1
|
Cigsar Kuzu EB, Tiryaki S, Guney N, Polatdemir K, Cakir Y, Karagozlu Akgul A, Toper MH, Karaguzel G, Ucar M, Bassorgun CI, Ozel SK, Ozkanli S, Salci G, Aydin Mungan S, Yilmaz MU, Aytac Vuruskan B, Yagmur I, Tarini EZ, Kaba M, Tanik C, Canbaz FA, Hurdogan O, User IR, Orhan D, Atici A, Gursoy D, Yagmurlu EA, Enneli D, Kilic SS, Erdogan S. Low-Grade Injury following Testicular Torsion: A Multicenter Study Confirming a Disturbing Possibility. Urol Int 2023; 107:971-976. [PMID: 37913756 DOI: 10.1159/000534454] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2023] [Accepted: 09/26/2023] [Indexed: 11/03/2023]
Abstract
INTRODUCTION There is an ongoing debate whether to perform orchiectomy or orchidopexy following testicular torsion (TT) in cases where the testis seems non-viable. The main problem is lack of objective criteria defining testicular viability. The aim of this study was to investigate the grade of injury in orchiectomy specimens obtained from cases of TT and its association with clinical findings. METHODS This multicenter retrospective study involved double-blinded reassessment of the patient files and the pathological specimens using Mikuz classification to analyze the relation between clinical and pathological findings. RESULTS A total of 289 patient charts from 14 centers were reviewed and 228 were included in this study. Twenty (8.8%) patients had grade 1 injury which refers to reversible injury. The clinical findings of these 20 patients were compared to 208 patients with higher grades of injury. As expected, there was statistically significant difference regarding duration of symptoms (p < 0.001); however, range was wide in both groups (as long as 96 h for grade 1 and as short as 7 h for higher grades). There was no statistically significant difference in any other variable including age (median 14 for both, p = 0.531), symptoms (pain: 19/20 vs. 189/202, p = 0.801; swelling: 13/19 vs. 168/197, p = 0.094), absence of blood flow in Doppler US (15/19 vs. 164/197, p = 0.635), or degree of torsion (median 720° for both, p = 0.172). CONCLUSION Our study revealed necessity for better criteria to define viability of testis following TT. Histopathological injury appeared to be reversible even in some patients with more severe perioperative findings, late admission, or high degree of twisting. Our findings support the tendency for testicular fixation instead of orchiectomy as none of the clinical or perioperative findings could be attributed to high-grade injury.
Collapse
Affiliation(s)
| | - Sibel Tiryaki
- Div. Pediatric Urology, Department Pediatric Surgery, Ege University, İzmir, Turkey
| | - Neslihan Guney
- Department Pathology, Tepecik Training and Research Hospital, İzmir, Turkey
| | - Kamer Polatdemir
- Department Pediatric Surgery, Behcet Uz Pediatric Diseases and Surgery Training and Research Hospital, İzmir, Turkey
| | - Yasemin Cakir
- Department Pathology, Behcet Uz Pediatric Diseases and Surgery Training and Research Hospital, İzmir, Turkey
| | - Ahsen Karagozlu Akgul
- Div. Pediatric Urology, Department Pediatic Surgery, Marmara University Medical Faculty, İstanbul, Turkey
| | | | - Gungor Karaguzel
- Department Pediatric Surgery, Akdeniz University Medical Faculty, Antalya, Turkey
| | - Murat Ucar
- Department Urology, Akdeniz University Medical Faculty, Antalya, Turkey
| | | | - Seyhmus Kerem Ozel
- Div. Pediatric Urology, Department Pediatric Surgery, İstanbul Medeniyet University, İstanbul, Turkey
| | - Seyma Ozkanli
- Department Pathology, İstanbul Medeniyet University, İstanbul, Turkey
| | - Gul Salci
- Department Pediatric Surgery, Karadeniz Technical University Medical Faculty, Trabzon, Turkey
| | - Sevdegul Aydin Mungan
- Department Pathology, Karadeniz Technical University Medical Faculty, Trabzon, Turkey
| | - Mehmet Ugur Yilmaz
- Div. Pediatric Urology, Department Pediatric Surgery, Bursa Uludağ University Medical Faculty, Bursa, Turkey
| | | | - Ismail Yagmur
- Div. Pediatric Urology, Department Urology, Harran University Medical Faculty, Şanlıurfa, Turkey
| | - Emine Zeynep Tarini
- Department Pathology, Şanlıurfa Mehmet Akif İnan Training and Research Hospital, Şanlıurfa, Turkey
| | - Meltem Kaba
- Department Pediatric Surgery, Hamidiye Etfal Training and Research Hospital, İstanbul, Turkey
| | - Canan Tanik
- Department Pathology, Hamidiye Etfal Training and Research Hospital, İstanbul, Turkey
| | - Furkan Adem Canbaz
- Div. Pediatric Urology, Department Pediatric Surgery, İstanbul Medical Faculty, İstanbul, Turkey
| | - Ozge Hurdogan
- Department Pathology, İstanbul Medical Faculty, İstanbul, Turkey
| | - Idil Rana User
- Department Pediatric Surgery, Hacettepe Univesity Medical Faculty, Ankara, Turkey
| | - Diclehan Orhan
- Department Pathology, Hacettepe Univesity Medical Faculty, Ankara, Turkey
| | - Ahmet Atici
- Department Pediatric Surgery, Mustafa Kemal University Medical Faculty, Hatay, Turkey
| | - Didar Gursoy
- Department Pathology, Mustafa Kemal University Medical Faculty, Hatay, Turkey
| | - Emin Aydin Yagmurlu
- Department Pediatric Surgery, Ankara Univesity Medical Faculty, Ankara, Turkey
| | - Duygu Enneli
- Department Pathology, Ankara Univesity Medical Faculty, Ankara, Turkey
| | - Seref Selcuk Kilic
- Department Pediatric Surgery, Çukurova University Medical Faculty, Adana, Turkey
| | - Seyda Erdogan
- Department Pathology, Çukurova University Medical Faculty, Adana, Turkey
| |
Collapse
|
2
|
Enneli D. The importance of molecular classification of endometrial carcinomas in clinical practice: how to apply it and difficulties in application. J Turk Ger Gynecol Assoc 2023; 24:197-205. [PMID: 37264857 PMCID: PMC10493819 DOI: 10.4274/jtgga.galenos.2023.2023-4-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2023] [Accepted: 06/01/2023] [Indexed: 06/03/2023] Open
Abstract
Classification of endometrial carcinomas (EC) based solely on histological features is not sufficient for the prognostic and therapeutic guidance of patients. Furthermore, the existence of EC in which the histological type cannot be determined clearly and the poor reproducibility of histological typing have led to difficulties in clinical management. However, molecular classification of EC is very promising because of the high reproducibility and good correlation with clinical outcome. Within the scope of “the Cancer Genome Atlas Project”, EC were divided into four different genomic subtypes, and molecular classification models for EC were developed based on these molecular subcategories. The prognostic differences between these molecular subgroups and the benefit for guidance for adjuvant therapy have been clearly demonstrated in studies. In this article, the importance of molecular classification for EC is discussed and its use in clinical practice is reviewed.
Collapse
Affiliation(s)
- Duygu Enneli
- Department of Pathology, Ankara University Faculty of Medicine, Ankara, Turkey
| |
Collapse
|
3
|
Enneli D, Baglan T. The Many Faces of Urothelial Carcinomas: An Update From Pathology to Clinical Approach and Challenges in Practice. Urol Res Pract 2023; 49:147-161. [PMID: 37877864 PMCID: PMC10346099 DOI: 10.5152/tud.2023.23023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/30/2023] [Accepted: 03/25/2023] [Indexed: 10/26/2023]
Abstract
Urothelial carcinoma is a heterogeneous disease with histomorphological and genomic variations throughout the same tumor or between tumors from different patients. It has been shown that most of these histologic and genetic differences have prognostic significance and may have a guiding role in determining the appropriate treatment choice for the patient. Therefore, it is crucial for both the pathologist and the clinician to be conscious of these variations and to consider them in patient management. Recently, a consensus molecular classification has been developed and categorized urothelial carcinomas into 6 subclasses. These molecular subclasses seem to be associated with prognosis and/or response to certain therapeutic approaches like chemotherapy or immune checkpoint inhibitory therapy; however, it has not yet been sufficiently validated and has some limitations for routine application. As is well known, there are therapeutic limitations in locally advanced or metastatic urothelial carcinomas, especially those inappropriate for standard therapy with platinum-based chemotherapy regimens. Emerging new therapeutic approaches and testing for appropriate patient selection for those are discussed in this article.
Collapse
Affiliation(s)
- Duygu Enneli
- Department of Pathology, Ankara University School of Medicine, Ankara, Turkey
| | - Tolga Baglan
- Department of Pathology, Ankara University School of Medicine, Ankara, Turkey
| |
Collapse
|
5
|
Sevim S, Gedik E, Ozakinci H, Kaygusuz G, Enneli D. Primary epithelioid angiosarcoma of endometrium. POL J PATHOL 2023; 74:219-222. [PMID: 37955542 DOI: 10.5114/pjp.2023.132302] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2023] Open
Abstract
Angiosarcoma is a poor prognostic tumor observed less than 1% in soft tissue, while it is rarely detected in the endometrium and has been described in few case reports. In this report, we present a case of primary epithelioid angiosarcoma of endometrium to raise awareness and emphasize for pathologists and clinicians.
Collapse
Affiliation(s)
- Selim Sevim
- Department of Pathology, Ankara University Medical School, Ankara, Turkey
| | - Ekin Gedik
- Department of Pathology, Ankara University Medical School, Ankara, Turkey
| | - Hilal Ozakinci
- Department of Pathology, Ankara University Medical School, Ankara, Turkey
| | - Gulsah Kaygusuz
- Department of Pathology, Ankara University Medical School, Ankara, Turkey
| | - Duygu Enneli
- Department of Pathology, Ankara University Medical School, Ankara, Turkey
| |
Collapse
|
6
|
Sevim S, Enneli D, Serbes ED, Ersoz CC, Yuksel S. Primary adenosquamous carcinoma of the endometrium with glassy cell features. A diagnostic pitfall as a very rare tumour type in the endometrium. Pathologica 2022; 114:332-338. [PMID: 36136902 PMCID: PMC9624138 DOI: 10.32074/1591-951x-757] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2022] [Accepted: 07/02/2022] [Indexed: 11/30/2022] Open
Abstract
Primary adenosquamous carcinoma of the endometrium with glassy cell features
(ASCGCF) is an extremely rare entity and to date, 16 cases of this entity have
been reported in the literature. ASC-GCF is an aggressive histological subtype
of cervical carcinoma with rapid growth and early metastases; however, very
little is known about those originating from the endometrium as they are limited
to only a few case reports. Herein, we report a case of primary adenosquamous
carcinoma of the endometrium with extensive glassy cell features which posed a
major diagnostic challenge by mimicking many entities with its histological
diversity.
Collapse
|
7
|
Sirlak M, Ozcinar E, Eren NT, Eryilmaz S, Uysalel A, Enneli D, Ozyurda U. Multiple hydatid cystectomy of the heart necessitating LIMA to LAD anastomosis in a young patient. Cardiovasc Pathol 2007; 18:53-6. [PMID: 18402806 DOI: 10.1016/j.carpath.2007.08.003] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/07/2007] [Revised: 08/01/2007] [Accepted: 08/07/2007] [Indexed: 11/28/2022] Open
Abstract
Cardiac hydatid disease is very rare, even in endemic regions. Clinical manifestations included chest pain, anaphylactic shock, constrictive pericarditis, congestive heart failure, and arterial embolism. Surgery is the exclusive therapy, where the cysts are excised during open-heart surgery. The surgical approach therefore must be performed carefully, given the potential complications that surgery may bring. Because of the risk of potentially lethal complications, early diagnosis and definitive treatment are important. A 32-year-old male patient was admitted with chest pain, weight loss, lethargy, and dizziness. On the transesophageal echocardiography study, a cystic mass (2.5 x 3 x 4.5 cm in dimension adjacent to the left ventricular posterior wall) that was divided into two by a septum was noted. Diagnosis of hydatidosis was confirmed with serologic tests (ELISA and indirect immunofluorescence). Echinococcosis, also known as hydatid disease, is common in several regions of the world, for example, the Mediterranean countries, the Middle East, South America, and East Africa. While performing pericystectomy in the anterior left ventricular wall, we noticed that there were three cysts, contrary to the preoperative diagnosis pointing a single one, and it was impossible to effectively complete the procedure without compromising anterosuperiorly displaced left anterior descending artery (LAD). We decided to go on bypass, arrest the heart, and complete the pericystectomy at the cost of injuring LAD and grafting the left internal mammary artery to LAD. Microscopic examination of the cyst showed a germinal layer and an avascular, eosinophilic, chitinous layer that confirmed the diagnosis of hydatid cyst. The patient was discharged on the fifth postoperative day on albendazole medication.
Collapse
Affiliation(s)
- Mustafa Sirlak
- Department of Cardiovascular Surgery, Heart Center, University of Ankara School of Medicine, 06340 Ankara, Turkey.
| | | | | | | | | | | | | |
Collapse
|