Carcinosarcoma of the breast: a case report

Meme karsinosarkomu, sarkom benzeri bileseni bulunan duktal tip karsinomayı ifade eden, malin epitelyal ve malin mezenkimal elemanların bir arada bulundugu bir malinitedir. Glandüler epitelin glandüler olmayan mezensimal dokuya farklanmasıyla ortaya çıkan ve seyrek görülen metaplastik meme kanserlerinin en seyrek görülen alt tipidir. Tüm meme malinitelerinin %1'inden azını olusturur. Literatürde karsinosarkomun radyolojik özelliklerinin degerlendirildigi sınırlı sayıda çalısma bulunmaktadır. Hastanemiz meme hastalıkları poliklinigine sol memede ele gelen kitle yakınmasıyla basvuran 44 yasında kadın hastada fizik bakı, mamografi ve ultrasonografi bulguları degerlendirildi. Mamografi ve ultrasonografide lobüle, karma solid ve kistik alanlar içeren kitle izlendi. Histopatolojik olarak karsinosarkom tanısı alan olguda parsiyel mastektomi ve aksiller diseksiyon yapıldı. Aksilladan çıkartılan 16 lenf nodunun biri metastatikti ve uzak metastaz saptanmadı. Bizim amacımız, nadir görülen bu tümörlerde radyolojik bulguları tanımlamak ve literatürü gözden geçirmektirCarcinosarcoma of the breast represents a ductal carcinoma which consists sarcoma like component. Both malign epithelial and malign mesenchymal elements exist together in the breast carcinosarcoma. Glandular epithelium differentiates into non-glandular mesenchymal tissue, a process called metaplasia. Metaplastic breast malignancy is a rare type of the breast cancer, moreover carcinosarcoma is the rarest subtype which is less than 1%of the whole breast cancers. There are limited studies and case reports of carcinosarcoma in literature. Fourtyfour aged woman applied to breast diseases polyclinic with palpable mass on her left breast. We evaluated the findings of the physical examination, mammography and ultrasound. On radiological evaluation we determined a lobulated complex mass with solid and cystic components. Histopathological examination resulted as carcinosarcoma. Lumpectomy and axillary dissection were performed. One axillary lymph node was metastatic out of 16 lymph nodes. There were no distant metastases. Our purpose is to define the radiologic findings about this rare tumour and to review the literature

Large bursitis asso ciated with osteochondroma of fibula presenting as a mass lesion :a case report

Soliter osteokondromların komplikasyonları; kemik boyun fraktürü, kitle etkisi ve sinir sıkışmasıdır. Oldukça nadir görülen diğer komplikasyonlar malign transformasyon ve bursittir. Semptomatik hale gelen osteokondromlu hastalar malign transformasyon açısından araştırılmalıdır. Sağ krurisinde kitle ve ağrı şikayeti ile başvuran bir hastada yapılan MR incelemesi sonucunda fibular osteokondrom ve eşlik eden bursit saptandı. Olgumuzda nadir görülen osteokondrom bursitinin klinik ve MR bulgularını tartıştık.The complications of solitary osteochondroma can be listed as fracture of the bony stalk, mass effect and nerve impingement syndromes. The other rare complications are malignant transformation and bursitis. Symptomatic patients with osteochondroma must be investigated for malignant transformation. A patient with pain and mass on the right cruris was examined and fibular osteochondroma associated with bursitis was found on MR examination. In this report clinical and MR findings of solitary osteochondroma with bursitis are discussed

Review of transrectal ultrasonography findings in the diagnosis of prostate cancer: radiopathological correlation

Amaç: Transrektal ultrasonografi (TRUS) esliginde prostat biyopsisi yapılan hastaları gözden geçirmek ve prostat kanseri tanısında yardımcı olabilecek ultrasonografik kriterleri degerlendirmek. Yöntem: Ocak 2003-Temmuz 2005 tarihleri arasında TRUS esliginde prostat biyopsisi alınan ve PSA degerleri gri zonda yer alan (410 ng/dl; ortalama PSA: 6.9 ± 2.7 ng/dl) 129 hasta retrospektif olarak degerlendirildi. TRUS\ud bulguları patoloji sonuçlarıyla karsılastırıldı. Periferik zon ekoyapısı (homojen ya da heterojen) ve prostat bezi konturları (düzgün ya da düzensiz) subjektif olarak sınıflandı. Bulgular: 44 hasta (% 34) prostat kanseri tanısı aldı. Incelenen kriterlerden periferik zon ekoyapısı ile periferik zonda hipoekoik nodül varlıgının patoloji sonuçlarıyla istatistiksel olarak anlamlı biçimde iliskili oldugu saptandı (p=0.000 ve p=0.007). Prostat kanseri yakalama olasılıgının, periferik zonun heterojen oldugu durumda 7 kat [Odds Oranı (OO): 7.06 (2.98-16.70) % 95 Güven Aralıgı (GA)], periferik zonda hipoekoik nodül varlıgında ise 3 kat [OO: 2.73 (1.18-6.28)%95 GA] arttıgı görüldü. Sonuç: Prostat kanseri tanısında TRUS'nin yeri sınırlıdır ve daha çok biyopsi kılavuzu olarak kullanılır. Bununla birlikte, bu çalısmanın sonuçları bahsedilen TRUS bulgularının varlıgında kanser yakalama olasılıgının anlamlı biçimde arttıgını ortaya koymaktadır. Nodüle yönelik biyopsi protokollerine benzer sekilde heterojen periferik zon varlıgında alınan biyopsi örneklerinin sayısının artırılmasına dayanan bir çalısma planı ile sunulan çalısmanın geçerliligi degerlendirilebilir.Purpose: To overview transrectal ultrasonography (TRUS) guided prostate biopsy cases and to evaluate the potentially useful sonographic criteria for the diagnosis of prostate cancer. Methods:Between January 2003 and June 2005, TRUS guided prostate biopsy specimens were obtained from 129 patients with a gray zone PSA level (4 - 10 ng/dl; average PSA: 6.9 ± 2.7 ng/dl). TRUS findings were compared with pathology results. Peripheral zone echostructure (homogenous or heterogeneous) and prostate contours (smooth or irregular) were classified subjectively. Presence of a hypoechoic nodule in the peripheral zone was noted, additional samples were obtained from the nodules. Results: 44 patients (34%) were found to have prostate adenocarcinoma. A statistically significant relationship was found between the peripheral zone echostructure - presence of hypoechoic nodule in the peripheral zone and pathological results (p=0.000 and 0.007, respectively). Prostate cancer detection rate increased 7 folds [Odds Ratio (OR): 7.06 (2.98-16.70) 95% Confidence Interval (CI)] when the peripheral zone was heterogeneous and 3 folds [OR: 2.73 (1.18-6.28) 95% CI] when there was a hypoechoic nodule in the peripheral zone. Conclusion:TRUS has a limited role in the diagnosis of prostate cancer and is especially used for biopsy guidance. On the other hand, the results of this study reveal a significant increase in cancer detection rate when the mentioned TRUS findings are present. Similar to the nodule targeted biopsies; the accuracy of the presented study can be evaluated with a prospective study including a larger number of biopsy specimens in case of peripheral zone heterogenity

Lesion characteristics, histopathologic results, and follow-up of breast lesions after MRI-guided biopsy

Purpose:We aimed to assess the effectiveness of magnetic resonance imaging (MRI)-guided vacuum-assisted breast biopsy (VABB), evaluate and compare the characteristics and histopathologic findings of lesions, and overview the follow-up results of benign lesions.Methods:MRI findings and histopathologic results of breast lesions biopsied by MRI-guided VABB between 2013 and 2016 were retrospectively analyzed. MRI findings closely related with malignancy were investigated in particular. Follow-up results of benign lesions were evaluated.Results:MRI-guided VABB was applied to 116 lesions of 112 women. Of the lesions, 75 (65%) were benign, while 41 (35%) were malignant. Segmental (94%), clustered (89%), and clustered ring (67%) non-mass-like enhancement patterns were found to be more related with malignancy. False-negative rate of MRI-guided VABB was 12%, underestimation rate was 21%. One of the 54 followed-up benign lesions had a malignant result.Conclusion:MRI-guided VABB is a reliable method for the diagnosis of breast lesions that are positive only on MRI. Follow-up results show that cancer detection rate is low for radio-pathologically concordant lesions. Further multicenter studies with larger patient population are needed to elucidate these results

Paget's disease of the breast: a case report

Our case is a twenty-eight-year-old female lady who admitted to dermatology clinic of our university hospital with itchy lesions on her nipple-areolar complex of her right breast. She had these symptoms and signs for nearly two years and these lesions did not respond to topical treatment. Punch biopsy of the lesion revealed Paget's disease of the breast and the patient was referred to general surgery department. A sharply demarcated erythematous lesion with yellowish crusts were found at the nipple-areolar complex of right breast. No lumps were palpated in both of the breast and axillary examination was normal bilaterally. Mammography of right breast revealed pleomorphic microcalcifications with suspicious features of malignancy in the upper outside quadrant of the breast. Vacuum-assisted biopsy was performed and histopathological examination revealed İntraductal carcinoma. Skin sparing mastectomy and an immediate breast reconstruction with a Becker prosthesis was performed. The incidence of Paget disease below the age of thirty and the clinicopathological features of the disease were discussed in this case report

Problem-solving breast MRI: useful or a source of new problems?

PURPOSE:We aimed to evaluate the findings and results from breast magnetic resonance imaging (MRI) examinations performed for problem-solving purposes due to inconclusive conventional imaging findings.METHODS:Imaging findings, biopsy and follow-up results were retrospectively evaluated for breast MRI performed for problem-solving purposes at our department between January 2011 and December 2016 for cases whose mammography, tomosynthesis, or ultrasonography findings were inconclusive. RESULTS:Lesions were identified in 414 of 986 problem-solving MRI examinations, and 13.3% of these lesions were diagnosed as malignant. A total of 124 lesions were additionally found by MRI, and 9.7% of these lesions were diagnosed as malignant. MRI produced false-negative results in four cases. In cases whose conventional imaging methods yielded indefinite results, the sensitivity, specificity, negative and positive predictive values of MRI were found to be 96.3%, 83%, 99.3%, and 46.5%, respectively. For the additional lesions identified, the sensitivity, specificity, negative and positive predictive values of MRI were found to be 91.7%, 69%, 98.7%, and 24%, respectively.CONCLUSION:Breast MRI is a reliable problem-solving method for excluding malignancy that cannot be confirmed by conventional imaging. In such cases, additional findings from MRI may help identify new cancers that cannot be detected with conventional methods. However, it has moderately low specificity which may cause unnecessary biopsies, follow-ups, and anxiety to patients

A new methodology for multi - echelon inventory management in stochastic and neuro - fuzzy environments

Managing inventory in a multi-echelon supply chain is considerably more difficult than managing it in a single-echelon one. A strategy that optimizes inventory one echelon at a time results in excess inventory without necessarily improving service to customer. In this paper, a methodology for effective multi-echelon inventory management is proposed. Subsequently; a neural network simulation of the model is then presented with the support of neuro-fuzzy demand and lead time forecasting, and finally its performance is calculated using performance metrics selected from the SCOR model. The results show that, the inventory is efficiently deployed and uses realistic breakdowns. The proposed methodology aims to provide an important tool for the management of general N-echelon tree-structured supply chains that overcomes some of the deficiencies of competing methodologies