Case Report Bilateral Adrenal Incidentalomas: A Rare Presentation of Lung Cancer

Adrenal incidentalomas are found incidentally during a radiologic examination performed for indications other than an adrenal disease, and 15% of them are bilateral adrenal masses. This study describes a 51-year-old male smoker patient admitted with diabetes mellitus. An abdominal ultrasonography performed due to his anemia revealed bilateral adrenal masses. His chest X-ray showed abnormal 10 cm opacity at the right upper lung, and brain, thorax, and abdomen CT scans showed multiple lesions compatible with lung cancer metastases. The pathological examination of the transthoracic lung biopsy specimen was consistent with lung adenocarcinoma. Findings in this patient indicate that, in middle aged patients with bilateral adrenal mass and a history or finding of any malignancy, the first diagnosis which should be considered is adrenal metastasis, and confirming the diagnosis by adrenal biopsy may be useless. Furthermore, screening all smoking patients by chest X-ray or thoracic CT for lung cancer may not be accepted as a routine procedure, but in smokers admitted to a hospital due to signs and symptoms attributed to a pulmonary disease, at least a chest X-ray should be requested

Does retinitis pigmentosa relate with polycystic kidney disease?

Autosomal dominant polycystic kidney disease (ADPKD) is one of the most common genetic disorders. A 21-year-old woman presented with temporary visual loss and gross hematuria. Fundoscopy showed retinitis pigmentosa, which was confirmed by electroretinogram. Her serum creatinine concentration was 1.6 mg/dl, and her renal ultrasonography revealed bilateral polycystic kidneys; she was unaware of having this condition. In this patient, there was probably an inherited ciliary defect, which may explain the association of ADPKD and retinitis pigmentosa

Tumor Volume Is a Better Prognostic Factor than Greatest Tumor Diameter in Operated Stage I-III Non–Small-Cell Lung Cancer

Introduction: The aim of this study was to investigate the prognostic impact of tumor volume (TV, recorded from surgical specimens) on patients with stage I-III non–small-cell lung cancer (NSCLC) after complete resection. Materials and Methods: A total of 129 patients with stage I-III NSCLC diagnosed and underwent curative resection from 2007 to 2014 in our center were included in the study. Their clinico-pathological factors were retrospectively reviewed. Overall survival (OS) and disease-free survival (DFS) analyses were performed with the Kaplan-Meier method and Cox's hazard model. According to the ROC analysis, patients were divided into 2 groups (Group 1: 58 patients <30.3 cm3 and Group 2: 71 patients ≥30.3 cm3) and the OS and DFS values were compared. Results: Median TVs and greatest tumor diameter were 12 cm3 (0.1-30) / 3 cm (0.4-6.5) in Group 1 and 98 cm3 (30.6-1521) / 6 cm (3.5-21) in Group 2. Median OS was 53 (5-177) months in Group 1 and 38 (2-200) months in Group 2 (P < .001). DFS was similar in both group (28 [1-140] vs. 24 [1-155] months, Introduction P = .489). Kaplan-Meier curves showed significantly higher OS rates in Group 1 than Group 2 (P = .04). In multivariable analysis (TV, tumor T stage, tumor N stage, receiving adjuvant radiotherapy) showed that TV (HR: 0.293, 95% CI: 0.121-0.707, P = .006) and tumor N stage (HR: 0.013, 95% CI: 0.001-0.191, P = .02) were independent factors associated with OS. Conclusion: Tumor volume, not considered in the routine TNM classification, may improve prediction accuracy of overall OS in operated Stage I-III NSCLC

Bilateral Adrenal Incidentalomas: A Rare Presentation of Lung Cancer

Adrenal incidentalomas are found incidentally during a radiologic examination performed for indications other than an adrenal disease, and 15% of them are bilateral adrenal masses. This study describes a 51-year-old male smoker patient admitted with diabetes mellitus. An abdominal ultrasonography performed due to his anemia revealed bilateral adrenal masses. His chest X-ray showed abnormal 10 cm opacity at the right upper lung, and brain, thorax, and abdomen CT scans showed multiple lesions compatible with lung cancer metastases. The pathological examination of the transthoracic lung biopsy specimen was consistent with lung adenocarcinoma. Findings in this patient indicate that, in middle aged patients with bilateral adrenal mass and a history or finding of any malignancy, the first diagnosis which should be considered is adrenal metastasis, and confirming the diagnosis by adrenal biopsy may be useless. Furthermore, screening all smoking patients by chest X-ray or thoracic CT for lung cancer may not be accepted as a routine procedure, but in smokers admitted to a hospital due to signs and symptoms attributed to a pulmonary disease, at least a chest X-ray should be requested

Pulmonary Extramedullary Hematopoiesis Mimicking Plasmacytoma in a Patient with Multiple Myeloma

A 42-year-old male patient was admitted to our hospital for planning autologous hematopoietic stem cell transplantation (auto-HSCT). He was diagnosed as multiple myeloma (IgG type Kappa) in 2003. His physical examination was normal with no important abnormality on laboratory evaluation. Chest radiography performed for routine evaluation prior to transplantation revealed a large, welldefined mass, that had obtuse angles with the chest wall consistent with extraparenchymal lesion superposed on second and third ribs. Also, there were multiple bony structures demonstrating changes of destructive effects of multiple myeloma. Computed tomography (CT)-guided biopsy was obtained from the mass by transthoracic fine-needle aspiration (FNAB) method. Biopsy was reported as extramedullary hematopoiesis (EMH) contrary to our expectation of multiple myeloma

Haematologic Parameters in Metastatic Colorectal Cancer Patients Treated with Capecitabine Combination Therapy

Background: The standard treatment in the metastatic colorectal cancer consists of 5-FU based infusional regimens. However, with oral fluoropyrimidines, equal tumor responses may be obtained. Capecitabine causes macrocytosis of the cells by inhibition of DNA synthesis. In this context, a relationship was found between mean corpuscular volume (MCV) and response to therapy in breast cancer patients treated with Capecitabine, but whether this relationship also pertains in colorectal cancer has not been established. Materials and Methods: A total of 102 metastatic colorectal cancer patients treated with a oxaliplatin (XELOX)+/- Bevacizumab combination were retrospectively evaluated. Patients were randomized into three groups. Hematological parameters (MCV, MPV, PCT, PLT, NLR) were recorded retrospectively, before treatment and after 3 cycles of chemotherapy. Results: After three cycles of therapy, 20 (19.6%) patients had progressive disease (PD), 41 (40.1%) had stable disease (SD), and 41 (40.1%) demonstrated a partial response (PR). In 62 (60.7%) treatment was with capesitabin plus XELOX therapy, and in 40 (39.2%) it was XELOX-Bevacizumab combination therapy. There was no difference among three groups before the treatment in terms of MCV, MPV, PCT, PLT, and NLR. MCV showed significant increase in chemotherapy response groups (PR and SD). In addition, a significant decrease was observed for platelet count in chemotherapy response groups. While NLR decrease was seen in only a PR group, PCT decrease was observed in all three groups. PCT and PLT values were higher in patients receiving Bevacizumab. Conclusions: PLT, PCT, MPV, and NLR values were decreased due to Capecitabine-based chemotherapy, however MCV was increased. PCT and PLT values were higher in patients who received Bevacizumab than those who did not. MCV, PLT, and NLR can be considered as important factors in predicting response to colorectal carcinoma treatment

THE RELATIONSHIP BETWEEN NEUTROPHİL / LYMPHOCYTES RATIO AND PLATELET / LYMPHOCYTES RATIO WITH PROGNOSIS IN OPERATED STAGE 1-2 OF NON- SMALL CELL LUNG CANCER DISEASE: ONE CENTRAL EXPERIENCE

Amaç: Nötrofil/lenfosit oranı (NLO) ve platelet/lenfosit oranı (PLO) ile çeşitli kanserlerin prognozu arasındaki ilişki gösterilmiştir. Ancak NLO ve PLO’ nun küçük hücreli dışı akciğer kanseri (KHDAK) prognozuna etkisi hala tartışmalıdır. Bu çalışmamızın amacı, hastanemizde radikal rezeksiyon uygulanan Evre 1-2 KHDAK hastalarında operasyon öncesi NLO ve PLO’ nun prognostik değerini araştırmaktır. Gereç ve Yöntemler: Çalışmaya 2001-2014 yılları arasında merkezimizde takip edilen ve radikal rezeksiyon uygulanan 59 Evre 1-2 KHDAK hastası dahil edilmiştir. Hastaların takip dosyaları incelenmiş ve gerekli bilgiler alınmıştır. NLO ve PLO’ nun optimal cut-off değeri için Receiver operating curve (ROC) analizi kullanılmıştır (NLO için 4,7, PLO için 199). NLO ve PLO’ nun genel sağ kalım (GSK) ve hastalıksız sağ kalım (HSK) üzerine etkisini incelemek için The Kaplan-Meier univariate analysis kullanılmıştır.  Bulgular: NLO ve PLO sınıflamaları ile klinik parametreler arasında yaş haricinde herhangi bir ilişki bulunmamıştır. NLO &lt;4,7 olan gurupta GSK ortalaması 53 ay, HSK ortalaması 43 ay, NLO &gt; 4,7 olan grupta ise GSK ortalaması 44 ay, HSK ortalaması 28 ay, bulundu (GSK için p=0,031, HSK için p=0,126). PLO &lt; 199 olan gurupta GSK ortalaması 55 ay, HSK ortalaması 39,5 ay, PLO &gt; 199 olan gurupta ise GSK ortalaması 42 ay, HSK ortalaması 30,6 ay olarak bulundu (GSK için p=0,020, HSK için p=0,856). Tartışma ve Sonuç: Tedavi öncesi yüksek NLO ve PLO değerleri opere akciğer kanseri hastalarında kötü prognoz için bağımsız belirteçlerdir. Preoperatif NLO ve PLO değerleri, Evre 1-2 KHDAK hastalarında radikal rezeksiyon öncesi,  prognostik bir parametre olarak kullanılabilir

Primary hepatic carcinosarcoma

BACKGROUND: Primary hepatic carcinosarcoma is a rare malignant tumor containing an intimate mixture of carcinomatous and sarcomatous elements. Reports on risk factors, epidemiology, and pathogenesis of the tumor as well as the experience in its treatment are limited

Prognostic Factors Obtained from Long-Term Follow-up of Pituitary Adenomas and Other Sellar Tumors

AIM: Pituitary adenomas do not have a single factor of aggressive behavior or recurrence. The objective of this study was to determine factors influencing the, prognosis in pituitary adenomas