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Objectives: To evaluate the correlation between lymphovascular space invasion (LVSI) indicating lower uterine segment involvement (LUSI) in endometrioid endometrial cancer and lymph node metastasis based on the lymphatic drainage difference between the uterine corpus and the lower segment. Material and methods: Patients who underwent staging surgery for endometrioid endometrial cancer between January 2010 and January 2019 at our institution were reviewed. The clinicopathologic findings and LUSI status of the patients were compared with their LVSI and lymph node metastasis status. Results: Of the 253 patients included in this study, 49 (19.4%) had LUSI. Among these patients, none of the 31 LVSI-negative patients had metastatic lymph node involvement. However, of the 18 LVSI-positive patients, half had metastatic lymph node involvement; this difference was significant (p < 0.05). Conclusions: The significant correlation between LVSI and lymph node metastasis in LUSI-positive cases indicates that pathologists should also focus on LVSI findings in the frozen examination required for the decision of staging surgery in patients with endometrioid endometrial cancer limited to the uterus. This is especially important in patients with a lower uterine segment involvement.

<b><i>Introduction:</i></b> Although there are several reports on omentum metastasis, limited studies have evaluated omental micrometastases, particularly isolated microscopic metastases in endometrial cancer (EC). We performed this study to assess the frequency of omental micrometastasis in EC, especially when the omentum is the only site of extrauterine spread. <b><i>Methods:</i></b> A retrospective study was conducted to assess cases of EC with an omental sample during primary surgical treatment for EC at the Gynecological Oncology Unit, Uludag University Hospital, Bursa, Turkey, between January 2005 and May 2018. <b><i>Results:</i></b> In total, 435 patients fulfilled the inclusion criteria, which comprised a complete surgical staging. The prevalence of omental metastases was 5.3% (<i>n</i> = 23), regardless of the subtype or clinical stage. Omental micrometastasis was detected in four cases (17.4%). In half of these patients, the omentum was the only site of disease outside the uterus, with an estimated 0.46% of isolated omental involvement. The grade of the endometrioid tumor was found to be statistically correlated with omental metastases (<i>p</i> = 0.01). There was a significant correlation between omental metastasis and positive peritoneal cytology, as well as adnexal involvement (<i>p</i> = 0.001 and <i>p</i> = 0.03, respectively). <b><i>Conclusion:</i></b> We recommend omentectomy routinely in serous EC. In addition, we suggest selective omentectomy in patients with EC who have concomitant adnexal involvement or grade 3 tumors.

Surgical anatomy of the posterior division of the internal iliac artery: The important point for internal iliac artery ligation to control pelvic haemorrhageLigation of the internal iliac artery is an effective procedure both to control post-partum haemorrhage 1 and to reduce operative blood loss at radical hysterectomy. 2 We performed a post-mortem anatomic dissection study which aimed to determine the location of the posterior division of the internal iliac artery, an important anatomical point for the ligation of anterior division of internal iliac artery for the elective control of pelvic haemorrhage. Anatomical dissection of the internal iliac artery, with anterior and posterior divisions, was performed in 22 fresh female cadavers (aged between 13 and 76 years) that were the subjects of forensic investigation, after institutional ethical approval for the study had been obtained.The following measurements were taken from the right and left sides of the pelvis: the distance from aortic bifurcation to the bifurcation of iliac artery, the distance from bifurcation of the iliac artery to posterior division of the internal iliac artery, the distance from the sacral promontory to the posterior division of the internal iliac artery and the distance from the pelvic midline to the posterior division of the internal iliac artery.The aortic bifurcation to the bifurcation of the iliac artery measurements were 60.9 ± 11.5 mm and 66.2 ± 12.5 mm on the right and left pelvic sides, respectively. The bifurcation of iliac artery to posterior division of the internal iliac artery measurements were 40.2 ± 8.3 mm and 38.4 ± 7.2 mm, on the right and left pelvic sides, respectively. The promontory to the posterior division of the internal iliac artery measurements were 42.01 ± 7.9 mm and 47.6 ± 7 mm, on the right and left pelvic sides, respectively. The distance from the pelvic midline to the posterior division of internal iliac artery was 35.3 ± 6.3 mm and 38.09 ± 4.9 mm, on the right and left pelvic sides, respectively. The values were not significantly different between cadavers under and over the age of 40. When the right and left pelvic sides were compared only the length of sacral promontory to the posterior division of internal iliac artery was significantly shorter on the right side (P = 0.018, Mann-Whitney U-test).The present study suggests that, by measuring a point approximately 4 -4.5 cms from the sacral promontory or common iliac bifurcation, the surgeon can identify the point of origin of the posterior division. The point is also located 3.5 cm away from the pelvic midline. However, in some clinical situations it may be easier or preferable to locate the anterior division by identifying the point of origin of the uterine artery or obliterated umbilical artery, and tying the internal iliac artery just proximal to their origin. There may be variations in the anterior and posterior division of the internal iliac artery. The two important structures, ureter and the internal iliac vein, should be identified by careful late...

Objective: To analyze the accuracy of frozen section (FS) examination of a borderline ovarian tumor (BOT) and the factors affecting it.Methods : We retrospectively evaluated 132 patients who were operated on in our clinic for ovarian mass between 1996 and 2016, who underwent FS examination and who had a BOT as a result of the final pathology. We investigated the Frozen accuracy, overdiagnosis and underdiagnosis rates and the factors affecting the accuracy of the diagnosis.Results : The mean age of the sample group was 44.6 ± 15.2 years. 50.8% of our patients were serous, 34.8% were mucinous and 14.4% were sero-mucinous in histology. Our Frozen Section accuracy rate was 75%, and underdiagnosis and overdiagnosis rates were 20.5% and 4.5%, respectively.The factors affecting the accuracy of the frozen section were histological type (p = 0.003), presence of solid component (p = 0.002) and preoperative CA 125 value (p = 0.001).Conclusion : Frozen examination has a low accuracy rate that affects the correct selection of surgical treatment for BOTs. FS should be performed by experienced gyneco-pathologists and it is necessary to consider carefully the factors that may cause misdiagnosis of the pathology.