Digital Mammography, Ultrasound and Magnetic Resonance Imaging Characteristics in Differential Diagnosis of Papillary Carcinoma Subtypes of the Breast and Diagnostic Challenges

Objective: We aimed to investigate mammography (MG), ultrasound (US), and magnetic resonance imaging (MRI) findings of papillary breast carcinoma subtypes and to compare the diagnostic features and performance of the imaging method in distinguishing subtypes. Materials and Methods: Forty-two patients presenting with pathological diagnosis of 45 papillary carcinoma lesions, between 2014 and 2019, were included. Cases were assigned to five subgroups according to the latest World Health Organization (WHO) classification. The clinical characteristics (n = 45) and imaging features of each pathological subgroup were retrospectively related to imaging findings from US (n = 45), MG (n = 37), and breast MRI (n = 23), and further compared. Results: The finding of a palpable mass in all subgroups was more common than nipple discharge on clinical breast evaluation, and no significant difference was found between the subgroups. Irregular shape on MG (10/12, 83.3%, p = 0.039) and US (11/12, 91.7%, p = 0.039) was found more frequently in invasive micropapillary carcinoma (IMPC) compared to other subgroups. Circumscribed margins (4/5, 80%, p = 0.002) occurred more frequently in papillary ductal carcinoma in situ (pDCIS) and encapsulated papillary carcinoma (EPC) than in other subgroups (6/8, 75%, p = 0.002). Lower apparent diffusion coefficient (ADC) values were found in solid papillary cancer (SPC) than in other subgroups (ADC = 0.35 x 10(-3), p = 0.017). Conclusion: Radiological findings of papillary carcinomas overlap with each other. US and MRI are complementary when revealing specific morphological characteristics

Radyofrekans Termal Ablasyon Öncesi Enjekte Edilen Solüsyonların Oluşan Ablasyon Tünelinin Büyüklüğü Üzerine Olan Etkilerinin Histopatolojik Olarak Ve Apoptozis Markerları Kullanılarak Değerlendirilmesi

Nazal obstrüksiyon ve uykuda solunum bozukluklarına yol açabilen alt konka hipertrofilerin tedavisinde kullanılan yöntemlerden biri de radyofrekans termal ablasyon işlemidir. Gerek lokal anestezi gerekse genel anestezi altında yapılabilen bu işlemde, submukozal planda bir ablasyon tüneli oluşturulur. Ablasyon sahasında oluşacak fibrozis sonucu alt konka hacmi küçülür ve nazal pasaj açıklığında artış sağlanır. KBB pratiğinde işlem öncesi rutin olarak çeşitli oranlarda ve miktarlarda solüsyonlar kullanılarak lokal anestezinin sağlanması, efektif bir submukozal ablasyon yapılması ve ablasyon işlemi esnasında alt konka çapını artırarak çevre dokulara zarar gelmemesi amaçlanmaktadır. Kullanılan solüsyonların hacim ve konsantrasyonlarının oluşan ablasyon tünelinin boyutları üzerine olan etkileri onkoloji ve üroloji gibi farklı disiplinlerce detaylı bir şekilde incelenmiştir ve özellikle tümör ablasyonu amacıyla yapılan işlemler öncesi kullanılan farklı solüsyonların ablasyon sahasını artırmada başarılı oldukları bildirilmiştir. Konka hipertrofisine yönelik yapılan işlemlerde ise, lezyon sahasının büyümesi çevre dokulara zarar verilme riski nedeniyle istenmeyen bir durumdur. KBB pratiğinde kullanılan bu solüsyonların ablasyon tünelinin boyutları üzerine olan etkilerini inceleyen herhangi bir çalışma yapılmamıştır. Bu çalışmada KBB pratiğinde kullanılan solüsyonlar, mezbahada sakrifiye edilmiş tavuklardan elde edilen ve konka modeli olarak kullanılmak üzere kesilerek şekillendirilmiş olan dokulara enjekte edildikten sonra radyofrekans termal ablasyon işlemi uygulanacaktır. Farklı solüsyonlar kullanılarak elde edilen ablasyon tünellerinin boyutları arasında anlamlı bir fark olup olmadığı histopatolojik olarak ve apoptozis markerları kullanılarak değerlendirilecektir. Alt konkaya yapılan radyofrekans işleminde dokuda etkili bir küçülmeye yol açabilecek ancak çevre dokuda yer alan konka mukozası, goblet hücreleri ve mukosiliyer ünite gibi yapılara zarar vermeyecek büyüklükte bir lezyon oluşturulması idealdir. Çalışmamızdan elde edilecek sonuçlar, klinik uygulamalarda işlem öncesi enjekte edilen solüsyonların ideal ablasyonu sağlayacak hacim ve konsantrasyonlarının belirlenmesi ve standardize edilmesi için bir model oluşturacaktır

The Role of Adipocytokines in Colon Cancer and Adenomas

Background: Metabolic changes resulting from obesity, insulin insensitivity, and imbalances in hormones such as adiponectin, leptin, resistin, apelin and visfatin, which are derived from white adipose tissue-derived hormone, are directly linked to both colon cancer (CC) and inflammatory bowel diseases increasing tissue-derived risk. We conducted this study to evaluate the relationship between the circulating concentrations of adiponectin, leptin, resistin, apelin and visfatin and colon adenoma and CC. Methods: Our study included 90 participants aged >18 years who were divided into three groups: colon cancer, adenoma and control. The serum concentrations of the investigated adipohormones were measured with ELISA in 30 patients with colon adenoma, 30 with CC and 30 controls with no colon pathology. Results: Demographic, anthropometric, metabolic and hormonal parameters were also recorded. The group means were compared by using one-way analysis of variance (ANOVA). Dual comparisons between groups were analyzed with the Tukey test. Pearson correlation coefficient was used to determine the relation between continuous variables. Adiponectin and leptin levels in patients with adenomas (p<0.000; p<0.000, respectively) and CC (p<0.000; p<0.000, respectively) were lower than in controls. Apelin level in patients with CC (p<0.000; p<0.000, respectively) was lower than in patients with adenomas and in controls. Resistin and visfatin levels in patients with CC (p<0.000; p<0.000, respectively) were higher than in patients with adenomas and in controls. Conclusions: We have concluded that adiponectin, leptin, resistin, apelin and visfatin levels may play an important role in colon carcinogenesis. We also assume that adiponectin and leptin may be associated with the risk of colon adenoma

Gastric gastrointestinal stromal tumor with bone metastases - Case report and review of the literature

Gastrointestinal stromal tumors (GISTs) represent rather rare neoplasms. Most GISTs are benign; malignant tumors account for 20-30% of cases (overall, approximately 10-30% of GISTs exhibit malignant behavior). GISTs most commonly metastasize to the liver and abdominal cavity. Distant metastases to other sites, especially to the bones, are relatively rare. We report a case of a 62-year-old man with metastatic spread of GIST to skull, ribs and both sacroiliac joints manifesting six months after surgical resection of a gastric tumor. Although bone metastases from GISTs are rare and there are only a few reported cases in the literature, this case emphasizes that metastatic disease should always be considered in a patient with gastric GIST and suspicious bone lesions

A synchronous occurrence of urothelial carcinoma with abundant myxoid stroma and inverted papilloma of the urinary bladder

Abundant myxoid stroma rarely occurs in urothelial carcinomas, and may cause diagnostic challenges when cells with eosinophilic cytoplasm forming nests and cords in a myxoid background are seen, particularly in the absence of typical carcinomatous appearance. Microscopic examination of transurethral resection specimen of a 71-year-old male patient revealed non-cohesive oval or elongated tumor cells with eosinophilic cytoplasm arranged in cord-like filigree pattern in an abundant myxoid stroma. Immunohisto chemically the tumor was positive for cytokeratin 7, cytokeratin 20, and 34BE12. About 90 to 100% nuclear staining was observed with p63, p53, and Ki-67. A second neoplasm with a flat overlying urothelial epithelium and a complete inverted cellular growth pattern was also noted. The neoplasm exhibited less than 2% and 10% nuclear staining with Ki-67 and p53, respectively. Considering histological, histochemical, and immunohistochemical findings, a diagnosis of synchronous urothelial carcinoma with abundant myxoid stroma and inverted papilloma was made

Lymphangioma: Surrounding the ovarian vein and ovary

Lymphangiomas are usually benign lesions seen in the head and neck region in children. Intra-abdominal localisation is rare and the majority of these cases are in early childhood. Retroperitoneal lymphangiomas constitute approximately 1% of all lymphangiomas. They are generally diagnosed incidentally, may be asymptomatic or may present with a palpable abdominal mass. A limited number of cases of ovarian lymphangiomas have been reported in women, whereas there are no reported cases of paraovarian localisation. We present a rare case of lymphangioma located in bilateral paraovarian region and along the left ovarian vein with radiological findings

Lichen nitidus presenting with trachyonychia

[No Abstract Available

Inverted (hobnail) high-grade prostatic intraepithelial neoplasia and invasive inverted pattern

High-grade prostatic intraepithelial neoplasia (HGPIN) is considered to be an important precursor for prostatic adenocarcinoma. The present study aimed to investigate the histological features of the uncommon inverted (hobnail) pattern of HGPIN in transrectal ultrasonographic (TRUS) prostatic needle biopsies from 13 cases. These 13 diagnosed cases of inverted HGPIN were identified out of a total of 2,034 TRUS biopsies (0.63%), obtained from patients suspected to have prostate cancer. The hobnail pattern is comprised of secretory cell nuclei, which are histologically localized at the luminal surface of the prostate gland, rather than the periphery, and exhibit reverse polarity. Histological examinations were performed and the results demonstrated that 5 of the 13 cases exhibited pure inverted histology, while HGPIN was observed to be histologically associated with other patterns in the remaining 8 patients. In addition, an association with adenocarcinoma was identified in 7 of the 13 cases. All 7 carcinomas accompanied by inverted HGPIN were conventional acinar adenocarcinoma cases; of note, for these 7 cases, the Gleason score was 7 for each. One acinar adenocarcinoma case accompanying inverted HGPIN demonstrated hobnail characteristics in large areas of the invasive component. It was observed that nuclei were proliferated in the invasive cribriform glands, which was comparable to that of inverted HGPIN, and were located on the cytoplasmic luminal surface; a similar morphology was also observed in individual glands. In conclusion, the results of the present study suggested that the hobnail HGPIN pattern may be of diagnostic importance due to its high association with adenocarcinoma and the high Gleason scores in the accompanying carcinomas

Yüksek Dereceli Kasa İnvaze Olmayan Mesane Tümörlerinde Histolojik Derecelendirme Oranının Progresyona Etkisi

Aim: Histopathological classification is one of the main prognostic factors for non-muscle invasive bladder tumors (NMIBT). Weevaluated the relationship between tumor progression and the ratio of high-grade differentiation plus other routine pathologicalparameters in NMIBT.Materials and Methods: Ninety-two patients diagnosed with high grade NIMBT were analyzed between 2010-2018. Demographicinformation, tumor size, localization, multicentricity, and recurrence/progression situation were evaluated retrospectively. The high/lowgrade percentage ratio of tumor cells, tumor stage, differentiation, necrosis, lamina-propria invasion, lymphovascular invasion, andcarcinoma in-situ presence were also examined by two uro-pathologist. The effect on tumor progression was evaluated with pathologicalfindings.Results: Seventy-four (80.4%) of the patients were reported as T1 and 18 (19.6%) as Ta. The mean ratio of high-grade findings was11.9±8.5% and 69.5±28.1% for Ta and T1 patients, respectively(p25%, >50% and >75% was found to be 67(72.8%),54(58.7%) and 43(46.7%), respectively. The high-grade ratio for >25% was in only 1 Ta patient while it was in 66 of the T1patients(p75%(p50%(p=0.025).Conclusion: When evaluating the nuclear grade, defining tumors solely as high-grade leads to stratifying a highly heterogeneouspopulation in a single group. Higher rate of progression is observed in NIMBT patients with high-grade ratio >50%.KİOMT’de yüksek dereceli hücresel farklılaşma oranı ve diğer rutin patolojik parametrelerin progresyona etkisi değerlendirildi. Materyal ve Metot: Çalışmaya 2010-2018 yılları arasında transüretral mesane rezeksiyonu sonrası yüksek dereceli KİOMT tanısı alan 92 hasta dahil edildi. Hastaların demografik bilgileri, tümör çapı, lokalizasyonu, multisantrisitesi ve nüks/progresyon varlığı-süresi retrospektif olarak değerlendirildi. Ayrıca tümör hücrelerinin yüksek derece/düşük derece yüzdesi, tümör evresi, diferansiyasyon, nekroz, lamina propria invazyonu, lenfovasküler invazyon ve karsinoma in-situ varlığı iki üro-patolog tarafından incelendi. Elde edilen bulguların tümör progresyonu üzerine etkisi araştırıldı. Bulgular: Hastaların 74’ü(%80,4) T1, 18’i(%19,6) Ta olarak rapor edildi. Ta tanılı hastalarda yüksek derece oranı %11,9±8,5 iken, T1’lerde %69,5±28,1 olarak tespit edildi (p%25,>%50 ve>%75 olan hasta sayısının sırasıyla 67(%72,8), 54(%58,7) ve 43(%46,7) olduğu görüldü. Ta olan hastaların sadece 1’inde yüksek derece oranı>%25 olarak gözlenirken, T1 hastalarının 66’sında yüksek derece oranının>%25 olduğu belirlendi (p%75 olduğu görüldü. T1 yüksek derece oranları>%50 olan hastalarda progresyon, patolojik evresi T1 yüksek derece oranları %50 olan hastalarda progresyon anlamlı derecede artmaktadır

Prognostic Role of Lymphovascular Invasion and Perineural Invasion in Breast Cancer Treated with Neoadjuvant Chemotherapy

In our study, we investigated the predictive properties of LVI (lymphovascular invasion) and PNI (perineural invasion) on survival times from pathology specimens obtained from surgical operation after neoadjuvant chemotherapy (NAC) with breast cancer patients. Two hundered eleven female patients were included in this study. We evaluated the relationship between potential prognostic factors and mean recurrence-free survival (RFS) and overall survival (OS) times using Kaplan-Meier methodology and Cox proportional hazard modelling.The mean follow-up time was 27.3 months.PNI positive patients had shorter RFS and OS times than PNI negatives (p< 0.001, p= 0.002, respectively), and LVI positive patients had shorter RFS and OS times than LVI negatives (p< 0.001, p< 0.001, re-spectively). In the multivariate analysis performed, the presence of pN stage and PNI were found to be predictive for RFS (p= 0.047, p< 0.001, respectively), while pT stage and PNI positivity were found to be predictive for OS (p= 0.035, p= 0.017, respectively). LVI did not show the property of being an independent predictive marker for survival. PNI caused significant survival differences in all subtypes for both RFS (log-rank p< 0.001, p= 0.003, p= 0.001, respectively) and OS(log-rank p= 0.035, p= 0.006, p= 0.020 respectively) in HR+/Her2-, Her2+ and Triple negative breast cancer subtyping. LVI, on the other hand, caused survival distribution difference for RFS (p= 0.021) in the HR+/Her2-subtype and for both RFS and OS in the Triple-negative subtype (p< 0.001, p= 0.025, respectively). PNI is strongly and significantly associated with RFS and OS. We suggest that it can be used in identifying high-risk patients for recurrence of PNI and in new staging systems