding this subject.
Oncological and obstetric outcomes after fertility-sparing radical abdominal trachelectomy for early stage cervical cancer: a tertiary centre's 10 years' experience
(2019) Ayhan, Ali; Tohma, Yusuf Aytac; Sahin, Hanifi; Kocaman, Eda; Tunc, Mehmet; Haberal, Asuman Nihan; 0000-0001-9418-4733; 30371139; AAE-6482-2021
The aim of this study is to present our clinical experience about fertility-sparing procedures in early stage cervical cancer and its obstetrical and oncological outcomes. Between the years 2006 and 2016, a total of 22 early stage cervical cancer patients who underwent a fertility-sparing radical abdominal trachelectomy in our clinic were retrospectively analysed. The median age was 33 (range: 28-39) years. The median follow-up was 47 (range: 22-125) months. Five patients (22.7%) had Stage IA1, three patients had (13.6%) Stage IA2, and 14 patients (63.6%) had Stage IB1 disease. Only one patient had a recurrence. A pregnancy was obtained in five patients (22.7%) and one of them (20%) had a live birth. A pregnancy was obtained spontaneously in two patients (40%), whereas assisted reproductive techniques were used in three of the patients (60%). A miscarriage occurred in two patients (40%), and one of them was within the first trimester and the other was within the second trimester.
Possible Impact of Immunosuppressive Therapy Regimens on Histopathologic Outcomes of Abnormal Uterine Bleeding in Solid-Organ Transplant Recipients
(2018) Tohma, Yusuf Aytac; Akilli, Huseyin; Kirnap, Mahir; Haberal, Asuman Nihan; Akyel, Dilan; Zengin, Hatice Yagmur; Zeyneloglu, Hulusi Bulent; Kuscu, Esra; Ayhan, Ali; Haberal, Mehmet; https://orcid.org/0000-0001-9418-4733; https://orcid.org/0000-0002-5240-8441; https://orcid.org/0000-0001-9852-9911; https://orcid.org/0000-0002-9855-2449; https://orcid.org/0000-0002-0289-2642; https://orcid.org/0000-0002-3462-7632; 29851156; AAE-6482-2021; AAX-3230-2020; AAH-9198-2019; AAK-4587-2021; ABA-3224-2021; B-6487-2009; AAJ-8097-2021
Background: In this study, we aimed to determine the frequency of histopathologic outcomes of solid-organ transplantation in women with abnormal uterine bleeding (AUB) receiving immunosuppressive therapies. Methods: This is a retrospective study including a single-center experience. Data were extracted from hospital records, and solid-organ transplant recipients who were diagnosed with AUB were included. Results: Fifty-five of these patients were renal transplant recipients (79.7%), and 14 were liver transplant recipients (20.3%). Histopathologic examination showed various histopathologic patterns of endometrium in patients with AUB consisting of normal histopathologic findings of endometrium in 31 patients (48.4%); 29 hormonal imbalance during proliferative and secretory phases of menstrual cycle and two atrophic endometrium. Endometrial hyperplasia without atypia was observed in 11 patients (17.2%). Polyp was seen in 22 patients (34.4%); 21 endometrial polyp and one endocervical polyp. There were significant differences in terms of histopathologic findings among the three groups of patients according to different immunosuppressive regimens (P = .029). There was no endometrial hyperplasia in women receiving sirolimus-based immunosuppressive regimens. Moreover, there was no endometrial hyperplasia in the liver transplant recipient group. Conclusions: Sirolimus-based immunosuppressive regimens may be administered to patients who have risk factors for endometrial precancerous lesions, such as endometrial hyperplasia. However, additional well-designed, large-scale studies are warranted to confirm our findings.
Prevalence of Endometrial Cancer or Atypical Hyperplasia Diagnosed Incidentally in Infertility Clinic
(2018) Tohma, Yusuf Aytac; Zeyneloglu, Hulusi Bulent; Aslan, Oner Deniz; Haberal, Asuman Nihan; Onalan, Gogsen; Ayhan, Ali; 0000-0001-9418-4733; 0000-0002-0289-2642; 0000-0003-0386-7614; 0000-0001-9852-9911; 30118694; AAE-6482-2021; B-6487-2009; AAK-4587-2021; GZG-9810-2022; AAJ-5802-2021
Primary Ovarian Malignant Melanoma Arising in Teratomatous Component of Mixed- Germ Cell Tumor in a Child: Case report
(2014) Ozyoruk, Derya; Demir, Haci Ahmet; Emir, Suna; Haberal, Asuman Nihan; Bugdayci, Meral; Otgun, Ibrahim; https://orcid.org/0000-0001-9852-9911; 24499012; AAK-4587-2021
Primary ovarian malignant melanoma arising in teratomatous component of germ cell tumors is seen extremely rare with most reports being only of single cases and small series in reproductive aged woman and mostly from cystic teratoma, whereas information on pediatric presentation is sparse. This case is reported for being extremely rare tumor.
Relation of Preoperative and Postoperative Echocardiographic Parameters With Rejection and Mortality in Liver Transplant Patients
(2020) Yilmaz, Kerem Can; Ciftci, Orcun; Akgun, Arzu Neslihan; Muderrisoglu, Haldun; Boyacioglu, Sedat; Haberal, Asuman Nihan; Moray, Gokhan; Haberal, Mehmet; 0000-0001-8926-9142; 0000-0002-9635-6313; 0000-0003-2498-7287; 0000-0002-9370-1126; 0000-0001-9852-9911; 0000-0002-3462-7632; 29790458; W-5233-2018; AAG-8233-2020; AAJ-1331-2021; AAE-1041-2021; AAE-7637-2021; AAK-4587-2021; AAJ-8097-2021
Objectives: Survival in liver transplant after end-stage liver disease is associated with major cardiac functions. In a significant number of patients with end-stage liver disease, cardiac dysfunctions may be observed, which can include high-output heart failure, cardiac valve disease, and pulmonary venous and arterial hypertension. All of these affect perioperative survival. The aim of our study was to determine whether preoperative and postoperative echocardiographic parameters, specifically right heart-related tricuspid regurgitation, estimated systolic pulmonary arterial pressure, and tricuspid annular plane systolic excursion, are associated with rejection and mortality in liver transplant patients. Materials and Methods: Adult patients (> 18 years old) who underwent liver transplant at our center between January 2011 and March 2017 were included in the study, with 64 patients retrospectively screened. The echocardiographic images that were taken immediately before and immediately after liver transplant were evaluated. The patients were divided into 2 groups according to rejection data and mortality. All parameters were analyzed for both variables. Results: For the 24 patients with liver rejection and 40 patients without liver rejection, there were no statistically significant differences in terms of demographic data, echocardiographic parameters, and laboratory data. However, when patients were evaluated according to survival, there was a statistically significant difference between these 2 groups concerning the echocardiography parameters of systolic pulmonary arterial pressure (P = .005), tricuspid annular plane systolic excursion (P = .001), and postoperative right ventricular width (P = .01). Conclusions: Echocardiography, being a simple and easily accessible technique that is reliable in excluding pulmonary hypertension diagnosis, can be used as a guide in the evaluation of right ventricular function and tricuspid regurgitation, particularly in patients who are not hemodynamically stable before and after liver transplant.
Survival impact of number of removed para-aortic lymph nodes in stage I epithelial ovarian cancer
(2021) Gunakan, Emre; Akilli, Huseyin; Kara, Atacan Timucin; Altundag, Ozden; Haberal, Asuman Nihan; Meydanli, Mehmet Mutlu; Ayhan, Ali; 0000-0002-5240-8441; 0000-0003-0197-6622; 0000-0001-8854-8190; 34410474; AAX-3230-2020; W-9219-2019; ABI-1707-2020
Purpose The survival effect of presence or absence of lymphadenectomy in early-stage epithelial ovarian cancer (EOC) was priorly shown but the effect of number of removed lymph nodes kept in background. We aimed to evaluate the survival impact of number of removed lymph nodes and their localizations in stage I EOC. Methods This study included 182 patients. The best cut-off levels for number of pelvic and para-aortic lymph nodes (PaLN) were 24 and 10, respectively. Univariate and multivariate survival analyses were performed for these cut-offs and other prognostic factors. Results The median age of the patients was 49. The median number of removed pelvic and paraartic lymph nodes were 29 and 9, respectively. The median overall (OS) and progression-free survival (PFS) were 67 and 50 months, respectively. The 5-year OS rate was 89.6%. Recurrence occured in 24 (19.5%) patients. In univariate analyses tumor grade (p: 0.005), pelvic LN number (p: 0.041) and PaLN number (p: 0.004) were the factors that were significantly associated with PFS. Tumor grade and PaLN number were independently and significantly associated with PFS in multivariate analyses (p: 0.015 and p: 0.017, respectively). In OS analyses, age, tumor grade, presence of LVI, number of pelvic and PaLNs were the significantly associated factors (p < 0.05 for all). In multivariate analyses, age and PaLN number were independently and significantly associated with OS (p: 0.011 and p: 0.021, respectively). Conclusions The number and localizations of removed lymph nodes may have a survival affect in stage I EOC. We also think that this study may constitute a kernel point for larger prospective series on lymph node number and lymphatic regions.