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Placenta percreta is a rare complication potentially fatal to fetus and the mother. We present here a 41-year-old female patient who underwent curettage for incomplete abortion at 6(th) week of pregnancy. She had persistent vaginal bleeding for 2 months after the curettage, for which she was treated with hysterectomy. Preoperative ultrasonography and magnetic resonance imaging (MRI) made the diagnosis of placenta percreta. Postoperative pathological examination confirmed this diagnosis.

The pathogenesis and etiology of endometrial polyps has not been elucidated. In this study, we aimed to examine the pathogenic mechanisms of endometrial polyp development using immunohistochemistry. We evaluated the expression of galectin-3 and cyclooxgenase-2 (COX-2) during the menstrual cycle in premenopausal women with endometrial polyps or normal endometrium. Thirty-one patients with endometrial polyps and 50 healthy control patients were included in this study. The levels of expression of COX-2 and galectin-3 were studied by immunohistochemistry. The percentage of COX-2-positive cells and the intensity of COX-2 staining in the endometrium did not vary during the menstrual cycle either in the control group or in patients with endometrial polyps. However, expression of galectin-3 was significantly lower in endometrial polyps and during the proliferative phase of the endometrium compared with the secretory phase. Our data suggests that the pathogenesis of endometrial polyps does not involve expression of COX-2 or galectin-3.

Objective The aim of the present study is to determine the potential risk factors for adenomyosis and to investigate its relationship with accompanying gynecological pathologies and clinical characteristics. Materials and method This study is a retrospective analysis of 945 patients who underwent hysterectomy between May 2005 and January 2013 at the Sifa University Medical Faculty Hospital, Clinic of Obstetrics and Gynecology. The study included 327 patients with adenomyosis and 618 patients without adenomyosis by histopathological examination of the uterus. Results There was a significant positive correlation between development of adenomyosis and presence of leiomyoma ( p  < 0.0001), history of previous abortion ( p  < 0.0001), history of previous pregnancy ( p  = 0.0002), and normal body mass index ( p  < 0.0001). However, no significant relationship existed between development of adenomyosis and smoking ( p  > 0.4300), normal delivery ( p  = 0.9600), cesarean delivery ( p  = 0.5705), endometrial hyperplasia ( p  = 0.1721), or ovarian endometriosis ( p  = 0.8595). Conclusion Women who are multiparous have leiomyoma, a previous history of abortion, and a normal body mass index are at increased risk for development of adenomyosis. Adenomyosis might be one cause of unexplained recurrent spontaneous abortion during pregnancy.

PurposeThis study aimed to evaluate the therapeutic effect of radiotherapy and to determine possible prognostic factors in patients with painful vertebral hemangioma.MethodsIn the last two decades, 80 patients with vertebral hemangioma who received radiotherapy in our institute were evaluated in terms of pain response, treatment-related side effects, and prognostic factors. All patients were questioned 3 months after radiotherapy for the evaluation of pain response and were divided into three groups (complete response, partial response, and no change). Moreover, the visual analog scale (VAS) was used for pain response assessment in 46 patients. Pain status was assessed to detect recurrence at each clinical examination during the follow-up period. Possible prognostic factors such as gender, size of the hemangioma, location, multilevel involvement and additional musculoskeletal disease on pain response were analyzed.ResultsIn this study, 45 individuals had lesions in the lumbar spine, 28 in the thoracic, and 7 in the cervical region. Furthermore, 51 patients had additional musculoskeletal conditions such as disc herniation, degenerative diseases, spondylolisthesis, and compression fracture. Radiotherapy was performed with a median daily dose of 2 Gy and a median total dose of 40 Gy. Complete pain response occurred in 58.8% of patients, 26.2% of patients had partial pain response, and 15% of patients had no pain response. The overall response rate was 85%, and 7 patients showed recurrent pain symptoms in the overall response group at routine follow-up. Additional musculoskeletal disorders were found to be the only prognostic factor associated with pain response. The median follow-up time was 60 months. Secondary malignancy was not found in any of the patients in this short follow-up time. No acute or late radiation-associated side effects greater than grade II were observed.ConclusionTo our best knowledge, this study is one of the largest single-institution radiotherapy series on vertebral hemangiomas reported to date. The obtained data support the efficacy and safety of radiotherapy in the treatment of painful vertebral hemangioma. Our study showed that additional musculoskeletal disease plays an important role in pain response. Other prognostic factors and treatment of vertebral hemangioma with stereotactic radiosurgery should be investigated in future studies.

OBJECTIVE This study aimed to evaluate the effect of prognostic factors and treatment on survival in childhood intracranial ependymoma. METHODS In the past two decades, 28 patients with pediatric intracranial ependymoma who received postoperative radiotherapy in our institute were evaluated statistically in terms of prognostic factors and survival. Progression-free survival (PFS) and overall survival (OS) were analyzed using the Kaplan-Meier method. Possible prognostic factors, such as sex, histopathological grade, the extent of resection, tumor location, spinal metastasis, and chemotherapy were also analyzed by log-rank test. RESULTS Median age at diagnosis was 4 years (range, 1-17 years). Eighteen patients had infratentorial tumor, and 19 patients had Grade III tumor. Gross total resections (GTRs) were performed in 16 patients. The median clinical follow-up time was 66.9 months (range, 8-253 months). The estimated 5-year PFS and OS rates are 38% and 55%, respectively. The extent of resection was found the only prognostic factor associated with improved PFS and OS. Other factors, such as gender, histopathological grade, tumor location, spinal metastasis, and chemotherapy, showed no statistically significant effect on survival outcomes. CONCLUSION A multidisciplinary approach is required in the management of pediatric intracranial ependymomas. GTR is a crucial prognostic factor on survival. The lack of aggressive salvage treatments may result in worse survival. Future trials are needed to investigate molecular classification and individualized treatment algorithms.

Holoprosencephaly is a brain malformation that develops as a result of a defect in development of prosencephalon during early gestation. Holoprosencephaly can be diagnosed with prenatal ultrasonography and magnetic resonance imaging. We report herein a case with cyclopia and holoprosencephaly detected by prenatal ultrasonography.

Objective To evaluate the effects of letrozole and cabergoline in a rat model of ovarian hyperstimulation syndrome (OHSS). Study design In this prospective, controlled experimental study, the 28 female Wistar rats were divided into four subgroups (one non-stimulated control and three OHSS-positive groups: placebo, letrozole, and cabergoline). To induce OHSS, rats were injected with 10 IU of pregnant mare serum gonadotropin from day 29 to day 32 of life, followed by subcutaneous injection of 30 IU hCG on day 33. Letrozole rats received with a single dose of 0.1 mg/kg letrozole via oral gavage, on the hCG day. Cabergoline rats received with a single dose of 100 µg/kg cabergoline via oral gavage, on the hCG day. All animals were compared in terms of body weight, vascular permeability (VP), ovarian diameter, ovarian tissue VEGF expression (assessed via immunohistochemical staining), and blood pigment epithelium-derived growth factor (PEDF) levels. Results The OHSS-positive placebo group (group 2) exhibited the highest VP, ovarian diameter, extent of VEGF staining, and lowest PEDF level, as expected. No significant difference was evident between the letrozole and cabergoline groups in terms of any of body weight; VP; PEDF level; ovarian diameter; or the staining intensity of, or percentage staining for, VEGF in ovarian tissues. Conclusions Letrozole and cabergoline were equally effective to prevent OHSS, reducing the ovarian diameter, VP, and PEDF and VEGF levels to similar extents.

Epithelial-myoepithelial carcinoma (EMC) is an uncommon neoplasm that is predominantly seen in major salivary glands. Although it is considered as low grade, the high recurrence rate is quite common. EMC of the nasal cavity is extremely rare. A case of EMC detected in the nasal cavity is reported. A 44-year-old woman presented with a 1-year history of nasal congestion and bleeding. Magnetic resonance imaging (MRI) revealed a 4×4 cm necrotic expansile lesion involving the bilateral nasal cavity, extending to the nasopharynx, oral cavity, maxillary sinus, and ethmoid cells. The patient was found to be inoperable since complete surgical resection was not possible, and excisional biopsy was performed. Histopathological and immunohistochemical analyses led to a diagnosis of EMC. Definitive radiotherapy (RT) with concomitant cisplatin was applied. After 4 years, the patient is asymptomatic, and MRI showed a stable status with no progression. EMC is rarely seen in the nasal cavity. If possible, the first treatment modality should be surgery. The role of RT is controversial. To the best of our knowledge, this is the only case treated with definitive chemoradiotherapy for EMC in the nasal cavity.