Thyroid auto-immunity (TAI) has been implicated as the most common cause of hypothyroidism in general population, especially in women. Many studies revealed that increased infertility incidences with TAI. The aim of the present article was to evaluate the effect of thyroid auto-antibody (TAA) positivity on embryological parameters, IVF-outcome and endometrial volume (EnV) in infertile patients who were applied for routine artificial reproductive technologies (ART) programme. This study included prospective, sequential, cross-sectional analyses of parameters obtained from 69 patients with unexplained infertility. It was the first ART application of patients. Patients were homogenous for age, body mass index, basal hormone measurements and underwent same ovulation induction protocol. They were evaluated for thyroid hormone profile and TAAs and divided into three groups; TAA negative group (n = 31), TAA positive group (n = 23) and TAA positive and euthyroid with medication group (n = 15). There were no differences among groups for the number of Grade-1 and Grade-2 embryos, distribution of embryo-grades, number of oocytes retrieved and fertilised, biochemical pregnancy ratios (PR), EnV and miscarriage ratio. However, the clinical PR was significantly lower in the TAA positive group (p = 0.024). In conclusion, the embryo grades and EnV did not differ among groups. But the clinical PR differs and the anti-thyroid peroxides positivity, above the cut-off point, affects the clinical PR.

INTRODUCTION: Subclinical inflammation markers play a significant role in hyperemesis gravidarum (HEG). Simple hematological markers such as mean platelet volume (MPV), platelet distribution width (PDW), neutrophil-to-lymphocyte ratio (NLR), red cell distribution width (RDW), plateletcrit (PCT), and platelet-to-lymphocyte ratio (PLR) have been shown to reflect inflammatory burden and disease activity in several disorders. Ketonuria is a parameter used in the diagnosis of severe HEG, but its correlation with disease severity remains controversial. The relationship of subclinical inflammation markers with degree of ketonuria has not been examined previously. In this study, we aimed to determine the diagnostic value of these subclinical inflammation markers and the relationship between these markers and grade of ketonuria in patients with HEG. MATERIALS AND METHODS: A total of 94 pregnant women with a diagnosis of HEG and 100 gestational age-matched healthy pregnant women were enrolled in this retrospective study. MPV, PDW, NLR, PLR, PCT, and ketonuria were calculated and analyzed from complete blood cell counts and total urine analyses. RESULTS: Lymphocyte count was significantly higher in the control group (P < 0,001); NLR and PLR values were significantly higher in the HEG group (P < 0,001). Among inflammation markers, RDW increased significantly (P = 0,008) with an increase in ketonuria in patients with HEG. A statistically significant correlation was found between white blood cell (WBC) and NLR, PLR, PCT. A moderate uphill relationship was observed between NLR and WBC and a weak uphill linear relationship was observed between WBC and PLR and between WBC and PCTCONCLUSIONS: PLR and NLR can be considered effective markers to aid in the diagnosis of HEG. No marker was found to correlate with ketonuria grade except RDW, although the relationship of the severity of ketonuria with severity of disease is controversial. RDW increases as the degree of ketonuria increases.

Estrogen and progesterone receptor expression were lower in the stromal portion of the endometrial polyp than in the glandular portion in postmenopausal patients. Stromal progesterone receptor expression was lower in older patients and there was a relation between low estrogen hormone levels and lower stromal progesterone receptor expression.

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A 65-year-old G6, P5 post-menopausal woman was admitted to Selcuk University School of Medicine Hospital (Konya/Turkey) with abnormal uterine bleeding since two weeks. On examination her external genitalia and cervix were found to be normal. On gynaecologic examination there was a palpable pelvic mass. Ultrasound showed thickened, irregular uterine lining of about 9mm and a heterogeneous, well-circumscribed intramural mass measuring 8cm in the largest transverse diameter. The mass occupied almost the entire anterior wall of the uterus. The diagnostic findings were similar to cystic degeneration of fibroids [Table/ Fig-1]. Dilation and Curettage (D&C) was performed on the same day. Afterwards, endometrial sampling revealed focal adenocarcinoma but the exact histologic subtype and grade could not be specified because of the limited pathologic material and fragmentation of tissue. Immunohistochemical stains showed tumoural cells diffuse positivity for vimentin and CK7, focal weakly positive for ER and negative for the expression of CD56 and PR. She was scheduled for surgery. The patient then underwent laparoscopic surgical staging, including hysterectomy, bilateral salpingo-oopherectomy, and bilateral pelvic and para-aortic lymphadenectomy. Specimen was cut open for gross examination, the polypoid mass was dirty white/cream-coloured, gelatinous and 8cm in size with smooth surface. The operation was uneventful and the patient was discharged from hospital 48 hours after the procedure.On microscopic examination, tumour exhibited different levels of maturity: from cords, trabeculae, nests, and rosette-like structures to well-defined rings and pseudotubular structures [Table/ Fig-2,3]. There were anastomosing trabecule and cords of cells with retiform architecture. The overlying endometrium was atrophic without any findings of malignancy. Focal tumour cell necrosis and increased mitotic index up to 8 mitoses per 10 high-power fields was present. The presence of an ovarian sex cord tumour component was confirmed by immunohistochemistry. The immunohistochemical staining pattern of tumour was: negative for desmin, alpha inhibin, calretinin, chromogranin, HMB45, MelanA, sinaptofizin, S100, CK20 and CK5/6. Vimentin, CD99 and p53 were highly expressed in tumour, while CD56, CD10, SMA, PanCK, EMA, CK7 and CK19 showed focal expression. Stromal cells were found to be ER positive and PAS-positive. Diastase-resistant inclusions were seen.Based on pathological findings and immunohistochemical examination a diagnosis of UTROSCT was made. The tumour was completely confined to the myometrium and distance of tumour from closest margin to uterine serosa was 2 cm. There were no lymph node metastases. The patient received no other postoperative therapy and she had been uneventful over 12-month follow-up. Uterine Tumour Resembling Ovarian Sex-Cord Tumours (UTROSCTs) are an extremely rare type of uterine body tumours arising from the endometrial stroma. Epidemiology, aetiology, pathogenesis, management and natural history of UTROSCTs are st...

Letters to the Editor 693resolved spontaneously and did not result in cord prolapse in labor 3 . These authors also observed that several cases of cord prolapse in labor had not had prenatally detectable cord presentations 3 . Therefore they concluded that funic presentation at a prenatal sonogram was not synonymous with cord prolapse in labor. While in selected cases conservative management with close monitoring and attempt at vaginal delivery have been advocated 4 , it is our opinion that in the presently described case funic presentation would not resolve, and cord complications in labor would have been likely due to the anatomical relationship between the internal cervical os and the marginal cord insertion. We recommend that in all cases of funic presentation the cord insertion into the placenta should be identified. This will allow appropriate obstetric management and may help prevent the mortality and morbidity associated with cord prolapse. Prenatal sonographic and magnetic resonance imaging diagnosis of cystic neuroblastomaNeuroblastoma is the most frequent extracranial solid tumor in childhood, but it is seldom diagnosed prenatally. These tumors may arise from any site of the sympathetic nervous system in fetuses. With the increasing use of prenatal ultrasound to detect fetal anomalies, the possibility of early detection of children with neuroblastoma is increasing 1 . We report such a case and present magnetic resonance imaging (MRI) findings. A 20-year-old primigravida first presented at 26 weeks of gestation for routine examination.Transvaginal ultrasound examination showed a simple cystic intra-abdominal mass measuring 16 × 19 mm in diameter. The possibility of neuroblastoma was raised. A follow-up sonographic examination performed at 29 gestational weeks showed an increase in size of the mass (to 43 × 44 mm) with intracystic septations, suggesting intracystic hemorrhage (Figure 1). MRI performed at 33 weeks revealed a complex mass which was located between the right kidney and liver. For the fetal MRI, an ultrafast imaging sequence, Half-Fourier acquisition single shot turbo spin echo (HASTE) was employed. In T2-weighted MRI scans, the lesion appeared as a welldefined, predominantly cystic complex mass measuring 55 × 46 mm (Figure 2). Three weeks after the MRI scan, the woman went into spontaneous labor and delivered

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