Molecular Mechanisms of Breast Cancer Metastasis

Breast cancer (BC) is one of the most frequently occurring diseases with high morbidity and mortality rates in the world today. BC cells live under stress with altered pathway signaling, chromosome and microsatellite instability, aneuploidy, hypoxia, low pH, and low nutrient conditions. In order to survive and reproduce in these stressful environments, BC cells rapidly undergo adaptive mutations, rearrange their chromosomes, and repress tumor suppressor genes while inducing oncogene activities that cause the natural selection of cancer cells and result in heterogeneous cancer cells in the tumor environment. Unfortunately, these genetic alterations result in aggressive BC cells that can not only proliferate aggressively but also migrate and invade the other tissues in the body to form secondary tumors. In this review, molecular mechanisms of metastasis of BC subtypes are discussed

Important Points of Diagnosis and Treatment Strategy of Intraperitoneal Bladder Perforation due to Blunt Pelvic Trauma in a Pediatric Case

Intraperitoneal bladder perforation is a vital condition that ischaracterized by perforation of the bladder into the intra-abdominalarea. It can lead to severe peritonitis and a delayed diagnosis canbe life-threatening. Bladder perforations are occurred by highenergy blunt trauma that disrupts the bony pelvis, direct blowto a distended bladder, penetrating traumas, urogynecologicalinterventions, indwelling catheters and iatrogenic causes. A 9-yearold boy who was involved in a moderate velocity a motor vehicleaccident was referred to our hospital due to pelvic fracture. Primaryassessment of the patient suggested hemodynamic stability withoutany signs of peritonitis and/or distention. With this case report,we aimed to present the clues in the diagnosis of intraperitonealbladder perforation and our treatment strategy in cases where thesymptoms and signs are insufficient to show intraperitoneal bladderperforation.</p

ADDITION OF A TRANSFIXION SUTURE TO THE PURSE‐STRING SUTURE DURING LAPAROSCOPIC INGUINAL HERNIA REPAIR INCREASES PERI‐HERNIA NECK SAC COLLAGEN FORMATION

Aim: Several laparoscopic inguinal hernia repair (IHR) andsuture techniques have been developed. We have been performing single portlaparoscopic IHR with ''Single Port Incisionless – Intracorporeal ConventionalEquipment-Endoscopic Surgery'' (SPICES) method since 2005. In this method,transfixion suture was placed in addition to intracorporeal purse-stringsuture. An experimental study was conducted to investigate the effects ofsuture techniques on collagen formation, which is an indicator of fibrosis inthe peri-hernia neck sac. Methods: Thirty-five adult male, Wistar-Albino rats (260-300 g)were used in the current study. Rat testes being intraabdominal physiologicallyprovided an open inguinal channel model. The testes were descended to thescrotum with silk suture. Suture techniques were applied and on 15thday post-operative inguinal channels were examined.Results were statistically analyzed and a p-value&lt;0,05 was considered statistically significant. There were 5 experimental groups:Group 1: Control group (n=7) Group 2: Sham group (n=7) Group 3: IHR with purse-string suture only(n=7) Group 4: IHR with transfixion suture only(n=7) Group 5: IHR with purse-string suture plustransfixion suture (n=7) Main results: Collagen thickness of the peritoneum around theinternal inguinal ring were similar in the control and sham groups. Thecollagen thickness in group 5 was significantly higher compared with groups 4and 3 (p&lt;0.001). However, no statistical difference was found betweengroups 4 and 3 (p=0.5468).Conclusion: The combined use of purse-string and transfixionsuture in laparoscopic inguinal hernia repair stimulates collagen formation,hence fibrosis, the most and thus prevents recurrence.</p

THE EFFECT OF BODY MASS INDEX ON PERMANENT TUNNELED INTRAVASCULAR CATHETER COMPLICATIONS IN PEDIATRIC PATIENTS

Aim: Permanent tunneled intravascular catheters (PTIC) areincreasingly used in children. Although the effects of body mass index (BMI) oncomplications in different surgical procedures in children have been studied,there is no study evaluating the effects of BMI on management of PTIC. Herein,we aimed to evaluate the correlation between BMI and complications seen in childrenwith PTIC.Methods: Patients who underwent PTIC placement between 2006and 2022 were analyzed retrospectively. Demographic characteristics, underlyingdiseases, catheter indications, surgical reports, BMI values and complicationswere evaluated. BMI values were evaluated in five groups according topercentile (p) ranges. Results were statistically analyzed and a p-value &lt;0,05 was considered statistically significant.Results: 400 patients were included in the study – 182 female(45.5 %) and 218 male (54.5 %). Intravascular catheter line-associatedbloodstream infection (CLABSI) and wound infection (WI) were the most commoncomplications. The BMI percentile groups were &lt;3 p, 3-15 p, 15-85 p, 85-97 pand &gt;97 p, containing 26, 26, 259, 58, 31 patients respectively. CLABSI was foundto be highest in the &lt;3 p group (13 patients 50 %). As BMI decreased, CLABSIrates have been found to be significantly increased (p &lt;0.001). WIwas found to be highest in the &gt;97 p group (17 patients, 44.7 %). WI rateswere found significantly higher as the patients BMI increases (p &lt;0.001).Conclusion: While patients with higher BMI are at more risk ofWI, the risk of CLABSI decreases. It appears that BMI has a protective effecton CLABSI.&nbsp;</p

Çocukluk çağında nadir bir olgu: İzole brakiosefalik ven anevrizması ve mediastinal kistik higroma birlikteliği

Giriş: Kistik higroma (KH), lenfatik sistemden kaynaklanan çocukluk çağının benign konjenital birmalformasyondur. KH, yerleşim olarak en sık yüz ve boyun bölgesinde yerleşmekte olup olguların %1’indetoraksa uzanım veya izole olarak mediastinal yerleşim görülebilir. Mediastinal KH ve ana damarsal yapılardaanevrizma birlikteliği oldukça nadir görülmektedir. Burada, pulmoner hava yolu malformasyonunu taklit edenmediastinal KH ile izole sakküler brakosefalik ven anevrizması birlikteliği olan nadir bir olgu sunulmaktadır.Olgu: Bilinen bir hastalığı olmayan 5 yaşında kız hasta göğüs ağrısı yakınması ile başvurdu. Laboratuvar bulgularınormal sınırlarda olan hastanın çekilen akciğer grafisinde sol üst hemitoraksta kitle imajı saptandı. Hastanınyapılan ileri incelemelerinde, yüksek çözünürlüklü bilgisayarlı tomografi ve manyetik rezonans görüntülemelerisol üst mediasten yerleşimli 5x6 cm’lik konjenital pulmoner hava yolu malformasyonu ile uyumlu kitle vekomşuluğunda izole brakiosefalik ven anevrizması olarak raporlandı. Anevrizmanın kitle ile ilişkisinideğerlendirmek amacıyla konvansiyonel anjiografi yapıldı. Anjiografi sırasında kitlenin anormal arteriyel vevenöz anatomisi net olarak görüldü. Median sternotomi ile kitle eksizyonu yapıldı, brakiosefalik ven anevrizmaonarıldı. Ameliyat sonrası 2. günde beslenmeye başlayan hastanın 4. günde tüp torakostomisi çekildi ve 5. gündetaburcu edildi. Kitlenin histopatolojik incelemesi KH olarak raporlandı.Sonuç: Mediastinal yerleşimli kistik kitle ve komşuluğunda saptanan büyük ven anevrizmalarında KH ön tanıolarak düşünülmelidir. Bu olgudan hareketle, radyolojik çalışmalarda majör vasküler anomalilerin varlığındamutlaka konvansiyonel anjiyografi yapılması gerektiğini, kitlenin cerrahi diseksiyonu sırasında hayati organlardanve frenik sinirden titiz diseksiyonun başarılı eksizyon için önemli olduğunu düşünüyoruz.Anahtar Kelimeler: Kistik higroma, Anevrizma, Anjiografi&nbsp;Introduction: Cystic hygroma (CH) is a benign congenital malformation in childhood derived from the lymphaticsystem. CH are mostly located in the cervico-facial region and nearly 1% of CH extend into or primarily involvethe mediastinum. Mediastinal CH adjacent to aneurysmal veins are extremely rare. We herein report a rare casewith the mediastinal CH associated with isolated saccular brachiocephalic vein aneurysm, mimicking congenitalpulmonary airway malformation.Case: A healthy 5-year-old girl presented with chest pain. The patient's laboratory findings were within normallimits, and a mass image was detected in the left upper hemithorax in the chest X-ray. In the further examinationsof the patient, high resolution computed tomography and magnetic resonance imaging revealed a 5x6 cm masslocated in the left upper mediastinum, consistent with congenital pulmonary airway malformation, and isolatedbrachiocephalic vein aneurysm in its vicinity. Conventional angiography was performed to evaluate therelationship of the aneurysm with the mass. Abnormal arterial and venous anatomy of mass was visible clearlyduring angiography. Mass excision was performed with median sternotomy, brachiocephalic vein aneurysm wasrepaired. The patient started feeding on the 2nd postoperative day, tube thoracostomy was removed on the 4th dayand was discharged on the 5th day. Histopathological examination of the mass was reported as CH.241Conclusion: In the case of an intrathoracic large vein aneurysm and a mediastinal mass, the CH should beconsidered as a preliminary diagnosis. Based on the present case, we suggest that conventional angiography shoulddefinitely be performed in the presence of major vascular anomalies in radiologic studies, meticulous dissectionfrom vital organs and phrenic nerve during surgical dissection of the mass are important for successful excision.</p

AN UNUSUAL OVARIAN GERM CELL TUMOR AND HISTOPATHOLOGICAL FINDINGS

Aim: Mixed germ cell tumors (MGCT) of ovary are rareaggressive cancers affecting young adolescent girls. Most MGCT consist ofdysgerminoma accompanied by endodermal sinus tumors, immature teratoma orchoriocarcinoma. Besides radiologic imaging, tumor markers such as alphafeto-protein (AFP), lactate dehydrogenate (LDH) and CA-125, contribute to thediagnosis, prognosis, and follow-up of the disease. Modality of treatment isusually fertility sparing surgery followed by chemotherapy. Herein, we report aunique case of giant ovarian MGCT and its pathological findings.Case description: A 7-year-old girl with no prior historyadmitted to the emergency room with an abdominal mass. On physical examinationabdominal distention without pain was noted. Computed tomography (CT) showed a23 cm long mass containing heterogeneous cystic lesions, including areas ofcontrast and thick septations. Additional magnetic resonance imaging could notdetermine its origin. Only CA-125 was found to be high (170 U/mL), AFP, LDH andother tumor markers were negative. An explorative laparotomy was performed. Amulticystic, grape-like mass surrounded by omentum covering the entire abdomenwas found (Figure 1). Left ovary originated tumor was carefully dissectedwithout any rupture in addition to salphingo-oopherectomy. Pathology wasreported as MGCT with yolk sac dominancy. However, both tissue and serum AFPlevels were negative. DICER-1 mutation was found. Patient received chemotherapypostoperatively.Conclusion: Tumor markers can be helpful for diagnosis of MGCT. However,this patient is the first case which shows negative AFP on tissue while beingyolk sac dominancy with an unusual appearance.</p