Small cell neuroendocrine carcinoma of the bladder with synchronous Warthin’s tumor of the parotid gland: A rare case and overview of the literature

Introduction. Neuroendocrine tumors (NETs) develop from the epithelium rich in enterochromaffin cells. NETs most commonly originate from the gastrointestinal and respiratory tract. NETs rarely occur in the urinary bladder. Synchronous tumor is defined as having two different tumors growing at the same time in an organ. NETs are frequently associated with synchronous or metachronous second-primary malignancies. In this paper, we describe a synchronous tumor: a small cell neuroendocrine carcinoma (SCNEC) of the bladder and a Warthin's tumor (WT) of the parotid gland, both of which are highly rare in the literature.  Case report. A 79-year-old male patient was admitted to the hospital with gross hematuria and nodular mass involving the wall of the urinary bladder. The bladder neck resection and transurethral bladder resection (TURB) were performed. The tumor consisted of small, uniform, round, and spindled-shaped cells with chromatin dark nuclei and numerous mitotic figures. The cells were immunoreactive for CD56, synaptophysin (diffuse), and keratin (focal). The diagnosis of SCNEC with focal urothelial carcinoma in situ component was established. PET-CT was performed for staging purposes, and it showed a residual/recurrent tumor behind the lumen of the bladder floor and two nodular lesions with metabolic activity in the left parotid. After the biopsy of the parotid gland, it was diagnosed as WT. No metastasis of SCNEC was found at the time of diagnosis, and the patient received four cycles of induction chemotherapy (Etoposide combined with carboplatin chemotherapy) followed by chemoradiotherapy.  Conclusion. In this case report, an extremely rare case of primary SCNEC of the bladder with synchronous of the parotid gland is presented, along with a discussion on the clinical presentation, immunohistochemical and cytomorphological characteristics, management, biological behavior, and prognosis

Affinity-Division Multiplexing for Molecular Communications with Promiscuous Ligand Receptors

A key challenge in Molecular Communications (MC) is low data transmission rates, which can be addressed by channel multiplexing techniques. One way to achieve channel multiplexing in MC is to leverage the diversity of different molecule types with respect to their receptor binding characteristics, such as affinity and kinetic binding/unbinding rates. In this study, we propose a practical multiplexing scheme for MC, which is based on the diversity of ligand-receptor binding affinities. This method requires only a single type of promiscuous receptor on the receiver side, capable of interacting with multiple ligand types. We analytically derive the mean Bit Error Probability (BEP) over all multiplexed MC channels as a function of similarity among ligands in terms of their receptor affinities, the number of receptors, the number of multiplexed channels, and the ratio of concentrations encoding bit-1 and bit-0. We investigate the impact of each design parameter on the performance of multiplexed MC system

A case of pathologic complete response after neoadjuvant triplet chemotherapy for locally advanced colon cancer with mismatch repair enzyme proficiency

Patients with potentially resectable colon cancer and expected to have negative margins should undergo resection rather than neoadjuvant chemotherapy. Recent studies have suggested that neoadjuvant immunotherapy may be an option for tumors with mismatch repair enzyme deficiency (dMMR), but standard treatment for locally advanced colon cancer with mismatch repair enzyme proficiency (pMMR) is still unclear. A 37-year-old male patient was diagnosed with clinical stage IIIC (T4b N1a M0) transverse colon cancer. Mismatch repair proteins were proficient. After 3 cycles of oxaliplatin (85 mg/m2, day 1), irinotecan (150 mg/m2, IV, day 1), leucovorin (200 mg/m2, IV, day 1), and 5-fluorouracil (3000 mg/m2, 46 hours of continuous infusion initiating from day 1), there was a remarkable reduction in the tumoral mass on the abdominal computed tomography. A right hemicolectomy was performed. A pathologic complete response was obtained. Although there is no consensus on which patients are suitable for neoadjuvant therapy in pMMR locally advanced colon cancer, triplet chemotherapy may be a reasonable option in selected patients

Management of priapism: Results of a nationwide survey and comparison with international guidelines

Objective: The aim of this study is to evaluate current urologic practice regarding the management of priapism in Turkey and compare with international guidelines. Methods: Urologists and urology residents were invited to an online survey consisting of 30 multiple-choice questions on priapism-related clinical practices that were considered most important and relevant to practices by using Google Forms. Results: Total number of responses was 340. Respondents reported that they recorded a detailed patient’s medical history and physical examination findings (n = 340, 100%) and laboratory testing, which includes corporal blood gas analysis (n = 323, 95%). Participants announced that they performed Doppler ultrasound for 1/4 cases (n = 106, 31%), but 22% of the participants (n = 75) replied that they performed in >75% of cases. Participants (n = 311, 91%) responded that the first-line treatment of ischemic priapism is decompression of the corpus cavernosum. Moreover, most respondents (n = 320, 94%) stated that sympathomimetic injection drugs should be applied as the second step. About three-quarters of respondents (n = 247, 73%) indicated adrenaline as their drug of choice. Phosphodiesterase type 5 inhibitors seems to be the most preferred drug for stuttering priapism (n = 141, 41%). Participants (n = 284, 84%) replied that corpora-glanular shunts should be preferred as the first. A large number of participants (n = 239, 70%) declared that magnetic resonance imaging can be performed in cases with delayed (>24 hours) priapism to diagnose corporal necrosis. Most of the participants (84%) responded that penile prosthesis should be preferred to shunts in cases with delayed (>48 hours) priapism. Conclusion: It would be appropriate to improve the training offered by professional associations and to give more training time to the management of priapism during residency

Development of second primary multiple myeloma five years after treatment for limited-stage small cell lung cancer: a rare case report

Introduction. The development of a second primary malignancy (SPM) following small cell lung cancer (SCLC) has been previously reported in the literature. Especially smoking-related malignancy coupling is well known. The development of multiple myeloma (MM) in long-term survivors after treatment for SCLC is unknown. Here, we report the first case in the literature who developed MM 5 years after treatment for limited-stage SCLC. Case report. A 67-year-old male patient was diagnosed with limited-stage SCLC. After he received chemotherapy and radiotherapy, he was followed up without medication. He was admitted to the hospital with back pain and dyspnea 5 years after the diagnosis of small cell lung cancer. MRI revealed osteolytic lesions in the vertebrae. Laboratory testing revealed a markedly elevated serum IgA and an elevated serum beta-2 microglobulin level. Serum immunofixation revealed IgA lambda-type M-protein. Lambda excretion in urine immunofixation electrophoresis was observed. Bone marrow aspiration revealed the frequency of plasma cells to be 80% of all nucleated cells. Hence, the final diagnosis revealed IgA lambda free light chain MM. Treatment was given for multiple myeloma. In the follow-up, the patient experienced increased dyspnea and developed bilateral pleural effusion. The cytology sent from thoracentesis sampling was reported as plasmocyte-rich material. The patient fell into a coma and died in an intensive care unit. Conclusion. We presented the development of MM 5 years after treatment in a patient with SCLC who were treated for one year and then followed up with stable findings. It should be kept in mind that a patient with SCLC who is a long-term survivor and presents with back pain may have developed a primary malignancy originating from bone marrow rather than a bone metastasis. Patients should be advised smoking cessation after the treatment and diagnosis of SCLC. Also, the patients with SCLC who are long-term survivors should be closely monitored for the development of SPM

Recurrent Her-2 positive occult breast cancer presenting with zosteriform cutaneous metastases: a case report

Various cutaneous metastasis patterns are described in breast cancer. Zosteriform metastases are rare cutaneous metastases, which appear in a dermatomal distribution. A 66-year woman presented with a 1-month history of nodular lesions on the left posterior hemithorax area. Biopsy was reported as human epidermal growth factor receptor (Her) 2 positive, hormone receptor-negative breast carcinoma metastasis. Dual blockade therapy targeting Her-2 overexpression was initiated for the patient. Treatment response was obtained after 3 cycles. There was a significant improvement in skin lesions. Zosteriform cutaneous metastases can be the early sign of systemic spread and can show an initial response to therapy. Therefore, physicians should perform an exhaustive physical examination including that of skin

Türk sosyal güvenlik hukukunda kısa vadeli sigorta kollarından sağlanan haklar

Günümüz Türkiyesinde ise sosyal güvenlik hakkı, mevcut hukuk sistemimizde, 1961’de olduğu gibi, anayasal güvenceye sahip bir “insan hakkı” olup “herkes” için öngörülmüştür. Öyle ki, Türkiye Cumhuriyeti Anayasası’nın 60’ıncı maddesi çok net bir şekilde bunu ortaya koymaktadır. Bu çalışmada, Türk Sosyal Güvenlik Hukukuna göre Kısa Vadeli Sigorta Kollarından Sağlanan Hakların neler olduğu açıklanmaya çalışılacaktır. ABSTRACT In today's Turkey, the right to social security is a “human right” with constitutional guarantee in our existing legal system and is accepted for "everyone" as in 1961. Moreover, the 60th article of the Constitution of the Republic of Turkey clearly shows this. In this study, it will be tried to explain what is the rights provided by short term insurance branches according to Turkish Social Security Law

Clinical and pathological properties of patients with metastatic colorectal cancer according to the RAS mutation status

Bu çalışmada metastatik kolorektal kanserli hastalarda tanı anındaki histopatolojik ve klinik özelliklerin RAS mutasyon durumuna göre karşılaştırılması amaçlandı. Bu kesitsel çalışma için, 01.04.2012-24.08.2017 tarihleri arasında bir üniversite hastanesinin onkoloji merkezinde takip ve tedavisi yapılmış toplam 530 kolorektal kanser tanısı almış hastanın dosyası retrospektif olarak incelendi. Çalışmaya 18 yaşından büyük, tanı anında metastatik hastalığa sahip veya takipleri boyunca metastaz gelişen ve RAS mutasyonu bakılmış 75 hasta dahil edildi. Rasmutant olan ve olmayan hastaların tümör lokalizasyonu, tanı anındaki metastaz yerleri, tümör belirteçleri, tümör diferansiyasyon derecesi ve genel sağkalım süreleri arasındaki farklılıklar analiz edildi. RAS mutasyonu sıklığı %50.7 olarak saptandı. Klinik ve patolojik özellikler açısından bakıldığında RAS mutant ve wild gruplar arasında istatistiksel anlamı farklılık saptamadık. RAS mutasyon durumuna göre genel sağkalım süreleri incelendiğinde, RAS wild tip olan hastaların 2 yıllık genel sağkalımı% 59 iken, RAS mutant hastalarımızın 2 yıllık genel sağkalımı %27.8 idi ve bu fark istatiksel olarak anlamlıydı (p=0.004). Ancak, RAS wild hastaların ilk hat tedavisinde bevacizumab veya cetuksimab/panitumumab alan hastaların ortalama sağkalımları arasında (sırasıyla %57.1'e karşı %70.7; p=0.221) istatistiksel fark saptanmadı. Bu çalışmada, metastatik kolorektal kanserli hastalarımızın RAS mutasyon durumunun daha ziyade Batılı ülkelere benzer olduğunu ve hastaların tanı anındaki klinik ve patolojik özelliklerinin RAS mutasyon durumundan bağımsız olduğunu saptadık. Ancak bu konuda yapılacak prospektif ve daha geniş katılımlı çalışmalara hala ihtiyaç duyulmaktadır.We aimed to compare the clinical and histopathologic features at the time of diagnosis of patients with metastatic colorectal cancer according to the RAS mutation status. In this cross-sectional study, archive records of patients with diagnosing colorectal cancer who were followed-up and treated at oncology center of an university hospital in Turkey between 01.04.2012 and 24.08.2017 was analyzed retrospectively. A totally 530 patients' archieve records were evaluated. The relationship between the RAS mutant/wild groups and primary tumor localization, location of metastases at diagnosis, tumor markers, tumor differentiation grade and overall survival rates were compared with the literatüre data. We found no statistically significant difference between RAS mutant and wild groups. When overall survival rates were compared with the RAS mutation status, the overall survival of 2 years in patients with RAS wild type was 59% while the 2 year overall survival of RAS mutant patients was 27.8% and this difference was statistically significant (p = 0.004). However, there was no statistically significant difference between the median survival of patients receiving bevacizumab or cetuksimab/panitumumab in th efirst line treatment of RAS wild patients (57.1% versus 70.7%; p=0.221, respectively). In this study, we determined that RAS mutation status of our patients with metastatic colorectal cancer is more similar to Western countries and the clinical and pathological characteristics of patients at the time of diagnosis are independent of RAS mutation status. However, there is still need broader participation and prospective trials in this subject