Does neoadjuvant chemotherapy provide any benefit for surgical de-escalation in luminal B, HER2(-) breast cancers?

BACKGROUND

The use of neoadjuvant chemotherapy (NAC) in less aggressive breast cancer (BC) is controversial.

OBJECTIVE

To investigate the effect of neoadjuvant chemotherapy in HER2 negative luminal B breast cancer.

PATIENTS AND METHODS

Patients between January 2016 and December 2021 were retrospectively evaluated.

RESULTS

A total of 128 patients were included in the study. Patients with pathological complete response (pCR) were younger and had higher ki67 levels. Cutoff levels for ki67 based on pCR and ypT status were ≤ 40% and ≤ 35%, respectively. According to pre-NAC magnetic resonance imaging findings, only mastectomy was viable in 90 patients, but after NAC breast-conserving surgery (BCS) was possible in 29 (32%). Moreover, 68.5% became eligible for sentinel lymph node biopsy (SLNB) after NAC. Since SLNB was positive in 45 (54.2%), axillary lymph node dissection (ALND) was performed and the remainder, 38 (31.4%), avoided ALND.

CONCLUSION

In patients with Luminal B, HER2(-) BC a low pCR rate should not discourage the use of NAC. The ki67 level is a guide for individualizing treatment. Especially in young patients with high ki67 levels, NAC increases the chance of breast-conserving surgery and may spare patients from ALND.

The Effect of FDG-PET/CT on Clinical Prognostic Staging of Breast Cancer Patients being Planned Neoadjuvant Treatment

OBJECTIVE

To evaluate the effect of FDG-PET/CT in the radiological imaging of breast cancer (BC) patients planned for neoadjuvant treatment (NAT), on the clinical prognostic stage (CPS).

STUDY DESIGN

A descriptive study.

PLACE AND DURATION OF STUDY

Haydarpasa Numune Training and Research Hospital, Istanbul, Turkey, between June 2014 and September 2020.

METHODOLOGY

Consecutive patients with stage I-III breast cancer (BC) who were planned for neoadjuvant treatment (NAT). The distribution of CPS detected by both conventional radiological methods (c-CPS) and FDG-PET/CT (PET-CPS) were compared.

RESULTS

Significant upstaging on CPS was detected with the addition of FDG-PET/CT to conventional imaging methods in 25/121 (20.7%) patients (p <0.001). In the c-CPS stage, IB, IIA, IIB, IIIA, IIIB patients, the stage change rate was 22.7%, 28.6%, 37.5%, 50%, and 9.1%, respectively. There was no change in patients with c-CPS stage IA and IIIC. There was a significant change in the cN stages (p <0.001), while no significant change was detected in the cT stages of the patients (p = 0.180). Upstaging was detected in 5/16 (6.3%, p=0.034), 14/71 (19.7%, p <0.01), 15 / 30 (50%, p <0.01) of initially cN 0, 1, 2 patients, respectively (p<0.001).

CONCLUSION

The change in CPS was due to nodal upstaging. The effectiveness of including FDG-PET/CT in the initial radiological imaging in patients planned for NAT should be evaluated with prospective studies evaluating treatment choices to be used in NAT. Key Words: PET scan, Breast cancer, Positron emission tomography, Neoadjuvant treatment, Cancer staging, Staging system, TNM.

Evaluation of In Vivo Adhesion Properties of New Generation Polyglactin, Oxidized Regenerated Cellulose and Chitosan-Based Meshes for Hernia Surgery

Introduction

Composite meshes coated with anti-adhesive barriers have been developed by taking advantage of the robustness of polypropylene meshes for use in hernia repair. We aimed to evaluate the effects of composite meshes containing polyglactin, polycaprolactone, oxidized regenerated cellulose and chitosan on the adhesion formation.

Methods

Forty-two Sprague Dawley male rats were divided into six groups of seven rats according to the content of the meshes used. A defect was created on the right abdominal wall of the rats and an oval composite mesh of 2 cm in diameter was placed over the defect and fixed. The rats were sacrificed under anesthesia on the 7th postoperative day. Macroscopic and histopathological examination was performed and the incorporation of the mesh with the abdominal wall and the presence of intraabdominal adhesions were evaluated.

Results

When the macroscopic findings of the rats were evaluated, there was a statistically significant difference between the rat groups in terms of the distribution of peritoneal adhesion scores (p<0.05). There was no statistically significant difference between the rat groups in terms of the distribution of inflammation, fibrosis and macrophage levels (p>0.05).

Conclusion

It was evaluated that the development of intraabdominal adhesion and the strength of adhesion decreased when biocompatible adhesion barriers with anti-adhesive properties such as oxidized regenerated cellulose and chitosan were used in the structure of composite meshes used in hernia repair. Hemostatic and antibacterial properties of these substances are promising to create the ideal mesh.

Pathological Complete Response to Neoadjuvant Chemotherapy in Patients With Breast Cancer: The Relationship Between Inflammatory Biomarkers and Molecular Subtypes

Purpose

Among patients with breast cancer, pathological complete response (pCR) to neoadjuvant chemotherapy (NAC) is an important prognostic predictor of survival. This study aimed to investigate the relationship between platelet-lymphocyte ratio (PLR) and neutrophil-lymphocyte ratio (NLR) along with overall pCR.

Method

A total of 150 patients with breast cancer who were first administered NAC and then operated on were retrospectively evaluated. Neutrophil-lymphocyte ratio and PLR obtained from the complete blood count analysis performed immediately before NAC treatment were analyzed. The cut-off value was calculated as 150 for PLR and 2.24 for NLR. We studied the predictive value of NLR and PLR levels for the pathologic response of breast cancer to NAC.

Results

Pathological complete response was observed in 34.7% (n = 52) of the patients, pCR in the breast in 42.7% (n = 64), and that in the axilla in 44% (n = 66). There was a statistically significant difference between the pCR rates according to the PLR levels (p = 0.013). In addition, a statistically significant difference was found in the pCR rates in the breast and axilla according to PLR levels (p = 0.018, p = 0.009). Patients with low PLR in the human epidermal growth factor receptor 2 (HER-2) group had significantly higher axillary pCR rates than in those with high PLR (p = 0.019).

Conclusions

A low PLR level showed high chemotherapy sensitivity independent of molecular subtypes in the treatment of breast cancer with NAC. The PLR level can serve as a predictive marker of the therapeutic effect of NAC on the breast and axilla. Low PLR levels in HER-2 enriched groups can predict pCR in the axilla.

Symptomatic Bilateral Xanthogranuloma of the Choroid Plexus

Xanthogranulomas (XGRs) of the choroid plexus are rare, asymptomatic, and benign lesions usually found incidentally. Here, we present a case of a 47-year-old male with bilateral XGR of the choroid plexus with periventricular edema and discuss our case in relation to a review of existing literature pertaining to the radiology of XGRs. To the best of our knowledge, this is the first reported case of bilateral trigonal XGR causing brain edema without ventricular dilatation. Despite the fact that they can cause hydrocephalus, XGRs are silent and benign lesions. Although the etiopathology of XGRs remains poorly understood, enhanced imaging analyses may provide additional information regarding edema and focal white matter signal changes.

Oncoplastic surgery; volume displacement techniques for breast conserving surgery in patients with breast cancer

BACKGROUND

Surgical management of breast cancer has drastically changed. Breast-conserving surgery (BCS) has now become a commonly used method for its treatment. Oncoplastic techniques are widely applied with satisfactory aesthetic results. We evaluated the aesthetic and oncological outcomes of BCS with glandular tissue displacement techniques.

METHODS

Seventy-five patients with invasive breast cancer were surgically treated by oncoplastic techniques. Preoperative evaluations, including breast and tumor size, localizations and features, were performed by physical examination, imaging methods, and histopathological analysis. Appropriate volume displacement techniques were planned according to breast and tumor size and localization. Early and late aesthetic results were evaluated.

RESULTS

The mean age of the patients was 54 years, and mean tumor size was 25 mm. Tumors were located in the upper-outer quadrant in 44% of patients. Glandular flaps were used in 55 (73%) patients. Racquet mammoplasty was the most preferred method. Nipple areolar complex (NAC) recentralization was performed in 26 (47.3%) of 55 patients with glandular tissue displacement. Therapeutic reduction mammoplasty was performed in 20 patients. All patients underwent adjuvant radiotherapy. After an average follow-up of 24 months, neither locoregional recurrence nor distant metastases were observed. Aesthetic results of the oncoplastic BCS method were very good in 54 (72%) patients.

CONCLUSION

Breast remodeling by glandular flap displacement after a wide local excision should be the primary aim in patients with breast cancer for better aesthetic outcomes. NAC recentralization is the primary component that could be considered for achieving better results. BCS associated with oncoplastic techniques allows wide excision of larger tumors and provides good and satisfactory aesthetic results at long-term follow-up.

The Role of Ischemia Modified Albumin and D-dimer as Early or Late Biochemical Markers in Ovarian Torsion

OBJECTIVE

Our aim was to examine the potential roles of ischemia modified albumin(IMA) and D-dimer as reliable early diagnostic markers of ovarian torsion.

MATERIALS AND METHODS

24 Wistar albino rats were included and randomized into three groups. Control (sham) rats underwent laparotomy then bilateral ovaries removed for histopathological examination and concomitant blood sampling for IMA and D-dimer assays after 4 h. In the remaining groups, ovarian ischemia was achieved by rotating bilateral ovaries 1080° clockwise then blood samples were obtained and ovaries were removed after 4 h and 24 h. IMA and D-dimer levels as well as the histopathological injury scores were assessed in all groups.

RESULTS

A statistically higher significant difference in D-dimer levels in the 4-h torsion group (Group 2) than the other groups (P = 0.001, P < 0.01). Despite absence of statistical significance, the difference in IMA levels between the groups was close to statistical significance (P = 0.064; P > 0.05); accordingly IMA levels were higher in the 24-h torsion group (Group 3), than in 4-h torsion (Group 2) or sham (Group 1) group.

CONCLUSION

Our results suggest that D-dimer may represent a valuable acute marker of ovarian torsion. The cut-off value for D-dimer was 402 ng/ml. Although rats in Group3 had higher IMA than in other groups, the difference was only close to statistical significance. Also, increasing duration of torsion was associated with reduced D-dimer levels, while IMA levels exhibited an increase during the 24 h period. In contrast with previous studies, IMA appeared to be a potential marker in the long term rather than the short term.

Preoperative assessment of the axilla by surgeon performed ultrasound and cytology in patients with breast cancer

BACKGROUND

Preoperative evaluation of the axilla, an important prognostic determinant for patients with invasive breast cancer, is achieved by non- or minimally invasive methods to avoid the potential hazards of operative intervention. The aim of this study was to determine statistical power of axillary ultrasound (US) and US-guided fine needle aspiration cytology (FNAC) for evaluating axillary status.

METHODS

Axillary lymph nodes were imaged for malignant involvement by high resolution US in 93 breast cancer patients with clinically negative axilla. Cytological samples were obtained by US-guided FNAC from image-suspicious lymph nodes. Cytology-positive patients directly underwent axillary lymph node dissection (ALND). Patients with US and/or cytology-negative axilla underwent sentinel lymph node biopsy (SLNB). Using statistical analysis, US findings and US combined with FNAC were compared with SLNB and final pathology to measure performance.

RESULTS

US was suspicious for metastasis in 38 patients (41%), of whom 16 (42%) were cytology-positive. Axilla was positive in 36/93 patients (38.7%). Sixteen patients with positive FNAC directly underwent ALND. SLNB and/or final pathology was positive in 13/55 patients (23.7%) with negative US (false negative of US) and in 7/22 patients (31.8%) with positive US but negative cytology (false negative of FNAC). SLNB and/or final pathology was negative in 15/38 patients (39.5%) with positive US (false positive of US). Sensitivity, specificity, accuracy, positive predictive value (PPV) and negative predictive value (NPV) of US alone were 63.8%, 73.6%, 69.8%, 60.5% and 76.3%, respectively, and 69.6%,100%, 81.6%, 100% and 68.1%, respectively, for US combined with FNAC.

CONCLUSION

Statistical measures of the US alone did not achieve a satisfactory value for excluding operative biopsy. US-negative and US-positive but cytology-negative cases still require SLNB for accurate evaluation of axillary status. On the other hand, US-guided positive cytology can obviate SLNB proceeding directly to ALND and avoiding frozen section of sentinel node(s).

Prophylactic and therapeutic effects of oral budesonide for acute radiation-induced enteritis and colitis in rats

No satisfactory means has been found to control the symptoms of diarrhea and weight loss caused by radiation-induced enteritis and colitis. As a glucocorticoid, budesonide has multiple effects, and this study aimed to test whether it could be effective in treating these symptoms. Twenty-eight male Wistar albino rats were randomly allocated into 4 groups. Group I received 0.1 mg/kg/day budesonide at 8-h intervals for 5 days and did not undergo radiation. Group II received 0.1 mg/kg/day budesonide at 8-h intervals for 1 day before radiation treatment and 4 days after irradiation. Group III received 0.1 mg/kg/day budesonide at 8-h intervals for 4 days after irradiation. Group IV received only radiation treatment. On the fifth day after radiation treatment, the rats underwent laparotomy. The rats were weighed before irradiation and before laparotomy. Because of diarrhea, all rats lost weight except group I, which showed weight gain. Weight loss was statistically significant only in group IV. Group I rats exhibited a normal jejunum, ileum, and colon. The other groups showed varying degrees of damage. We conclude that, particularly when given before irradiation, budesonide decreased the side effects of radiation-induced enteritis and colitis both clinically and morphologically. Future pathophysiological and clinical studies will be needed to support this result.

The effects of resveratrol on flap survival in diabetic rats

Resveratrol is an antioxidant agent with multiple positive impacts on the body. It is known to have anti-diabetic, anti-inflammatory, anti-carcinogenic, and neuroprotective effects. The goal of this study is to demonstrate the antioxidant and anti-diabetic effects of resveratrol on flap survival in diabetic rats. Streptozotocin-induced diabetic Sprague-Dawley albino rats were treated with 10 mg/kg resveratrol following a flap surgery. Histological findings regarding polymorphonuclear leukocyte (PMNL) density, vascular proliferation, fibroblast density, and tissue necrosis were compared between resveratrol-treated and control rats. Significantly higher PMNL density was found in the control group (p = 0.005); while vascular proliferation and the fibroblast density were higher in the resveratrol group (p = 0.004 and p = 0.021, respectively). Collagen density was also higher in the resveratrol group and the difference has statistical significance (p = 0.024). Lymphocyte density was not significantly different between groups (p = 0.061). When the necrosis in the distal areas was evaluated histologically, 20% of the resveratrol group had epidermal tissue necrosis, thus 90% of the control group had epidermal or full-layer necrosis. Resveratrol improved flap survival significantly in diabetic rats. Therefore, diabetic patients requiring complex reconstructive procedures may benefit from resveratrol; so, clinical trials are required to support this study.

Re-evaluation of cases with gastroenteropancreatic neuroendocrine tumors between 2004 and 2012 according to the 2010 criteria

BACKGROUND/AIMS

We re-evaluated the clinical, histopathological and immunohistochemical features of neuroendocrine tumors (NETs) diagnosed in our pathology laboratory between 2004 and 2012 and re-classified them according to the WHO-2000 and WHO-2010 criteria.

METHODOLOGY

The study included NET samples of 106 patients having gastroenteropancreatic and hepatobiliary tumors. The histopathological findings were re-assessed. The cases were re-appraised based on the WHO-2000 and WHO-2010 criteria. The association between survival and Ki-67 index was analysed.

RESULTS

The most frequent localization was the stomach. The average tumor size was 3.0±4.1 cm. Differentiation was poor in 17 cases (16.0%). Lymphovascular invasion was detected in 16.1% (n = 17) and necrosis was identified in 15.1% (n = 16). The average number of Ki-67 was 9.1±19.9. Ki-67 measurements were significantly higher in patients who died compared to those who survived (p <0.01). In ROC analysis, the cut-off point for Ki-67 was 5.

CONCLUSIONS

Our study is a single-center study comprising patients from Turkey for a period of 8 years. We found that the most frequent localization is the stomach. This ratio is associated with common use of endoscopy in our center. The specimens were re-evaluated according to the WHO-2000 and WHO-2010 classification systems the data and terminology have been updated.

Potential relationship between BK virus and renal cell carcinoma

The objective of the present study was to investigate the potential association between the presence of BK virus (BKV) DNA and mRNA and renal cell carcinoma and bladder transitional cell carcinoma. The formalin-fixed and paraffin-embedded tissue samples were obtained from 50 cancer patients with renal cell carcinoma, 40 cancer patients with bladder transitional cell carcinoma, 45 control patients with the benign renal pathology, and from another 25 control patients with benign bladder pathology. The samples were subjected to nested PCR for detection of BKV DNA and real-time reverse transcription PCR (real-time RT-PCR) for determining mRNA levels of BKV. The results of the nested PCR indicated that 23 (14.3%) of 160 samples were positive for BKV DNA. The relationship between the cancer and the presence of BKV DNA was significant (P < 0.05). The BKV DNA positivity was significantly associated with the histological diagnosis of renal cell carcinoma (P = 0.03), but not with that of bladder transitional cell carcinoma. The results of real-time RT-PCR showed that the mRNA of BKV VP1 was present in 69.5% of the BKV DNA positive samples. The levels of BKV mRNA were significantly higher in the renal cell cancer samples than in the control samples (P < 0.05). The results of the present study confirm the association between BKV and renal cell cancer. The findings also indicated that the presence of BKV DNA resulted in a fivefold increase in the risk of development of renal cell carcinoma.

Evaluation of colorectal adenocarcinomas at single-institution with respect to microsatellite instability

BACKGROUND AND AIM

Hereditary non-poliposis colorectal cancers exhibit a high rate of microsatellite instability. Comparative studies involving stage and other prognostic parameters demonstrate a better prognosis in the presence of microsatellite instability versus colon cancers without microsatellite instability.

METHODS

Our study included 608 cases diagnosed with colorectal adenocarcinoma by our laboratory between 2004-2010. The cases were re-evaluated with respect to criteria defined for MSI, taking into consideration age, anatomic localization, and histopathological criteria. Immunohistochemical study was performed in appropriate blocks for using MLH-1, MSH-2, MSH-6, and PMS-2.

RESULTS

The specimens were re-evaluated according to the histological criteria defined for microsatellite instability. Anti-MLH-1, anti-MSH-2, anti-MSH-6, and anti-PMS-2 antibodies were applied to the paraffin blocks of 27 cases which presented morphological criteria suggestive of DNA repair mutation and had a high Mspath score. Immunohistochemical study with MLH-1, MSH-2, MSH-6, and PMS-2 for the analysis of mismatch repair was refined using the cases with higher Mspath scores.

CONCLUSIONS

In this study, we reviewed the clinical and histopathological features of 608 cases with colorectal adenocarcinoma diagnosed in our laboratory between 2004-2010 and assessed pathological features in terms of microsatellite instability. The results were discussed in view of the literature.

Medical and surgical treatment of idiopathic granulomatous lobular mastitis: a benign inflammatory disease mimicking invasive carcinoma

Purpose

Idiopathic granulomatous lobular mastitis (IGLM) is a rare chronic inflammatory disease of the breast with obscure etiology that mimics invasive carcinoma both clinically and radiologically. The treatment of IGLM remains controversial. The aim of proper management is to use a combination of medical and surgical treatment of this benign condition to achieve a good cosmetic result and low recurrence rate.

Methods

A retrospective analysis of 19 patients with IGLM is performed based on the findings of clinical, radiological, and pathological examinations. The results of two treatments are presented: medical treatment with oral corticosteroids, and consecutive surgical excision after a follow-up period of 20 months (range, 6-75 months).

Results

The majority of patients treated in this paper were young (mean, 34 years) parous women with a history of hormonal medication use. The main clinical finding is large, irregular, and painful mass. Hypoechoic lobulated, irregular tubular or oval shaped masses had been imaged by ultrasound. Mammographic findings were an ill-defined mass, enlarged axillary lymph nodes, asymmetric density, and architectural distortion. Diagnoses of IGLM had been established by cytological or histological examination. Symptoms subside and inflammatory changes regressed with medical treatment. The remaining lesions were excised by consecutive breast conserving surgery. The disease recurred in one patient during the follow-up period.

Conclusion

IGLM is an inflammatory breast disease found in young women who present with a large painful irregular mass, which mimics carcinoma, as a physical change. Breast imaging modalities are not helpful to differentiate IGLM from invasive cancer. The correct diagnosis is established by cytological or histological examination. Medical treatment with corticosteroids provides significant regression of the inflammatory disease, allowing more conservative surgery. Consecutive surgical excision of the remaining lesions with good cosmetic results provides definitive treatment and reduces the risk of recurrence.

Pseudoaneurysm of the superficial temporal artery following revision of a middle cerebral artery aneurysm clipping: case report and review of the literature

Pseudoaneurysms of the superficial temporal artery are mostly traumatic in origin. Here, a case of a superficial temporal artery aneurysm that emerged following a recraniotomy is presented. A 59-year-old woman was admitted with subarachnoid hemorrhage. She underwent a pterional craniotomy and clipping of a saccular aneurysm of middle cerebral artery bifurcation. A control digital subtraction angiography on the 3rd postoperative day revealed partial filling of the aneurysm and a revision was performed. The second control digital subtraction angiography on the 4th postoperative day of the revision showed a pseudoaneurysm of the left superficial temporal artery. The pseudoaneurysm was excised successfully under local anesthesia. In conclusion, pseudoaneurysm of the superficial temporal artery should be considered among the early postoperative complications of the surgical procedures at the superficial temporal artery territory. Although some conservative approaches are used, excision of the aneurysm is recommended for treatment.

Tumor characteristics influencing non-sentinel lymph node involvement in clinically node negative patients with breast cancer

Purpose

The negative sentinel lymph node (SLN) biopsy avoids conventional axillary dissection in patients with breast cancer with clinically negative axilla. Despite negative SLN, there is a risk of leaving involved non-SLN behind in the axilla. We investigated the predictive power of tumor characteristics for non-SLN metastasis.

Methods

Lymphatic mapping with blue dye method for SLN biopsy and level 1-2 axillary dissections were performed to establish axillary status in 59 patients with T1 and T2 breast cancer and clinically negative axilla. Tumor's characteristics were histopathologically established to assess their association with non-SLN metastasis.

Results

The axilla was malignant in 23 (39%) patients. The SLN alone was metastatic in 10, both SLN and non-SLN in 9, and non-SLN alone in 4 (7%) patients. The false negative rate for SLN biopsy was 10% in our series. The rate of positive non-SLN was found as 0% in T1a-b, 19% in T1c, and 40% in T2 tumors (p=0.035). Lymphovascular invasion was positive in 14 (61%) patients with axillary metastasis (p<0.001), and in 10 (77%) patients with non-SLN involvement (p<0.001).

Conclusion

We concluded that there was a small risk of involved non-SLN despite negative SLN. Tumor size (near or greater than 2 cm) was significantly associated with non-SLN metastasis. Peritumoral lymphovascular invasion was a positive predictor of the metastatic involvement in non-SLNs.

Histopathological changes of rat kidney with exposure to chronic thinner inhalation

INTRODUCTION

Organic solvents are liquid substances commonly used in everyday life at home and in industrial workplaces. These solvents are found primarily in paint as thinner. Because other narcotics are hard to find, thinner is used as a narcotic especially among youngsters of low socioeconomic level. The aim of this study is to determine the histopathological changes of rat kidney with exposure to chronic thinner inhalation.

METHODS

Randomized trial--the study was conducted at the animal care facility of Haydarpasa Numune Education and Research Hospital. Forty albino Wistar male rats were used throughout the experiment. Three groups of rats inhaled thinner in a glass cage for 1, 3, and 5 weeks, respectively. Ten rats inhaled only the air in the room as the control group.

RESULTS

We observed the development of inflammation in the kidneys that became more remarkable as exposure time extended. Development of inflammation because of thinner apparently differed between the groups of week 1 and week 5. There was no difference in granuloma development. If the experiment lasted longer, there might have been granuloma development.

CONCLUSIONS

Based on histopathological evaluations, it was shown that exposure to chronic thinner inhalation causes detectable damage on the kidney, which becomes more prominent as exposure period extends. As we established disorders in movement and consciousness in the rats during thinner inhalation, we can conclude that thinner also has a damaging effect upon the central nervous system.

Intraductal papilloma of the parotid gland in a child

Intraductal papillomas are rare benign tumors, most commonly encountered in minor salivary glands and rarely in major salivary glands. They are cystic, solitary neoplasm that arise from ductal epithelium and produce painless swelling. We report a case of intraductal papilloma of the parotid gland in a child.

Lymphovascular invasion, as a prognostic marker in patients with invasive breast cancer

PURPOSE

The markers of prognosis are used to predict the clinical course of disease and the outcome for patients with invasive breast cancer. Our aim is to investigate the relationship of peritumoural lymphovascular invasion (LVI) with well-known prognostic markers.

PATIENTS AND METHODS

Eighty-one surgically treated patients with invasive breast cancer were evaluated in this study during a mean follow-up period of 46 months (12-72). The patient's age (menopausal status), tumour size, nuclear grade, axillary lymph node involvement, and hormone receptor status were determined as markers of the prognosis. The relationship of LVI with these markers was established.

RESULTS

Except for menopausal status (p = 0.25) a close relationship was found between the presence of LVI and studied prognostic factors. LVI was positive in 29% of T1, 54% of T2 (p = 0.028) and 100% of T3 tumours (p = 0.002). The rate of LVI (+) has increased gradually as 0%, 38% and 77% (p = 0.001) with grades 1, 2 and 3 respectively. Positive LVI has been determined in 85% (p < 0.0001) and 73% (p = 0.0004) of oestrogen and progesterone receptor negative tumours respectively. LVI was present in 14% and 73% (p < 0.0001) of patients with negative and positive axilla respectively. Metastatic cancer caused mortality in seven patients of whom 86% had more than four involved axillary nodes, and 100% LVI (+).

CONCLUSION

The high rate of positive LVI shows a close relationship with known markers of poor prognosis. The presence of LVI can predict a worse outcome for patients with invasive breast cancer. LVI may be used as an indicator of aggressive behaviour, metastatic ability (nodal and systemic) of the primary malignancy.

Large Cystitis Glandularis: A Very Rare cause of Severe Obstructive Urinary Symptoms in an Adult

Cystitis glandularis is a very rare proliferative disorder of the mucus-producing glands within the mucosa and submucosa of urinary bladder epithelium. We report such a case of glandular cystitis with intestinal metaplasia masquerading as a bladder tumor in a young male patient who presented with severe obstructive urinary symptoms. Cystoscopy revealed a tumor well circumscribed, measuring 5 x 4 cm on the trigone. Transurethral resection of the mass was carried out and the histopathology suggested cystitis glandularis. The literature regarding this entity has been reviewed and the differential diagnosis was discussed. Short-term follow-up of the patient with sonography and cystoscopy showed no recurrence.

Spermatic cord metastasis as an initial manifestation of non-small cell carcinoma of the lung

Lung cancer is among the most common cancers which continue to be a major cause of death in the world and many present with distant metastasis in advanced stages precluding curative treatment. Herein, we report a 62-year-old male patient admitted to our hospital with complaint of a painful mass in his left inguinal region. Surprisingly, a chest radiograph revealed a mass in his left lung with ipsilateral pleural effusion. Thorough radiological and pathologic examinations he was confirmed to have a non-small cell lung cancer with only spermatic cord metastasis and unfortunately the patient died two weeks after admission.

Isolated metachronous splenic metastasis from synchronous colon cancer

Background

Isolated splenic metastases from colorectal cancer are very rare and there are only 13 cases reported in the English literature so far. Most cases are asymptomatic and the diagnosis is usually made by imaging studies during the evaluation of rising CEA level postoperatively.

Case presentation

A 76-year-old man underwent an extended left hemicolectomy for synchronous colon cancers located at the left flexure and the sigmoid colon. The tumors were staged as IIIC (T3N2M0) clinically and the patient received adjuvant chemotherapy. During the first year follow-up period, the patient remained asymptomatic with normal levels of laboratory tests including CEA measurement. However, a gradually rising CEA level after the 14^th postoperative month necessitated further imaging studies including computed tomography of the abdomen which revealed a mass in the spleen that was subsequently confirmed by ¹⁸FDG- PET scanning to be an isolated metastasis. The patient underwent splenectomy 17 months after his previous cancer surgery. Histological diagnosis confirmed a metastatic adenocarcinoma with no capsule invasion. After an uneventful postoperative period, the patient has been symptom-free during the one-year of follow-up with normal blood CEA levels, although he did not accept to receive any further adjuvant therapy. To the best of our knowledge, this 14^th case of isolated splenic metastasis from colorectal carcinoma is also the first reported case of splenic metastasis demonstrated preoperatively by ¹⁸FDG PET-CT fusion scanning which revealed its solitary nature as well.

Conclusion

Isolated splenic metastasis is a rare finding in the follow-up of colorectal cancer patients and long-term survival can be achieved with splenectomy.

Accuracy of sentinel lymph node biopsy for the assessment of axillary status in patients with early (T1) breast carcinoma

OBJECTIVE

To determine the accuracy of SLN biopsy for the assessment of axillary status, and prognostic markers leading to lymphatic metastasis in patients with early (T1) breast cancer.

DESIGN

Cross-sectional study.

PLACE AND DURATION OF STUDY

Department of Surgery, Teaching and Research Hospital. Between January 2000 and August 2004.

PATIENTS AND METHODS

SLN mapping by blue dye method was performed on 39 patients with T1 breast carcinoma. SLNs, level 1 and 2 axillary nodes were dissected and excised. The size, pathologic features of the primary tumor, SLNs and other axillary nodes, and hormone receptors were evaluated by histopathologic examination. The rate of SLNs and non-SLNs involvement, and demographic, clinical and pathologic risk factors leading to nodal metastasis were established. The diagnostic accuracy of SLN for axillary status was calculated.

RESULTS

SLNs were identified in 37 (95%) patients. The axilla had metastasis in 11 (28%) patients. Malignant cells involved SLNs in 8 patients. Non-SLNs had metastasis in 3 patients without SLN involvement. The sensitivity, specificity and accuracy of SLN biopsy for predicting axillary status was calculated as 73%, 100% and 92% respectively. Four of 5 patients with non-SLN metastasis were pre-menopausal (p=0.03), and hormone receptor negative (p=0.04). All 5 patients had T1c tumors (p=0.14) and lymphovascular invasion (p=0.0004).

CONCLUSION

SLN biopsy with high diagnostic accuracy may prevent unnecessary dissection of the axilla in the majority of patients with early (T1) breast carcinoma. Some risk factors as pre-menopausal status, absence of hormone receptors, and presence of lymphovascular invasion must be taken into account as important determinant of non-SLNs metastasis.

Intraparenchymal meningioma in a child

The authors reported a rare case of temporal intraparenchymal meningioma without dural attachment. A 14-year-old boy presented with a 4-month history of generalized tonic-clonic seizures. Neurological examination showed no abnormality. Magnetic resonance (MR) imaging revealed an anteromedial temporal mass, which appeared to be totally intraaxial and caused peritumoral white matter edema. The tumor was hypointense on T1-weighted and hyperintense on T2-weighted MR images, and enhanced heterogeneously after Gd-diethylenetriamine pentaacetic acid administration. Gross-total excision of the tumor was accomplished. Histopathological examinations indicated that the lesion was a meningioma. The outcome was favorable. The patient has returned to baseline activities without sequelae or epilepsy. Magnetic resonance images revealed no residual tumor during a 3-year follow-up period. In this report, the authors review the literature and discuss intraparenchymal meningiomas in the differential diagnosis of intraaxial lesions.

Intra-suprasellar meningioma mimicking pituitary apoplexy

The clinical and radiological features of an intra-suprasellar meningioma diagnosed as a pituitary macro-adenoma are presented. It is emphasized that this unusual tumour can mimic pituitary apoplexy. Differential diagnosis and surgical treatment of intrasellar meningioma versus pituitary adenoma are discussed with a review of the literature.

Microscopic endometrioid carcinoma arising in endosalpingeal endometriosis

We present a case of microscopic adenocarcinoma arising in the right fallopian tube, which was incidentally found in 74-year-old woman undergoing total abdominal hysterectomy with salpingo-oophorectomy for uterine myoma, hematometra and bilateral hydrosalpinx. A small focus of endometrioid adenocarcinoma confined within the endosalpingeal mucosa of the right fallopian tube associated with endometriosis was fortuitously found during histological examination. Our case seems to be unique since it shows an evident filiation between the lesions of tubal endometriosis and an adjoining focus of microscopic carcinoma. This is the second case report of a microscopic endometrioid carcinoma associated with endosalpingeal endometriosis.

Estrogen and progesterone expression of vessel walls with intravascular leiomyomatosis; discussion of histogenesis

We report seven cases of intravenous leiomyomatosis. Growth beyond the uterus occurred in two of the seven cases in the broad ligament. One 21-year-old patient is one of the youngest reported cases in the literature. Five patients had total abdominal hysterectomy with removal of the adnexa and two patients underwent myomectomy. One of the myomectomy cases had abdominal hysterectomy and bilateral salpingo-oophorectomy one year later due to recurrence. The other one was disease free six months after the operation. Vessel walls harboring intravascular tumor were investigated immunohistochemically for Factor VIII, CD 34, estrogen and progesterone receptors with the hope of making the histogenesis of intravenous leiomyomatosis clear. Immunohistochemical analyses of estrogen receptors, progesterone receptors, vimentin, desmin, smooth muscle actin, CD 10 and h-caldesmon were performed on intravascular tumor cells. Endothelial and subendothelial cells expressed none to scant, very weak progesterone and estrogen receptor positivity. Intravascular tumor cells showed weak (10%) to strong (70%) progesterone receptor positivity and weak (10%) to strong (60%) estrogen receptor positivity. These results do not support the hypothesis of a vessel wall origin for intravenous leiomyomatosis.

Prostaglandins E1 and E2 analogues ameliorate mucosal injury secondary to distal colonic obstruction

After colonic obstruction, increased intraluminal pressure may impair blood circulation and cause mucosal injury that sometimes progresses to perforation. This experimental study aims to evaluated effects of prostaglandin E (PGE) analogues in order to prevent mucosal injury secondary to distal colonic obstruction. This study was carried out on 40 male Wistar rats equally divided into four groups: group 1, control; group 2, colonic obstruction by ligation of the sigmoid colon; group 3, obstruction and administration of PGE1; group 4, obstruction and administration of PGE 2. Mucosal structural changes were assessed and scored by histopathological examination at 24 h postoperatively. The thickness of the mucosal layer of the cecal wall was measured as 179.3 and 122 microm (p <.001) in the control and obstruction alone group, respectively. Mucosal thickness was preserved by PGE1 (170 microm) and PGE2 (157.3 microm) administration. The mean damage score was 0.73 in the control and 3.3 (p <.001) in the obstruction alone group. This score was significantly lower in obstruction groups treated with both PGE1 and PGE2, 1.13 and 1.26 respectively (p <.001). Both PGE1 and PGE2 (PGE1 better than PGE2) ameliorate mucosal injury during distal colonic obstruction. We concluded that the administration of PGE analogues in case of mechanical obstruction of the left colon was beneficial for preserving the structure of the mucosal layer.

Prostaglandins E1 and E2 analogues ameliorate mucosal injury secondary to distal colonic obstruction

After colonic obstruction, increased intraluminal pressure may impair blood circulation and cause mucosal injury that sometimes progresses to perforation. This experimental study aims to evaluated effects of prostaglandin E (PGE) analogues in order to prevent mucosal injury secondary to distal colonic obstruction. This study was carried out on 40 male Wistar rats equally divided into four groups: group 1, control; group 2, colonic obstruction by ligation of the sigmoid colon; group 3, obstruction and administration of PGE1; group 4, obstruction and administration of PGE 2. Mucosal structural changes were assessed and scored by histopathological examination at 24 h postoperatively. The thickness of the mucosal layer of the cecal wall was measured as 179.3 and 122 microm (p <.001) in the control and obstruction alone group, respectively. Mucosal thickness was preserved by PGE1 (170 microm) and PGE2 (157.3 microm) administration. The mean damage score was 0.73 in the control and 3.3 (p <.001) in the obstruction alone group. This score was significantly lower in obstruction groups treated with both PGE1 and PGE2, 1.13 and 1.26 respectively (p <.001). Both PGE1 and PGE2 (PGE1 better than PGE2) ameliorate mucosal injury during distal colonic obstruction. We concluded that the administration of PGE analogues in case of mechanical obstruction of the left colon was beneficial for preserving the structure of the mucosal layer.

HSP 60 expression in mucocutaneous lesions of Behçet's disease

BACKGROUND

Heat shock protein (60 kd HSP) has been implicated in the etiology of Behçet's disease, but its expression at sites of inflammation is unknown.

OBJECTIVE

Our aim was to investigate local HSP 60 expression and to quantify T-cell receptor (TCR) gamma delta-positive cells, which are known to respond to HSP peptides.

METHODS

Patients with active Behçet's disease (n = 21) and controls (n = 18) were included. Flow cytometric analysis was performed on peripheral blood to investigate TCR gamma delta-positive cell counts. Biopsies were performed on active skin lesions, and immunohistochemical analysis was performed by a streptavidin-biotin method using the monoclonal ML-30 antibody; HSP staining intensity and distribution were evaluated in a blinded fashion. Immunohistochemical studies were performed to quantify TCR gamma delta-positive cells at lesional sites.

RESULTS

Mucocutaneous lesions of patients with Behçet's disease had statistically significantly increased expression of HSP 60/65. Peripheral blood TCR gamma delta-positive cell counts were similar in both groups. However, lesional skin of patients with Behçet's disease had significantly increased gamma delta-positive T-cell counts.

CONCLUSION

Up-regulation of HSP expression was found at lesional skin sites in Behçet's disease. The increased number of TCR gamma delta-positive cells, which are known to respond to HSP peptides, may support the function of HSPs in the etiology of Behçet's disease. However, these findings may also be an epiphenomenon that needs to be further investigated.

Hepatitis B surface antigen in tears and aqueous humor. A comparative study of serum hepatitis B surface antigen levels

Tear samples of 20 patients who were determined to have positive hepatitis B surface antigen (HBsAg) after an acute hepatitis B infection and aqueous humor samples of 10 patients who were HBsAg carriers were tested for HBsAg, and the results obtained for serum and these fluids were compared. In 85% of the 20 patients who were HBsAg positive, HBsAg was found to be positive in tear samples. In 50% of the other 10 patients in aqueous humor was also found to be HBsAg positive. Our findings show that tears and aqueous humor are important in the spreading of hepatitis B infections.

Hepatitis C virus antibodies among risk groups in Turkey

In order to determine the prevalence of hepatitis C virus (HCV) infection in the Black Sea region in Turkey, 287 serum samples taken from risk groups were investigated for anti-HCV antibodies using HCV EIA system. Anti-HCV antibodies were found to be positive in 51.2% of chronic haemodialysis patients, 20.6% of probable acute non-A, non-B hepatitis patients, 4% of patients who had multiple blood transfusions, 1.5% of the health personnel, while in new haemodialysis patients anti-HCV antibodies were not found.

[Effect of antisperm antibodies in male infertility]

Antisperm antibodies and their relationship with infertility has been investigated in semen and serum samples of 100 infertile and 25 fertile males. The investigation of antisperm antibodies has been done by latex agglutination test in semen samples and by ELISA procedure in serum samples. In addition, the semen samples have been investigation for several characteristics. Antisperm antibodies have been found 7% positive in blood and 30% positive in semen. In 28.5% of the patients with positive antisperm antibodies in blood, antisperm antibodies in semen have also been found to be positive. For cases with infertility of unknown cause the antisperm antibodies ratio has been found to be significantly high (p less than 0.002). These results have shown the importance of further investigation of antisperm antibodies in cases with infertility of unknown reasons.