Langerhans cell histiocytosis involving temporal bone: A case report [Temporal kemik yerleşimli langerhans hücreli histiositosis: Bir olgu sunumu]

Objective: Langerhans cell histiocytosis is a benign proliferative disease of langerhans type histiocytes. This type is the localized form of histiocytosis X group diseases. Ninety percent of patients are between 5 and 15 years of age. Case Presentation: A 29-year-old male patient consulted to neurosurgery clinic with symptoms of headache and swelling under skin of the right side of his head. The mass, which was detected in the right temporoparietal bone was excised totaly The patient, whose histopathology was reported as histiocytosis X was referred to medical oncology clinic. Conclussion: Langerhans-cell histiocytosis should be considered in the differential diagnosis of young patients, whose rontgenograms demonstrated osteolytic bone lessions, and advanced examinations should be performed.. Usually, surgical excision suffices. Appropriate therapy is important factor for the patient’s prognosis. Therefore localisation of the lesion, and identification of its subtype is very important for accurate planning of therapy approach. © 2014, Logos Medical Publishing. All rights reserved

Coexistence of tuberous sclerosis complex and malignant melanoma

PubMedID: 24276112Tuberous sclerosis complex (TSC) is a multisystem genetic disorder characterised by widespread hamartomas in organs such as the skin, brain, heart, lung, liver and kidney. Although associations of TSC with hamartomas, angiomyolipomas and fibromas have been reported, there has been no report of its association with malignant melanoma. Herein, we describe a 31-year-old man with malignant melanoma associated with TSC. The patient had a history of epilepsia, multiple hypomelanotic macules, periungual fibromas and multiple hepatic lesions. Malignant melanoma was diagnosed by hepatic biopsy. To the best of our knowledge, this is the first report of malignant melanoma coexisting with TSC in the literature. We also present and discuss the imaging findings, prognosis, underlying mechanisms and practical approaches in relation to the disease

Primary cutaneous small-cell carcinoma: A case report

Most commonly arising in the gastrointestinal and genitourinary tracts, extrapulmonary small-cell carcinoma is quite rare. Although its prognosis is very poor, complete remission or even cure can be achieved by combination of different treatment modalities. We report here a 32-year-old woman with a cutaneous gluteal mass diagnosed as small-cell carcinoma of the skin. Combination chemotherapy containing cisplatin and etoposide was started. Radiotherapy was administered after two courses of chemotherapy. Following radiotherapy, additional 4 courses of chemotherapy were given. She has been in remission for three years with no evidence of tumor recurrence. © 2010 Springer Science+Business Media, LLC

Malignant mixed Mullerian tumor of the ovary with two cases and review of the literature

PubMedID: 21298439Introduction: Malignant mixed Müllerian tumor (MMMT) of the ovary is a rare and highly aggressive tumor. It accounts <1% of all ovarian carcinomas. It is characterized by the presence of both carcinomatous and sarcomatous components and tends to occur in low parity postmenopausal woman. These are mixed, mostly monoclonal tumors, and the predominance of the stromal component aggravates the prognosis. The staging system for ovarian and primary peritoneal cancer is also used for MMMT. After complete surgical staging, patient with stage II-IV at the time of surgery should have postoperative chemotherapy. Chemotherapy can be considered for stage I MMMT. Its optimal treatment is debatable. Taxane and platinum combination is standard for the epithelial ovarian carcinoma. There is very limited literature reporting this combination therapy in ovarian MMMTs. Case 1 and Case 2: We presented two cases of stage III primary ovarian MMMT. The patients were treated with the taxane/platin combination, without adverse events following surgery, and remained in clinical remission in Case 1 at follow-up. Case 2 has progressed after first line taxane/platin regimen and treated like epithelial ovarian carcinoma. Case 1 was in complete remission in the follow-up visit 2 years later. Case 2 died 14 months later after the tumor was initially diagnosed. Conclusion: Predominating carcinomatous or sarcomatous component should be taken into consideration in predicting the response and planning the chemotherapy protocol. © 2011 Springer-Verlag

Primary intrapulmonary thymoma associated with myasthenia gravis

PubMedID: 22610163Primary intrapulmonary thymomas are very rare. So far, research in the field has identified only 31 cases. In all databases, a total of two published articles describing primary intrapulmonary thymoma with myasthenia gravis were encountered between 1950 and 2010. We admitted a 58-year-old male patient with a mass in the right lower lobe of his lung. The tumor was excised, and histological findings were found to be consistent with Type AB thymoma. The patient was intubated due to respiratory distress during the postoperative period, and his acetylcholine receptor antibody was determined positive. He was diagnosed with myasthenia gravis. Pyridostigmine therapy and plasmapheresis were scheduled; yet, we could not begin therapy because of rapid deterioration of the patient's respiratory status due to myasthenia gravis and subsequently resulting in intubation-Associated pneumonia. The patient's health rapidly worsened, and he died. © The Japanese Association for Thoracic Surgery 2012

Effect of the cumulative dose of zoledronic acid on the pathogenesis of osteonecrosis of the jaws

Bisphosphonate-related osteonecrosis of the jaws (BRONJ) is a severe bone disease for which the pathogenetic mechanisms and risk factors are not fully understood. The present study evaluated the data of 652 patients with bone metastasis that had undergone treatment with biphosphonates. Subsequently, 24 patients with BRONJ and 20 control patients without BRONJ that were treated with zoledronic acid were enrolled. It was found that BRONJ occurred in 3.6% of patients. The mean age and the administration of dental treatment were found to be significantly associated with BRONJ development (P=0.049 and P=0.013, respectively). The cumulative dose median in the BRONJ group was found to be significantly higher compared with the cumulative dose average in the control group (P=0.037). In addition, at the time of BRONJ development, improvement in the disease was determined to be better in the BRONJ group than in the control group (P=0.031). The present study determined that age, the existence of dental extraction and the cumulative dose of zoledronate were all important risk factors in BRONJ development. © 2015, Spandidos Publications. All rights reserved

Retrospective analysis of neoadjuvant chemotherapy for breast cancer in Turkish patients

Background: Neoadjuvant systemic chemotherapy is the accepted approach for women with locally advanced breast cancer. Anthracycline- and taxane-based regimens have been extensively studied in clinical trials and consequently are widely used. In this study aimed to research the complete response (pCR) rates in different regimens for neoadjuvant setting and determine associated clinical and biological factors. Methods: This study included 63 patients diagnosed with breast carcinoma among 95 patients that had been treated with neoadjuvant chemotherapy between 2007 and 2010. TNM staging system was used for staging. The histologic response to neoadjuvant chemotherapy was characterized as a pCR when there was no evidence of residual invasive tumor in the breast or axillary lymph nodes. Biologic subclassification using estrogen receptor (ER), progesterone receptor (PR), HER2 were performed. Luminal A was defined as ER+, PR+, HER2-; Luminal B tumor was defined as ER+, PR-, HER2-; ER+, PR-, HER2+; ER-, PR+, HER2-; ER+, PR+, HER2+; HER2 like tumor ER-, PR+, HER2+; and triple negative tumor ER, PR, HER2 negative. Results: Patients median age was 54.14 (min-max: 30-75). Thirty-two patients (50.8%) were premenapousal and 31 (49.2%) were postmenapousal. Staging was performed postoperatively based on the pathology report and appropriated imaging modalities The TNM (tumor, lymph node, metastasis) system was used for clinical and pathological staging. Fifty-seven (90.5%) were invasive ductal carcinomas, 6 (9.5%) were other subtypes. Thirty nine (61.9%) were grade II and 24 (38.1%) were grade III. Seven (11.1%) patients were stage II and 56 (88.9) patients were stage III. The patients were classified for ER, PR receptor and HER2 positivity. Seventeen patients had complete response to chemotherapy. Forty patients (63.5%) were treated with dose dense regimen (cyclophosphamide 600 mg/m2 and doxorubicine 60 mg/m every two weeks than paclitaxel 175 mg/m2 every two weeks with filgrastim support) 40 patients (48%) were treated anthracycline and taxane containing regimens. Thirteen patients (76%) from 17 patients with pCR were treated with the dose dense regimen but without statistical significance (p=0.06). pCR was higher in HER2(-), ER(-), grade III, premenopausal patients. Conclusion: pCR rate was higher in the group that treated with dose dense regimen, which should thus be the selected regimen in neoadjuvant setting. Some other factors can predict pCR in Turkish patients, like grade, menopausal status, triple negativity, percentage of ER positivity, and HER2 expression

The effect of chemoradiotherapy on survival in locally advanced unresectable non-small cell lung cancer patients: Experience from the southeast region of Turkey

Introduction: Lung cancer is the leading cause of cancer mortality worldwide. Smoking cigarettes is the predominant risk factor. Chemotherapy (CT) plays an integral part in treating locally advanced-non-small cell carcinoma of the lung (LA-NSCLC) as it improves survival in all subgroups of patients. In this study, our aim was to perform a retrospective overview of our data in LA-NSCLC patients and to explore which CT regimen is more effective during chemoradiotherapy (CRT). Materials and methods: One hundred and thirty-two patients were included in this study. Seventy-six of the patients received 60 Gy radiotherapy (RT) concomitantly with chemotherapy at a weekly dose of 20 mg/m2 docetaxel and 20 mg/m2 cisplatin (P). Five patients received P 50 mg/m2 intravenously (IV) on days 1, 8, 29, and 36 as well as etoposide (E) 50 mg/m2 IV on days 1-5 and 29-33 concurrently with 60 Gy chest RT. Nine patients received weekly doses of carboplatin AUC 2 and paclitaxel 50 mg/m2 and fortytwo patients received only cisplatin 20 mg/m2 concurrently with 60 Gy chest RT. Results: The median age of the deceased patients was 61.20±9.96 and 57.70±8.60 for surviving patients. Following concomitant CRT, 26 patients (20%) showed complete response and 66 (50%) showed partial response (total response rate was 70%). The median follow-up period was 22 months (range: 8-36 months). Esophagitis developed in ten (13%) patients, neutropenia in fifteen (9%) patients and pneumonitis in eleven (12%) patients, as grade III-IV toxicity advanced due to concomitant CRT. Consolidation chemotherapy was given to patients with partial response. Conclusio: There are no clinical trials that have established the optimal regimen for concurrent CRT. In our study, the most effective regimen with CRT was carboplatin and paclitaxel. This finding should be evaluated in larger clinical trials

Sorafenib related three different skin toxicities: A case report [Sorafenib i·lişkili üç farklı deri toksisitesi: Olgu sunumu]

"Targeted therapy" has gained importance as a consequence of molecular genetics and biological research development. Sorafenib, a multi-tyrosine kinase inhibitor, is one of the options in targeted therapy. Its effectiveness was proven unresponsive to chemotherapy and radioactive iodine of metastatic well differentiated thyroid carcinoma by Phase II studies. In all the side effects of sorafenib, skin toxicities can be seen at a rate of 25%. Hand-foot syndrome is one of the very important skin toxicities, observed at a rate of 30%, depending upon the diversity and seriousness of the symptoms. For this reason, especially in the absence of alternatives in metastatic thyroid carcinoma treatment, and the approach to the toxic effects of sorafenib, the clinical benefit is considerable with treatment continuance. In this article, it was aimed to consider the use of sorafenib and three different skin toxicities related with the treatment; its management, situation and treatment approach in a patient having lung metastasis following postoperative and maximum radioactive iodine posttreatment. In addition, the hand-foot syndrome caused by both other tyrosin kinase inhibitors and chemotherapy agents, together with differences and similarities in the management of this case, were emphasised

Diagnostic and prognostic roles of DOG1 and Ki-67, in GIST patients with localized or advanced/metastatic disease

Aim: Gastrointestinal stromal tumor is the most common mesenchymal neoplasia in the gastrointestinal tract and has a broad spectrum of pathological patterns and also clinical features changing from benign to malignant. Although the well-characterized parameters to predict the outcome have been the size and the mitotic index of the tumor in the patients with early-staged disease, bulky recurrent or metastatic tumor, resistance to medical treatment and mutation analysis are the prognostic factors for advanced stage-GIST. The aim of this study is to investigate new and more practical tissue markers, such as DOG1 and Ki-67 to specify the GIST diagnosis and also to predict the outcome in GIST patients with both localized and advanced staged disease. Methods: For the last 14 years, from 1999 to 2013, 111 patients with a histopathological GIST diagnosis from the hospital files were enrolled to the study. In their parafin-embedded tissue samples, DOG1 and Ki-67 expressions were evaluated with immunohistochemisty by two independent pathologists from Cukurova University Medical Faculty. Patients were divided into two groups, the patients with localized disease treated by surgery and the patients with advanced/metastatic disease. DOG1 and Ki-67 expressions were corelated with other diagnostic and prognostic histopathological markers and also the clinical outcome in these two group of patients. Results: The specificity and the sensitivity of DOG1 in GIST diagnosis was found 94 and 43%, respectively. DOG1 expression was especially important in the diagnosis of c-kit negative cases. Although Ki-67 was not found a statistically significant prognostic factor for overall survival, it was strongly corelated with mitotic index which is a well-known standart prognostic factor for localized disease. Discussion: DOG1 seems to be an important diagnostic tool for clinically suspected GIST diagnosis in both advanced or early staged patients whose tumours are c-kit expression negative. On the other hand, Ki-67 can be a stronger candidate for prognostic factor instead of mitotic index to identify the proliferative cells out of mitotic phase but this statement needs be prospectively validated on studies with large number of patients