Skin Cancers of the Auricle: A Retrospective Analysis of 41 Patients

Objective: Skin cancers of the auricle usually present with challenges because of the unique anatomy and topography of the auricle and the behavior of the tumor. The purpose of this study was to evaluate the clinical and histopathological characteristics and the surgical outcomes in patients with skin cancer of the auricle.Methods: Medical records of patients who underwent surgery for a skin cancer of the auricle at two different tertiary medical centers during 2010 to 2020 were reviewed retrospectively. Sociodemographic data of patients, tumor location and size, histopathological type and subtype, T-stage, recurrence, and reconstructive technique were evaluated.Results: The study included 41 patients with skin cancers of the auricle. Thirty-six (87.8%) were male and five (12.2%) were female; with a male-to-female ratio of 7.2:1. The mean age of the patients was 71.4 (46-92) years. Eighteen (43.9%) tumors were basal cell carcinoma (BCC) and 17 (41.5%) tumors were cutaneous squamous cell carcinoma (cSCC). The most common subunit for tumor location was the helix (n=17, 41.5%). Wedge resection plus primary closure was the most common surgical technique (58.5%). Recurrent disease was detected in five patients (12.1%).Conclusion: The frequency of the skin cancers of the auricle was remarkably high in men, and the helix was the most common subunit. Both BCC and cSCC were the most common histopathological types. Poor prognostic factors such as lymph node metastasis, perineural invasion, and recurrence were relatively common in patients with cSCC of the auricle

Memenin primer skuamöz hücreli karsinomu: Olgu sunumu ve ayırıcı tanı açısından immunohistokimyasal özellikleri

Sağ memesinde hızlı büyüyen kitle yakınmasıyla başvuran 68 yaşında postmenopozal kadın hastaya tru-cut biyopsisi, lezyonun infiltratif yapısı ve immunohistokimyasal olarak c-erbB-2 (HER2/neu) ve progesteron reseptör pozitifliğine dayanarak “invaziv duktal karsinom” tanısı kondu. Hasta dört kür kemoterapiye (adriyamisin ve siklofosfamid) kısmi yanıt verdi. Kemoterapi sonrası modifiye radikal mastektomi ve aksiller lenf nodu diseksiyonu (level III) uygulandı. Makroskopik olarak üst iç ve dış kadranda 5 cm çaplı, kirli beyaz, solid, düzensiz sınırlı, merkezi kısmı nekrotik ve hemorajik tümör saptandı. Mikroskopik olarak kötü diferansiye skuamöz hücreli karsinom (SCC) niteliğindeki tümör çevresinde skuamöz metaplazili intraduktal epitelial hiperplazi ve multipl küçük SCC odakları gözlendi. Tümör, kemoterapiye bağlı regresyonu yansıtan nekrotik, hemorajik ve fibrotik alanlar içermekte idi. Deri tutulumu izlenmedi. İmmunohistokimyasal olarak tümörde CK7, CK8, CK19, HMW-CK ve E-cadherin diffüz, CEA fokal pozitifti. Östrojen ve progesteron reseptörleri ve c-erbB-2 negatifti. Materyalden ayıklanan 20 lenf nodundan beşi metastatikti. Klinik olartak skuamöz hücreli karsinomun gelişebileceği diğer organlar tarandı ve başka bir yerde herhangi bir tümör görülmedi. Operasyon sonrası oral kemoterapi (kapesitabin) alan hasta, bir yıldır sağlıklı bir şekilde yaşamını sürdürmektedir.We present a 68-year-old postmenopausal woman with a rapidly growing right breast mass. It was diagnosed as “invasive ductal carcinoma” on tru-cut biopsy owing to infiltrative pattern and c-erbB-2 (HER2/neu) and progesterone receptor positivities. Partial response was obtained after four cure chemotherapy (adriamycin and cyclophosphamide). Then, she underwent a modified radical mastectomy with axillary lymph node dissection (level III). Grossly, a white-tan, solid, ill-defined tumor with 5 cm diameter located in the upper inner and outer quadrant of the breast was detected. Central portion of the tumor showed necrotic and hemorrhagic changes. Microscopic examination revealed poorly differentiated squamous cell carcinoma (SCC) having intraductal epithelial hyperplasia with squamous cell metaplasia and multiple small tumor foci at the periphery. The tumor had patchy necrotic, hemorrhagic and fibrotic areas representing regressive changes due to chemotherapy effect. Immunohistochemically, the tumor stained diffusely with CK7, CK8, CK19, HMW-CK and E-cadherin, whereas focally with CEA. Estrogenand progesterone receptors and c-erbB-2 were negative in the tumor. Five out of 20 lymph nodes dissected from the specimen were metastatic. Clinically, other organs were ruled out as the originating site of the tumor. She had taken oral chemotherapy (capecitabine) after surgery and has been living healthy for one year

Soft tissue osteoma: A case report

Nadir görülen ve yumuşak dokunun diğer osseöz lezyonlarından ayırt edilmesi gereken yumuşak doku osteomlarının klinik, radyolojik ve histopatolojik özellikleri, iki olgu aracılığıyla literatür eşliğinde incelenmiştir. Olgulardan birincisi 17 yaşında, amatör futbolcu olan erkek hastadır. İkinci olgu 43 yaşında, sağ diz altında sert, ağrısız şişlik yakınması olan erkek hastadır. Her iki olgunun öyküsünde diz bölgesine alınan travma söz konusudur. Radyolojik incelemede, tibia proksimal metafizine komşu heterojen nodüler kalsifikasyon alanları görülmüş ve kemik ya da ligamanla ilişkisiz, sert, lobüle kitle çıkarılmıştır. Makroskopik olarak gri-beyaz renkli, iyi sınırlı, lobüle, sert görünümdeki her iki materyalin mikroskopik incelemesinde, iyi sınırlı, lobüle, matür lameller kemik ve enkondral ossifikasyon alanlarından oluşan lezyonlar izlenmiştir. Olguların dört yıllık postoperatif izlemleri sorunsuzdurSoft tissue osteomas are very rare and should be differentiate from other osseous lesions of soft tissue. We present two patients and discuss their clinical, radiologic and histopathological features with literatures. The first patient was 17-year-old boy, amateur football player. The other was a 43-year-old man had a firm, painless mass at his right knee. Their medical history had both trauma to their knees. Radiologically, heterogenous nodular calcification areas were observed near the proximal metaphysis of their tibias. Hardly lobulated lesions without bone attachment at the ligaments were excised. These lesions were gray-white coloured, well-circumscribed, firm masses. Microscopically, welldefined, lobulated lesions were involved mature lamellar bone trabeculae and enchondral ossification areas at peripherial portion. Both of our patients are survived healty for four years

Midede merkel hücreli karsinom metastazı: Olgu sunumu

Derinin Merkel hücreli karsinomu (MHK) agresif davranışlı, nadir bir tümördür. Merkel hücreli karsinomun lokal rekürrensleri, bölgesel lenf nodu ve uzak metastazları sık olmakla birlikte bildirilen üst gastrointestinal metastaz oldukça azdır. Yetmiş beş yaşındaki erkek hasta, sol bacağındaki MHK eksize edildikten sonra lokal radyoterapiye yönlendirilmiştir. Tümör eksizyonundan sonraki 5. ayda karında, 8. ayda toraks duvarında subkutan metastatik nodüller gelişmiştir. İlk operasyondan 10 ay sonra perfore duodenal ülser nedeniyle yapılan ikinci operasyon sırasında rastlantısal olarak midede, kardia duvarında farkedilen 2 cm çaplı, sarı-beyaz renkli, submukozal nodül eksize edilmiştir. Bu lezyon MHK'un mide metastazı tanısı almıştır. Hasta daha ileri bir tedaviyi reddetmiş ve başlangıçtaki tanıdan 17 ay sonra yaşamını yitirmiştir. MHK'un ayırıcı tanısı ile gastrointestinal MHK metastazlarının primer nöroendokrin tümörlerden ayrımı zorluk yaratabilir. Bu tür tanı sorunlarının çözümünde klinik bilgi, histopatolojik özellikler ve immunohistokimyasal çalışmalar oldukça önemlidir.Merkel cell carcinoma (MCC) of skin is a rare tumor with aggressive behavior. Local recurrences, regional lymph node and distant metastases of MCC are frequent but to date metastasis to upper gastrointestinal tract was reported only a few. We present a 75-yearold man who had primary MCC at his left thigh. The tumor was excised and the patient was directed to local radiotherapy. He had developed abdominal and thoracal subcutaneous metastatic nodules within 5 and 8 months after surgical excision, respectively. In the tenth month, a second operation had to be performed because of a perforated duodenal ulcer and incidentally a submucosal yellow-white nodule measuring 2 cm in diameter was found in the wall of gastric cardia and excised. This lesion was histologically identical to the primary tumor, hence, gastric metastasis of MCC. The patient rejected further therapy and died 17 months after the initial diagnosis. Differential diagnosis of MCC and distinction of gastrointestinal MCC metastasis from primary neuroendocrine tumors may be difficult. Clinical information and histopathological features along with the results of immunohistochemical stainings are very important in this distinction

Zależne od dawki neuroprotekcy¡ne działanie kwasu alfa-liponowego w eksperymentalnym uszkodzeniu rdzenia kręgowego

Background and purpose Free radical production after spinal cord injury (SCI) plays an important role in secondary damage. The aim of this study was to investigate neuroprotective effects of the powerful antioxidant alpha-lipoic acid (ALA) in a spinal cord clip compression injury model. Material and methods Fifty-six Sprague-Dawley rats, weighing between 210 and 300 g, were randomly divided into seven groups. Spinal cord injury was performed by an aneurysm clip placed extradurally at the level of T9. Group 1 (sham) received laminectomy only. Group 2 (control) received SCI; Group 3 received 30 mg/kg of methylprednisolone sodium succinate (MPSS); Groups 4, 5, 6 and 7 received ALA at doses of 50, 100, 150, 200 mg/kg, respectively, via the intraperitoneal route immediately after SCI. The rats were neurologically tested 24 hours after trauma. Spinal cord samples from injury sites were harvested for measurement of lipid peroxidation products and histopathological evaluation. Results Spinal cord malonyldialdehyde levels of rats in treatment groups decreased after administration of ALA. The difference between the trauma group and groups receiving MPSS-ALA was statistically significant. The difference between the ALA (50, 100, 150 mg/kg) and MPSS groups was insignificant. Group 7 (ALA 200 mg/kg) was excluded from the study because of the possible toxic effect. Alpha lipoic acid and MPSS had similar effects on spinal cord injury in terms of lipid peroxidation, neurological recovery and histopathological changes. Conclusions Alpha lipoic acid at a dose range of 50–150 mg/kg is as effective as MPSS (30 mg/kg) in neuroprotection after SCI. Further, more detailed experimental studies are needed to determine the effects of ALA on the detrimental results of secondary SCI before its use in humans.Wstęp i cel pracy Powstawanie wolnych rodników po urazowym uszkodzeniu rdzenia kręgowego (UURK) odgrywa istotną rolę w jego wtórnym uszkodzeniu. Celem badania było sprawdzenie neuroprotekcyjnego działania silnego antyoksydantu, kwasu alfa-liponowego (ALA), w eksperymentalnym modelu uszkodzenia rdzenia kręgowego wywoływanego uciskiem przez klips. Material i metody Pięćdziesiąt sześć szczurów rasy Sprague-Dawley o masie 210–300 g podzielono na 7 grup. Uraz rdzenia kręgowego wywoływano przez założenie klipsa zewnątrz-twardówkowo na poziomie Lh9. W grupie 1. (procedura pozorowana) wykonano jedynie laminektomię, w grupie 2. (kontrolnej) wykonano UURK. W grupie 3. podano bursztynian sodowy metyloprednizolonu (MPSS) w dawce 30 mg/kg m.c. W grupach 4.–7. po UURK podano ALA w dawkach odpowiednio 50, 100, 150 i 200 mg/kg m.c. dootrzewnowo bezpośrednio po UURK. Szczury badano neurologicznie po 24 godzinach od urazu. Próbki rdzenia kręgowego z miejsc uszkodzenia pobrano w celu oceny produktów peroksydacji lipidów i do badania histopatologicznego. Wyniki Stężenia malonylodialdehydu u szczurów poddanych leczeniu zmniejszyły się w grupach, w których stosowano ALA. Różnica między grupą kontrolną a grupami otrzymującymi MPSS-ALA była istotna statystycznie. Różnice między grupami, w których podawano ALA w dawce 50, 100 i 150 mg/kg m.c, a grupą, w której zastosowano MPSS, nie była istotna. Grupę 7. (ALA w dawce 200 mg/kg) wyłączono z analizy ze względu na możliwe toksyczne działanie ALA. Kwas alfa-liponowy i MPSS wywierały zbliżony wpływ na uszkodzenie rdzenia kręgowego oceniane za pomocą peroksydacji lipidów, poprawy stanu neurologicznego i zmian histopatologicznych. Wnioski Skuteczność ALA w dawkach 50–150 mg/kg m.c. w neuroprotekcji po urazie rdzenia kręgowego jest taka sama jak skuteczność MPSS (30 mg/kg m.c). Konieczne są dalsze, bardziej szczegółowe badania eksperymentalne w celu określenia wpływu ALA na niekorzystne następstwa uszkodzeń wtórnych po UURK przed zastosowaniem ALA u ludzi

Combined Therapy for Distant Metastasis of Sacral Chordoma

Chordomas are known as rare primary malign tumours that have formed from primitive notochord remains. Sacral chordomas grow slowly but locally and aggressively. Chordomas are locally invasive and have low tendency to metastasis and have a poor prognosis in long-term follow-up. Metastasis may be seen in a rate of 5–40% of the chordomas. Metastasis of chordomas is common in liver, lung, lymph nodes, peritoneum, and brain. The treatment approaches, including surgery, have been discussed in the literature before. Susceptibility to radiotherapy and chemotherapy is controversial in these tumours. The success of surgical treatment affects survival directly. In this report, we will report a sacral chordoma case in which an intraperitoneal distant metastasis occurred and discuss the surgical approach