Tubal splenosis: unusual location of the spleen

İntroduction: Splenosis is defined as the autotransplantation of splenic tissue to abnormal locations after splenic injury. Heterotopic spleen can be found within the abdominal and pelvic cavities. We report a tubal splenosis case in a 48 year old woman who underwent splenectomy following a blunt trauma 41 years prior to presentation. Case report: A 48 years old gravida 3, para 3, was admitted to our gynecology clinic for pelvic pain, menstrual irregularities and abnormal bleeding. The patient had a six months history of sonographically detected 40 x 20 mm pelvic mass. She also had a blunt trauma and splenectomy history from 41 years ago. Total abdominal hysterectomy with bilateral salpingo-oophorectomy was performed. Intraoperative exploration revealed a 40 mm sized suspicious mass immediately adjacent to the right fallopian tube. The histopathologic examination of the specimen reported normal splenic tissue with polymorphous small lymphocytes, granulocytes, and frequent hemosiderin laden macrophages. Discussion: Posttraumatic pelvic splenosis is a rare condition. Splenosis should be kept in mind as a differential diagnosis especially for patients with a history of posttraumatic splenectomy who are scheduled for pelvic mass surgery. Although most of the patients are diagnosed postoperatively, if preoperative diagnosis could be made, there is no medical indication for this normally functioning tissue to be resected

Hospitals, Unions, and Strikes

In April 12, 1967, the majority of the non-professional employees of St. Luke\u27s Hospital of Cleveland, Ohio, members of Local 47, Building Service and Maintenance Union, walked off their jobs and set up picket lines across the entrance of the Hospital. In addition to bringing into the limelight the extremely poor working conditions in modern non-profit hospitals, the strike also pointed out a serious shortcoming of the law in Ohio and most other states. Before we can fully understand the problems of employees in non-profit hospitals, it is useful to briefly review the history of the modern hospital

Leukemia Cutis and Second Primary Malignant Melanoma: An Extraordinary Case Report

Introduction: Chronic lymphocytic leukemia/small lymphocytic lymphoma (CLL/SLL) is the most common leukemia of adult. Patients with CLL/SLL are at higher risk for secondary malignancies such as skin, breast or lung tumours. Cutaneous infiltrates of CLL/SLL have been reported in association with squamous cell carcinoma (SCC), basal cell carcinoma (BCC) and actinic keratosis.Case Presentation: We present a patient with a previous history of CLL/SLL who developed a primary skin melanoma in the same area of leukemic infiltration, with the histological and immunohistochemical features.An 80-year-old man presented with an 3 cm nonpigmented, erythematous and ulcerated plaque on the abdomen. Microscopically, a primary melanoma with an ulcer and skin infiltration of CLL/SLL at the ulcer base was seen.Conclusion: Secondary cutaneous neoplasms can develop in patients with CLL/SLL and CLL/SLL infiltration can be associated with melanoma as in our case. The finding of a dense infiltrate of lymphocytes in cutaneous tumors should raise possibility of CLL/SLL and lead to a detailed examination

Synchronous Presentation of Two Extranodal Lymphomas: Follicular Lymphoma and Extranodal Marginal Zone Lymphoma of the Mucosa-Associated Lymphoid Tissue (MALToma)

Synchronous malignancies are rare conditions in oncology practices, generally seen as solid tumors with hematological neoplasms. However, occurrence of two different hematological malignancies in the same patient is extremely rare. Two primary malignancies should be considered especially in patients with extraordinary presentations and treatment resistance

Meme karsinomlarında sentinel lenf nodülü biyopsilerinin histopatolojik ve immunohistokimyasal değerlendirilmesi

Bu tezin, veri tabanı üzerinden yayınlanma izni bulunmamaktadır. Yayınlanma izni olmayan tezlerin basılı kopyalarına Üniversite kütüphaneniz aracılığıyla (TÜBESS üzerinden) erişebilirsiniz.Özet Meme karsinomu kadınlarda en sık görülen malignite olup, yüksek mortalite oranına sahiptir, kadınlarda akciğer kanserinden sonra ikinci sıklıkla ölüm nedenidir. Sentinel lenf nodülü biopsisi (SLNB) meme karsinomlu hastanın lenf nodülü durumunun belirlenmesinde yeni, minimal invaziv bir uygulamadır. Sentinel lenf nodülü (SLN), solid organ tümörlerinde, tümörün drene olduğu, metastaz yaptığı ilk lenf noduludur, bekçi, gözcü, aksilla hakkında bilgi verici lenf nodülü olarak adlandırılmaktadır. Tanısal doğruluk oranının yüksek olması, metodun hızla kabul görmesine neden olmuştur ve günümüzde rutin klinik uygulamalarda yoğun olarak kullanılmaktadır. Bu çalışmaya 2001-2005 yılları arasında Ege Üniversitesi Tıp Fakültesi Anabilim Dalı'nda sentinel lenf nodu biopsisi (SLNB) değerlendirilen 86 olgu dahil edildi ve bu olgular primer tümör eksizyon materyalleri (parsiyel mastektomi) ya da total mastektomi materyalleri ve aksiller diseksiyon uygulanmış olan olgularda aksillaya ait materyalleri ile birlikte incelendi. Sentinel lenf nodunda makrometastaz saptanan 16 olgudan 9'unda aksiller metastaz saptandı. Mikrometastaz ve ITC saptanan 9 hastadan ise sadece birinde aksiller metastaz gözlendi. Özellikle makrometastazlann aksiller metastaz yönünden predikti fonemi ortaya kondu. tntraoperatif değerlendirme amacıyla sentinel nod frozen seksiyonlarda malignite saptanan 15 hastanın tümünde parafın blok örneklerinde de makrometastaz gözlendi ve introperatif değerlendirme amacı ile frozen incelemesinin önemi ortaya kondu. İlginç olarak primer tümör tanısı DCIS olan bir hasada sentinal lenf nodu metastazı (ITC) saptandı. Sentinel lenf nodu metastazı saptanan hastalan Kİ67 ortalama değerleri metastazı olmayan hastalara göre anlamlı derecede yüksek bulundu. Tümörü iyi prognostik drupta yer alan hastalarda sentinel lenf nodu metastaz oranı daha düşük bulundu. 3

Intraorbital ectopic lacrimal gland mimicking malignant orbital tumor

A 6-year-old boy with left proptosis which was realized 2 months earlier was evaluated. The left eye movements were restricted in all gaze positions. The left lacrimal gland was hypertrophic on examination. An orbital magnetic resonance imaging revealed a mass lesion starting from the lacrimal gland region extending through the superior and lateral orbit causing a pressure on the lateral rectus muscle. An incisional biopsy from both the lacrimal gland and the orbital part of the mass revealed no tumor cells but minimally inflamed lacrimal gland tissue which supported an ectopic lacrimal gland in the orbit. Although rare, ectopic lacrimal gland of the orbit might mimic orbital malignancies in children. Histopathologic confirmation is mandatory for differential diagnosis

Amiloidozis tanısında zorluklar: Böbrek iğne biopsisinden kaçınılabilir mi?

Amyloidosis is a systemic disease and amyloid deposition in tissue has to be shown to reach the exact diagnosis. If there is a clinical suspicion of amyloidosis, adipose tissue or rectum biopsy is preferred. If amyloid deposition can't be shown, renal and/or other organ biopsies are done. Minute depositions and those which are evaluated improperly, could be missed. In this study, we have investigated the necessity of renal biopsy for determination of amyloidosis, by evaluation of other biopsies of cases with renal amyloidosis. Fifty-five cases with a diagnosis of renal amyloidosis in the last three years were included in this study. Thirty-five biopsies from other organs of the fifteen cases were reevaluated. Of these 35 biopsies, seven were from rectum, six frombone marrow, six mm stomach, three from liver, three from salivary gland, two from skin, two from adipose tissue, and one from bladder, muscle, jejunum, gingiva, intestine and kidney. Amyloid deposition was detected in other organ biopsies of fourteen cases. In ten of them diagnosis could be made without renal biopsy. Amyloid deposition was found in 6 rectum, 6 stomach, 3 salivary gland, 2 bone marrow, one skin, bladder, jejunum and kidney (without glomeruli) biopsies. In three of the cases other biopsies were done for determination of amyloid subtype and the etiology. Incomplete data, technical problems and insufficient biopsy were the reasons that cause delay in diagnosis. Amyloidosis can be identified if the patients' other organ biopsies are reevaluated with sufficient clinical data before considering a renal biopsy. In this situation it is possible to spare the kidney from biopsy.Amiloidozis sistemik bir hastalık olup kesin tanı için dokuda amiloid birikiminin gösterilmesi gereklidir. Klinik kuşku olduğunda öncelikle yağ doku ve rektum biopsileri tercih edilir, birikim saptanmazsa böbrek ve/veya diğer organ biopsileri yapılmaktadır. Ancak birikimler az olduğunda ve uygun koşullarda değerlendirilmediğinde gözden kaçabilir. Bu çalışmada böbrek biopsisinde amiloid saptanan olguların diğer biopsileri tekrar değerlendirilerek amiloid birikimi açısından böbrek biopsisinin gerekliliği araştırıldı. Çalışmaya son üç yıl içinde böbrek biopsisi ile amiloidozis tanısı almış 55 olgu alındı. Bu olguların 15'inin diğer organlara ait 35 biopsisi yeniden değerlendirildi. Biopsilerin 7'si rektum, 6'sı kemik iliği, 6'sı mide, 3'ü karaciğer, 3'ü tükrük bezi, 2'si deri, 2'si cilt altı yağ dokusu olup mesane, kas, jejunum, dişeti, barsak ve böbrek'e ait birer biopsi incelendi. Olguların 14'ünün diğer biopsilerinde de birikim saptandı, bunların 10'nunda böbrek biopsisi yapılmadan da amiloidozis tanısı konabileceği belirlendi. Amiloid birikimleri 6 rektum, 6 mide, 3 tükrük bezi, 2 kemik iliği ve birer deri, mesane, jejunum, glomerül içermeyen böbrek biopsisinde saptandı. Üç olguda diğer biopsiler amiloid tipi ve etiolojiyi belirleme için yapılmıştı. Tanıda gecikmeye klinik verilerin eksikliği, teknik sorunlar ve biopsinin yetersizliğinin neden olduğu belirlendi. Amiloidozis kuşkusu duyulan olgularda böbrek biopsisi uygulanmadan önce olgunun varsa diğer biopsileri yeterli klinik bilgi ile tekrar değerlendirildiğinde amiloid tanısı konulabilir. Bu şekilde böbrek iğne biopsisinden kaçınmak mümkündür