GC-MS Based Metabolomics Analysis to Evaluate Short-Term Effect of Tumor Removal on Patients with Early-Stage Breast Cancer.

In this study, it was aimed to demonstrate the short-term effect of breast cancer surgery and tumor removal on the metabolomic profiles of patients with early-stage breast cancer. This cohort consisted of 18 early-stage breast carcinoma patients who had breast cancer surgery to remove tumor and surrounding tissues. The blood samples obtained preoperatively and 24 h after surgery were used in this investigation. Gas chromatography-mass spectrometry (GC-MS) based metabolomic analysis was performed to determine the metabolites. The GC-MS-based metabolomics profile enabled the identification of 162 metabolites in the plasma samples. Postoperatively, glyceric acid, phosphoric acid, O-phosphocolamine, 2-hydroxyethyliminodiacetic acid, N-acetyl-D-mannosamine, N-acetyl-5-hydroxytryptamine, methyl stearate, methyl oleate, iminodiacetic acid, glycerol 1-phosphate, ß-glycerol phosphate and aspartic acid were found to be significantly increased (P < 0.05 for all), whereas saccharic acid, leucrose, gluconic acid, citramalic acid and acetol were significantly decreased (P < 0.05 for all). Breast cancer surgery and tumor removal has an impact on the metabolomic profiles of patients with early-stage breast cancer. These findings can be used for understanding the pathogenesis of breast cancer biology and screening the success of the surgery.

Clinical features of metaplastic breast carcinoma: A single-center experience.

AIM: Metaplastic breast cancer (MBC) is a rare subtype with unusual clinical features. We aimed to analyze treatment results and define patients' characteristic features in our large MBC patient series. MATERIALS AND METHODS: Fifty-six patients with early MBC who received adjuvant radiotherapy (RT) in our center were included in the study. The age, sex, subtypes of MBC, histopathology, hormone and nodal status, tumor size, and types of treatment were retrospectively provided from hospital records. RESULTS: The median tumor size was 4 (1.3-16.5) cm, and triple-negative MBC cases were 38 (67.8%) of all patients. Axillary nodal involvements were present in 25 (44.6%) patients. The median follow-up time was 45.8 (4.9-130) months; the overall survival (OS) and disease-free survival (DFS) for 5 years were 67% and 64%, respectively. While distant metastases were seen in 15 (26.7%) patients, local recurrences were seen in only 4 patients. The median OS and DFS were higher in patients with ≤5.2 cm tumor than >5.2 cm ([130 vs. 49 months, P = 0.01] and [130 vs. 30 months, P = 0.009], respectively). Nodal involvement, hormone receptor status, surgical treatment, and type of RT had no effect on survival. In multivariate analysis, tumor size was not an independent prognostic factor for OS (P = 0.068; hazard ratio [HR]: 3.4, 95% confidence interval [CI] = 0.91-12.8), whereas age >65 years was found an independent poor prognostic factor for OS ([HR: 4.25, 95% CI: 0.23-0.78, P = 0.021] and DFS [HR: 3.1, 95% CI: 0.02-0. 87; P = 0.04], respectively). CONCLUSIONS: Distant metastasis is at the forefront rather than local recurrence in MBC patients. More studies are needed to determine the factors that affect survival independently in MBC.

A Serous Peritoneal Cancer Revealing Itself With Double Breast Cancer Metastases in 2 Different Periods.

A 72-year-old woman presented with a mass on the right axilla. This was thought to be an occult breast cancer case, and the patient was treated with modified radical mastectomy, followed by hormonotherapy. Two years later she presented with incarcerated umbilical hernia. Pathology revealed Sister Mary Joseph's nodule inside the hernia sac. Further evaluation revealed that the primary tumor was papillary serous carcinoma of the peritoneal surface. The patient received adjuvant chemotherapy. Two years later the metastatic tumor was located on the other breast. The disease progressed gradually, and the patient eventually died from disseminated disease. This case is extraordinary in that it first presented with axillary metastasis without abdominal involvement and then later metastasized to the other breast after a long disease-free period.

Malignancy in Solitary Thyroid Nodules: Evaluation of Risk Factors.

BACKGROUND: The aim of the present study was to evaluate patients with suspicious solitary nodules undergoing bilateral total thyroidectomy for the presence of malignancy. PATIENTS AND METHODS: 141 patients with true solitary thyroid nodules who underwent bilateral total thyroidectomy at the Dr. Abdurrahman Yurtaslan Ankara Oncology Hospital between 2008 and 2013 were retrospectively evaluated. Parameters including demographics, ultrasonographic findings, and laboratory values were analyzed. RESULTS: When the final pathology results were evaluated, malignancy was found in 52/141 (36.9%) patients. 49 (94.2%) of these lesions were papillary carcinoma. Colloidal nodules accounted for 30.3% of all benign cases. Nodular irregularity, increased vascularity, microcalcification, and central/lateral lymphadenopathy significantly increased the risk of malignancy. Among these factors, increased vascularity was the most important risk factor and microcalcification the second. Nodule size did not affect the risk of malignancy. CONCLUSION: Irregular borders, microcalcification, increased vascularity, and detection of cervical lymphadenopathy were found to be correlated with malignancy in solitary nodules.

Evaluation of proinflammatory cytokine and neopterin levels in women with papillary thyroid carcinoma.

INTRODUCTION: Papillary thyroid cancer is a disease that has been associated with chronic inflammation. The purpose of this study is to measure the production of the proinflammatory cytokines IL-1ß, IL-6 and IL-8 and neopterin, which is a novel biomarker for cellular immune response in papillary thyroid cancer. MATERIALS AND METHODS: The serum IL-1ß, IL-6, IL-8 and neopterin values of 31 papillary thyroid cancer patients undergoing bilateral total thyroidectomy were measured before and 20 days after surgery. The values were compared with those of 39 healthy controls. RESULTS: Serum IL-1ß levels were similar across groups. IL-6 (p<0.001), IL-8 (p = 0.015) and neopterin levels (p = 0.002) were higher in presurgical samples and returned to normal following surgery. CONCLUSIONS: The proinflammatory cytokines IL-6 and IL-8, but not IL-1ß, were produced in greater amounts in papillary thyroid cancer. Serum neopterin seems to be a valid biological marker supporting the presence of papillary thyroid cancer.

Leptin levels in thyroid cancer.

BACKGROUND: Leptin has physiological roles in multiple systems, and has possible effects on several carcinogenesis steps. The aim of this study was to investigate the leptin levels in thyroid papillary carcinoma (TPC) patients. METHODS: Forty-three female TPC patients and 30 healthy female control subjects were recruited for the study. TPC was diagnosed by fine needle aspiration biopsy. TPC patients had a bilateral total thyroidectomy operation and their leptin levels were measured before and 20 days after the operation. RESULTS: Serum leptin levels of TPC patients were higher than in control group subjects (21.15 +/- 14.12 ng/mL vs. 9.89 +/- 0.21 ng/mL, p < 0.05). The leptin levels decreased after total thyroidectomy (13.92 +/- 10.55 ng/mL) compared to prethyroidectomy levels (22.94 +/- 14.67 ng/mL) in 34 patients who came to the follow-up visit (p < 0.05). However, the decreased post-thyroidectomy levels of leptin were still statistically significantly higher than the control group levels. Multivariate regression analysis showed that the leptin levels in TPC patients were not related to age, menopausal status or pathologic occult status but were directly related to the cancer group. CONCLUSION: Leptin levels were elevated in thyroid cancer, decreased after total thyroidectomy, and might be associated with thyroid papillary carcinogenesis.

Oxidant/antioxidant balance in patients with thyroid cancer

PURPOSE: To compare the antioxidant enzyme activities of superoxide dismutase (SOD), glutathione peroxidase (GSH-Px) and the levels of lipid peroxidation product malondialdehyde (MDA) in blood samples of thyroid cancer patients compared to healthy controls. METHODS: 43 control subjects (mean age 44±13 years) and 43 patients (43±13 years) presented with multinodular goiter whose fine needle aspiration revealed malignant cytology were included into this study. The SOD, MDA and GSH-Px activities were measured in control subjects, and before/20 days after thyroidectomy in thyroid cancer patients. RESULTS: SOD activities of pre-thyroidectomy, post-thyroidectomy and control groups were not different (p>0.05). Before thyroidectomy GSH-Px activities were lower (p<0.05) and MDA levels were higher (p<0.05) than the control group. In post- thyroidectomy, GSH-Px activity (p<0.05) increased, and MDA levels (p<0.05) decreased compared to prethyroidectomy levels. After thyroidectomy GSH-Px activity was significantly higher than the control group (p<0.05). Although post-thyroidectomy MDA levels significantly decreased, they were still higher than the control group (p<0.05). CONCLUSION: The superoxide dismutase does not seem to change with thyroid cancer and thyroidectomy but both antioxidant glutathione peroxidase and lipid peroxidation product malondialdehyde do. These preliminary findings may point out oxidant/antioxidant imbalance associated with thyroid cancer.

Oxidant/antioxidant balance in patients with thyroid cancer.

PURPOSE: To compare the antioxidant enzyme activities of superoxide dismutase (SOD), glutathione peroxidase (GSH-Px) and the levels of lipid peroxidation product malondialdehyde (MDA) in blood samples of thyroid cancer patients compared to healthy controls. METHODS: 43 control subjects (mean age 44+/-13 years) and 43 patients (43+/-13 years) presented with multinodular goiter whose fine needle aspiration revealed malignant cytology were included into this study. The SOD, MDA and GSH-Px activities were measured in control subjects, and before/20 days after thyroidectomy in thyroid cancer patients. RESULTS: SOD activities of pre-thyroidectomy, post-thyroidectomy and control groups were not different (p>0.05). Before thyroidectomy GSH-Px activities were lower (p<0.05) and MDA levels were higher (p<0.05) than the control group. In post- thyroidectomy, GSH-Px activity (p<0.05) increased, and MDA levels (p<0.05) decreased compared to prethyroidectomy levels. After thyroidectomy GSH-Px activity was significantly higher than the control group (p<0.05). Although post-thyroidectomy MDA levels significantly decreased, they were still higher than the control group (p<0.05). CONCLUSION: The superoxide dismutase does not seem to change with thyroid cancer and thyroidectomy but both antioxidant glutathione peroxidase and lipid peroxidation product malondialdehyde do. These preliminary findings may point out oxidant/antioxidant imbalance associated with thyroid cancer.

Advanced oxidation protein products, ferrous oxidation in xylenol orange, and malondialdehyde levels in thyroid cancer.

AIMS AND BACKGROUND: The oxidation of protein plays an essential role in the pathogenesis of an important number of degenerative and cancer diseases, which is now widely recognized. The aim is to examine advanced oxidation protein products (AOPPs), lipid peroxidation products malondialdehyde (MDA), and ferrous oxidation in xylenol orange (FOX) in blood samples of papillary thyroid cancer patients compared with healthy controls to determine the oxidation status and the change after thyroidectomy. METHODS: Thirty-five female thyroid cancer patients who underwent total thyroidectomy and 39 female control subjects were included into this study. Prethyroidectomy and postthyroidectomy, AOPP, FOX, and MDA levels were studied. RESULTS: Prethyroidectomy AOPP, FOX, and MDA levels were significantly higher compared to control (P < .05). In postthyroidectomy AOPP, FOX, and MDA levels were significantly decreased compared with prethyroidectomy levels (P < .05). However, postthyroidectomy levels on the 20th day were still significantly higher, compared to control subjects (P < .05). CONCLUSION: In conclusion, all of AOPP, FOX, and MDA levels that are markers of protein oxidation and lipid hyperoxidation may induce thyroid cancer development and begin to decrease after thyroidectomy.

Computed tomography in detecting bone metastases of breast carcinoma. Is it better than plain x-ray?

OBJECTIVE: To compare 5mm slice computerized tomography (CT) and conventional x-ray (XR) in the detection of bone metastases in breast carcinoma patients. METHODS: Ninety-eight female breast cancer patients treated in Ankara Oncology Hospital, Ankara, Turkey between September 1997 and March 2002 were assigned into 3 groups with respect to their Tc bone scan (Sc) results. Group 1 included patients with overt bone metastases, group 2 included patients with suspicious of metastases and group 3 were those patients with normal Sc results with back pain complaint. All patients underwent XR, and 5mm contiguous slice CT imaging for the related metastatic sites. For the third group, lumbosacral region was examined. RESULTS: A total 33 bone metastases have been diagnosed out of 98 patients. The Sc result showed 26/33 metastatic cases, XR 19/33 and CT 22/33 cases. There were no false positive results for CT and XR. Results of CT have 11 and XR has 14 false negatives out of 33 metastases. For XR the calculated sensitivity was 65.6, specificity was 100, diagnostic accuracy was 88.7, whereas for CT, sensitivity was 71.8, specificity was 100 and diagnostic accuracy was 90.8. When CT and XR were compared to detect bone metastases, results were not statistically significant (p>0.05). CONCLUSION: Our results suggest that 5mm slice CT is not superior than XR to detect metastatic bone lesions. Larger series comparing different slice thickness of CT are needed to clarify the issue.

Polidocanol at different concentrations for pleurodesis in rats.

PURPOSE: We previously found that 0.5% polidocanol was more effective than tetracycline for pleurodesis in rats. Thus, we conducted the present study to evaluate the efficacy of different concentrations of polidocanol for pleurodesis in rats. METHODS: We divided 54 albino Wistar rats into six groups. Groups 1, 2, and 3 were given isotonic saline, 35 mg/kg tetracycline, and 0.6 mg of diluted polidocanol, respectively, being the daily recommended dose for humans. Groups 4, 5, and 6 were given 0.5%, 1%, and 2% polidocanol, respectively. All solutions were given intrapleurally in a volume of 0.5 ml. We examined the rats for macroscopic pleural adhesions and compared the mean values of macroscopic scoring among the six groups. RESULTS: The rats given polidocanol and tetracycline had significantly more adhesions than the control group, and polidocanol at concentrations of 0.5%, 1%, and 2% was more effective for pleurodesis than tetracycline. The diluted polidocanol was not more effective than tetracycline. There was no difference between the effects of the 0.5% and 1% concentrations, but the 2% polidocanol group had significantly more adhesions than the other groups. CONCLUSIONS: Polidocanol at concentrations of 0.5%, 1%, and 2% was a more effective sclerosing agent than tetracycline for pleurodesis. While 2% polidocanol was the most efficient sclerosing agent, the daily maximum recommended dose of polidocanol for humans was not more effective than tetracycline.

Peritoneal carcinoembryonic antigen level for predicting locoregional and distant spread of gastric cancer.

PURPOSE: Peritoneal recurrence is not an uncommon cause of death after surgery for gastric cancer, even after surgery with curative intent. This indicates that there is undetected residual disease in the peritoneal cavity. We conducted this study to determine the value of peritoneal and serum carcinoembryonic antigen (CEA) levels and peritoneal washing cytology in predicting the locoregional and distant spread of gastric cancer. METHODS: We prospectively evaluated 70 consecutive patients with gastric cancer by measuring peritoneal CEA (pCEA) and serum CEA (sCEA) levels and peritoneal washing cytology results, and studying their effect on the histopathologic properties. The effect of the pCEA level on disease-free survival (DFS) and overall survival (OS) was also evaluated in patients treated with curative intent. RESULTS: Twenty-one (30%) patients had sCEA levels >10 ng/ml, whereas 25 patients (35.7%) had pCEA levels >10 ng/g protein and 26 patients (37.1%) had positive cytology. The pCEA levels were significantly higher in patients with hepatic metastases (P = 0.034), or serosal (P = 0.028), and peritoneal (P = 0.026) involvement, whereas the sCEA levels were significantly higher only in patients with hepatic metastases (P = 0.04). Similarly, positive cytology was mainly detected in patients with hepatic metastases (P = 0.004). The pCEA levels significantly affected DFS (P = 0.002) and OS (P = 0.01) in 34 patients treated with curative intent. CONCLUSION: Since pCEA levels are more useful for predicting locoregional recurrence, their measurement during surgery may help plan the most appropriate surgical strategy and adjuvant therapy.

The efficacy of fibrin tissue adhesives in pleurodesis in rats.

In search for a new sclerosing agent for pleurodesis, fibrin tissue adhesive is compared to tetracycline for its efficacy in rats. Twenty-four albino Wistar rats were divided into 3 groups. Groups 1, 2, and 3 were given intrapleural isotonic saline, 35 mg/kg tetracycline, and fibrin tissue adhesive with fibrinogen and thrombin concentrations of 30 mg/mL and 10 U/mL, respectively. Rats were evaluated for macroscopic pleural adhesions and mean values of macroscopic scoring were compared among the groups. Fibrin tissue adhesive- and tetracycline-treated rats had significantly more adhesions compared to the control group, whereas fibrin tissue adhesive was more effective for pleurodesis than tetracycline and no deaths or major side effects were observed in any rat. Thus, fibrin tissue adhesive was found as a more effective sclerosing agent than tetracycline for pleurodesis in rats.

The role of fibrin tissue adhesives in flap necrosis in rats.

Flap necrosis is an important issue in surgery, and fibrin tissue adhesives, due to beneficial properties in preventing flap necrosis, were used in this study. Two groups, each comprising of 10 rats, were formed. Group I served as a control group, and fibrin tissue adhesive was applied to group II. The fibrinogen and thrombin concentrations in fibrin tissue adhesive were 30 mg/ml and 10 U/ml, respectively. The mean area of flap necrosis was 687.5 +/- 72.5 mm2 and 78.5 +/- 11.0 mm2 in the control and fibrin tissue adhesive groups (p < .0001), respectively. The percentage of flap necrosis was significantly lower in the fibrin tissue adhesive group compared to the control group (5.6% vs 49.1%) (p < .0001). Fibrin tissue adhesives decreased flap necrosis significantly compared to the control group.

A long surviving case of Pseudomeigs' syndrome caused by Krukenberg tumor of the stomach.

Meigs syndrome is defined as the triad of benign ovarian tumor with ascites and pleural effusion that resolve after resection of the tumor. Pseudomeigs' syndrome is a serious disease characterized by malignant ovarian tumor, but ascites and hydrothorax usually reveal no malignant cells. Here, we report a 47-year-old pre-menapausal female patient with cardia cancer. Nearly 14 months after D3 dissection, she developed Krukenberg tumors on both ovaries causing a Pseudomeigs' syndrome with benign ascites and right hydrothorax, which resolved dramatically after resection of the tumors and rectouterine pouch peritonectomy. She survived nearly 3 years after metastasectomy with a total survival of 46 months. The patient died because of massive liver metastases. The present case suggests that Pseudomeigs' syndrome should be considered in patients with Krukenberg tumors, ascites and hydrothorax and that resection of the tumors may bring long-term palliation.

Frozen section in thyroid surgery: is it a necessity?

INTRODUCTION: Many surgeons use intraoperative frozen-section (FS) biopsy of thyroid nodules to predict malignant disease, but the findings are often not in agreement with those of fine-needle aspiration (FNA) biopsy. Our objective in this study was to assess the value of intraoperative FS biopsy in patients with nodular disease of the thyroid gland. METHODS: In this study, 203 patients underwent thyroid surgery at the Ankara Oncology Hospital. Nodules were assessed by FNA biopsy preoperatively, by FS intraoperatively and by histologic examination of the excised specimen. Sensitivity, specificity and accuracy were determined for FS and FNA with respect to the histologic findings. RESULTS: The sensitivity, specificity and accuracy rates for FNA, excluding occult cancers, were 74.1%, 100% and 95.2%, respectively, and for FS were 87.1%, 100% and 97.8%, respectively. FS influenced operative decisions in 0.6% of nodules found to be benign by FNA and in 20% of nodules found to be suspicious by FNA. FS contributed nothing for FNA-malignant disease since all the results in this group were true positive. CONCLUSIONS: Intraoperative FS was most helpful when the FNA findings were suspicious for malignant disease. FS does not seem to be necessary when FNA indicates malignant or benign disease. Both FNA and FS failed to detect occult thyroid carcinomas.

The efficacy of polidocanol in pleurodesis in rats.

PURPOSE: Pleurodesis is used to treat pleural effusions, and a number of agents with varying degrees of efficacy and systemic toxicity have been trialed. This study was conducted to evaluate the efficacy and systemic toxicity of polidocanol in pleurodesis. METHODS: Thirty albino Wistar rats were divided into three groups of ten rats each. Group 1 (control) was given isotonic saline, group 2 was given 35 mg/kg tetracycline, and group 3 was given 2.5 mg 0.5% polidocanol, all intrapleurally in a total volume of 0.5 ml. The rats were killed on postoperative day 30 and the macroscopic pleural adhesions and microscopic evidence of inflammation were evaluated. Hepatic, renal, and pancreatic function tests were done and various tissues were microscopically examined to detect systemic toxicity. The mean values of macroscopic and microscopic scoring and biochemical parameters were compared among the three groups. RESULTS: The polidocanol- and tetracycline-treated rats had significantly more adhesions than the control group rats, and polidocanol was more effective for pleurodesis than tetracycline (P = 0.027). Microscopic scoring was similar in the polidocanol- and tetracycline-treated rats, being significantly higher than that in the control rats. No significant difference was found in the biochemical parameters among the three groups. There were no signs of toxicity in any of the tissues studied microscopically. CONCLUSIONS: Polidocanol was found to be a more effective sclerosing agent than tetracycline for pleurodesis. Systemic toxicity was not shown by the biochemical parameters and histopathologic findings.

Efficacy of topical nitroglycerin and transcutaneous electrical nerve stimulation on survival of random-pattern skin flaps in rats.

We compared the efficacy of topical nitroglycerin and transcutaneous electrical nerve stimulation (TENS) on the survival of random-pattern skin flaps in rats. Thirty Wistar albino rats were used and a dorsal, cranially-based random-pattern flap was raised. The rats were divided into three groups of 10 rats each. The first group had only the flap raised while the second and third groups were given topical nitroglycerin 5 mg or TENS for one hour a day for seven days. The amount of flap necrosis was measured on the seventh postoperative day. The mean area of necrosis in the flaps were 726.2, 544.2, and 150.0 mm2 in the control, nitroglycerin, and TENS groups, respectively. The mean percentage of flaps that necrosed were 51.9, 38.9, and 10.7 in the corresponding groups. The TENS group had significantly higher percentage area of flap surviving than the control (p < 0.0001) and nitroglycerin groups (p = 0.002). TENS, with its efficacy on survival and with negligible side-effects, could be a reliable treatment. Clinically, it can easily be used postoperatively when flaps become ischaemic, and will be tolerated well by patients.