Objective: Accurate preoperative differentiation between benign endometrial conditions and malignancies is essential for guiding therapeutic interventions. However, high-quality evidence regarding the diagnostic accuracy of endometrial sampling techniques remains insufficient. This study aimed to evaluate the diagnostic efficiency of hysteroscopically directed biopsy, Pipelle suction curettage, and dilatation and curettage (D&C) for detecting endometrial hyperplasia or carcinoma in premenopausal women and to identify associated risk factors. Methods: A retrospective single-center cohort analysis was conducted on 2054 premenopausal women. Demographic, clinical, and obstetric data, along with biopsy techniques and histopathological findings, were recorded. Diagnostic accuracy of biopsy methods was compared against definitive surgical pathology. Results: The prevalence of endometrial hyperplasia and carcinoma was 5.6% and 1.0%, respectively. Hysteroscopically directed biopsy demonstrated superior diagnostic accuracy (AUC 0.957) compared to D&C (AUC 0.909) and Pipelle suction curettage (AUC 0.858). Sensitivity was highest for hysteroscopically directed biopsy (91.3%), followed by D&C (82.0%) and Pipelle suction curettage (71.7%), while specificity remained excellent across all methods (p < 0.001). Elevated BMI increased the risk of hyperplasia or carcinoma by 1.05 times per unit increase (OR = 1.054, p = 0.005), while hypertension nearly doubled the risk (OR = 1.99, p = 0.009). Multiparity showed protective effects, reducing risk with each additional delivery (OR = 0.877, p = 0.029). Conclusions: Hysteroscopically directed biopsy provides superior diagnostic accuracy for detecting endometrial hyperplasia and carcinoma in premenopausal women. Hypertension and elevated BMI increase risk, while multiparity offers protective benefits.

BACKGROUND Endometrial polyps are a common gynecological condition that often cause significant clinical symptoms. Hysteroscopic resection is considered the gold standard treatment; however, recurrence remains a notable risk even after surgery. The recurrence of endometrial polyps after surgery raises concerns for women, due to persistent symptoms and potential malignancy risk. Therefore, this study aims to identify factors influencing recurrence in reproductive-aged women undergoing hysteroscopic polyp resection. MATERIAL AND METHODS We conducted a retrospective analysis of 1021 reproductive-aged women who underwent hysteroscopic polypectomy for abnormal uterine bleeding between 2010 and 2024. Diagnoses were confirmed by histopathological examination. Multivariable logistic regression modeling was used to determine predictors of recurrence. RESULTS Endometrial polyp recurrence occurred in 8% of patients, with a median recurrence time of 42.5 months. Levonorgestrel-releasing intrauterine system (LNG-IUS) treatment significantly reduced recurrence (odds ratio [OR]=0.043, 95% CI=0.019-0.097, P<0.001). Risk factors for recurrence included adenomyosis (OR=10.297, 95% CI=5.251-20.188, P<0.001), polycystic ovarian syndrome (OR=8.990, 95% CI=2.855-28.312, P<0.001), body mass index ≥30 kg/m² (OR=8.698, 95% CI=4.521-16.736, P<0.001), tamoxifen use (OR=6.088, 95% CI: 1.936-19.140, P=0.002), and leiomyoma uteri (OR=4.012, 95% CI: 2.143-7.509, P<0.001). CONCLUSIONS Clinicians should inform patients at high risk, including those with adenomyosis, myoma uteri, polycystic ovarian syndrome, or tamoxifen use, about the increased risk of recurrence and should conduct regular follow-ups. LNG-IUS treatment can be considered for the prevention of recurrence and enhancement of management strategies.

Objective: This study aimed to present our single-center clinical experience regarding tumor clinicopathologic features, treatment modalities, and reproductive and oncologic outcomes in patients with non-epithelial ovarian cancer (NEOC) over 25 years. Materials and Methods: A total of 100 patients with clinicopathological diagnosis of NEOC who were treated at our tertiary care center between 1996 and 2022 were included in this retrospective cohort analysis study. Data on demographic, clinical and obstetric characteristics of patients at the time of initial diagnosis as well as tumor clinicopathologic features, treatment modalities, and oncological and reproductive outcomes were recorded. Results: NEOCs involved germ cell tumors (GCTs) in 46 (46%) patients and sex cordstromal tumors (SCSTs) in 54 (54%) patients. Thirty patients with GCTs and thirty-four patients with SCSTs possessed histological subtypes with malignant features. Most patients with GCTs (37%) and SCSTs (55.6%) had FIGO Stage 1 disease at the time of initial diagnosis. Overall, 76.6% of patients in the GCT group (n=23) underwent fertility-sparing surgery (FSS), while 76.5% of the patients in the SCST group (n=26) were treated with non-fertility-sparing surgical procedures. All patients who underwent FSS and had a recurrence in their follow-up (n=4) was stage 3 patients. Seven out of 10 patients (2 patients at stage 3 and 5 patients at stage 1) who desired pregnancy delivered between 38 and 40 gestational weeks without any congenital anomaly. The prognosis was excellent in both groups, with 5-year overall survival (OS) rates of 93.5% in GCTs and 96.3% in SCST groups. The 5-year disease-free survival was 89.1% in GCTs and 94.4% in SCSTs. FSS was not associated with worse oncologic outcomes. Conclusion: NEOCs usually have a good prognosis because they are detected at an early stage. FSS may be indicated for women of reproductive age with early-stage NEOCs.

Hidradenoma papilliferum (HP) is a rare, benign apocrine tumour occurring mainly in the anogenital region of female patients between 20 and 90 years of age (Raiteb and Kouach 2017, Birge et al. 202...

Objective: We aimed to analyze the impact of stage shifts on disease-free survival and overall survival in patients with uterine carcinosarcoma stratified based on FIGO 2009 and 2023 staging systems. Materials and Methods: A total of forty-five patients diagnosed with uterine carcinosarcoma between 2010 and 2024 were included in the study. Patients were classified and analyzed according to both the 2009 and the revised 2023 FIGO staging systems to evaluate the impact of the updated staging criteria on oncologic outcomes. The median disease-free (DFS) and overall survival (OS) rates were calculated and compared when stage shifts occurred. Results: A total of 17 upstage shifts (37.7%) occurred between the 2009 and 2023 FIGO staging system. All patients with upstage shifts were stage I patients categorized according to the FIGO 2009 classification. Restaging from the FIGO 2009 to the FIGO 2023 criteria resulted in a reduction in the number of stage I cases and an increase in the number of stage II cases. The two main factors leading to upstage were serous histology and LVSI positivity. The 5-year DFS and OS rates for stage I disease were 80% and 75%, respectively, according to the 2009 FIGO staging system, whereas the 2023 FIGO staging system demonstrated significantly higher rates of 100% for both DFS and OS. In stage II patients, the 5-year DFS and OS rates were 33.5% and 33.7%, respectively, according to the 2009 FIGO staging system, while the 2023 FIGO staging system demonstrated higher rates of 58.8% for DFS and 65% for OS. Conclusions: The revised FIGO 2023 staging system has better performance in predicting disease prognosis than the previous version.

Cervical cancer is one of the leading female cancers especially in developing countries and a common cause of death among middle-aged women. The main role of Human Papillomavirus (HPV) in both cervical cancer and pre-invasive lesions of the cervix has been proven in studies. Reducing the incidence of the disease can be achieved by the regular cervical screening of women and vaccination of appropriate age groups. The disease can be better controlled by better elucidating the details of HPV carcinogenesis, the interaction between the host and the virus, and determinants of the systemic and cellular immune response to the viral infection. HPV causes oropharyngeal and anogenital diseases in both men and women and is usually sexually transmitted. Most infections are transient and could be cleared spontaneously by the host immune system. After the first encounter with HPV infection, it takes years to progress to cervical cancer, which gives clinicians a long period to follow these patients in terms of precancerous lesions and to investigate the pathogenesis of the disease. HPV plays a major role in the development of cervical cancer, but histological types have different relationships with HPV genotypes. HPV can remain latent for a long time and the most important thing determining the persistence is the type of HPV. HPV vaccination provides a direct benefit to both men and women by providing safe protection against cancers that may result from persistent HPV infection.