IS REPEAT FNAB NECESSARY FOR THYROID NODULES WITH ND / UNS CYTOLOGY?

Context/Objective: The standard approach is to perform repeat FNAB (rFNAB) in thyroid nodules with non-diagnostic (ND) / insufficient (UNS) cytology. However, due to the nature of these nodules, recurrent FNABs may also be insufficient. Therefore, by comparing the clinical-radiological-pathological parameters of nodules with a definite diagnosis of excision, we questioned the possibility of patient management without rFNAB. Methods: Clinical-radiological parameters of 275 nodules belonging to 264 patients in the ND/UNS aspiration group with definite pathological diagnosis after surgery were determined. Under the guidance of these parameters, those with and without rFNAB were compared. Results: The incidence of malignancy was found to be significantly higher in nodules without rFNAB compared to nodules with rFNAB (p = 0.036). In addition, the incidence of malignancy in BC-1 nodules without rFNAB was significantly higher than in nodules with rFNAB result also BC-1 (p = 0.009). In all cases, nodule size smaller than 10 mm and border irregularity were found to be statistically significant for malignancy (p <0.020, p <0.002). When looking at the distribution of rFNAB results, a significant correlation was observed with female gender, solid component, hypoechogenicity, border irregularity and halo loss around the nodule in patients with BC-4,5,6 cytology results (respectively, 0.005 / 0.031 / 0.001 / 0.012 / 0.004). Conclusion: rFNAB did not show the expected effect in ND / UNS nodules. We recommend direct surgical excision without rFNAB for nodules with border irregularity, solid structure, halo loss and hypoechogenicity, which should be considered more important in female patients.

Mutation Status and Immunohistochemical Correlation of EGFR Mutations in Gastrointestinal Stromal Tumors.

Being one of the leading causes of cancer deaths worldwide and their resistance to conventional treatment methods, made gastrointestinal stromal tumors (GISTs) one of the hot topics in medical research areas in the past decade. To investigate molecular alterations underlying the tumor is of great importance to be able to develop new, targeted treatment options. In this study, GIST samples obtained from 40 Turkish patients were analyzed for actionable epidermal growth factor receptor (EGFR) mutations that are related to treatment regimes in non small cell lung cancer (NSCLC) to understand whether EGFR expression is altered in GISTs. Established alterations in EGFR can make the use of tyrosine kinase inhibitors possible, which are currently used in cancer therapy, especially in NSCLC. Our results indicated that EGFR mutations are rare in GISTs. Further research is needed to sequence whole coding regions of the gene to investigate new actionable mutations in EGFR in an increased sample size.

Clinical and pathological diagnosis and comparison of benign and malignant eyelid tumors.

PURPOSE: To assess and compare demographic and clinical features of benign and malignant eyelid tumors from 2011 to 2018 in a tertiary medical center. MATERIALS AND METHODS: The study was conducted retrospectively from medical records to compare demographic and clinical characteristics and recurrence of benign and malignant eyelid tumors after obtaining institutional review board approval. A total of 428 eyelid tumors with histopathologic diagnoses were studied. Premalignant lesions were not included. The lesions were classified into two groups according to malignancy: benign and malignant eyelid lesions. RESULTS: Among the 428 histopathologically confirmed eyelid lesions, 373 (87.1%) were benign and 55 (12.9%) were malignant. The patients with malignant eyelid tumors had a higher mean age at diagnosis than patients with benign eyelid tumors (P=0.012). The most common benign eyelid tumors were squamous papilloma (17.7%), xanthelasma (11.5%), and epidermal cysts (11.3%). The most common malignant eyelid tumors were basal cell carcinomas (65.5%), squamous cell carcinomas (14.5%), and sebaceous gland carcinomas (7.3%). There was no relative gender predominance between patients with benign and malignant eyelid tumors (P=0.287). Benign eyelid tumors were most commonly located on the right side and upper eyelid (P=0.027 and 0.036, respectively). Malignant tumors had a higher rate of recurrence (P=0.002). CONCLUSION: Differentiation between benign and malignant eyelid lesions is important, since it may lead to cosmetic complications and serious morbidity, particularly in patients with malignant eyelid tumors.

Acute hydrocephalus due to a primary malignant peripheral nerve sheath tumor of the cervicothoracic junction: A case report and review of the literature.

BACKGROUND: The estimated incidence of malignant nerve sheath tumors is 0.001% per year, and only 2-3% of those tumors involve the spinal nerves. We present a rare case of acute hydrocephalus caused by primary malignant peripheral nerve sheath tumor of the cervicothoracic junction. CASE DESCRIPTION: A 29-year-old previously healthy male patient, except for a history of two previous surgeries for ulnar nerve entrapment and progressive left upper extremity weakness, presented with acute onset somnolence. The CT and MRI revealed hydrocephalus and periventricular edema. The patient underwent ventriculoperitoneal shunt surgery. Postoperative MRI of the spine revealed a 6×3×3cm intra-extradural lesion at C7-T1 level and multiple metastases in other spinal segments. The patient underwent combined surgical excision and the tumor was diagnosed as a malignant peripheral nerve sheath tumor based on pathological and immunohistological findings. Radiation therapy and chemotherapy were initiated. CONCLUSION: Primary malignant peripheral nerve sheath tumor of the spine is a very aggressive tumor with a very high recurrence rate, significant potential for metastasis and very poor overall prognosis. They may present with features of more frequent diseases, such as peripheral neuropathies and may be overlooked as in our case. Thus, suspected cases should undergo a more detailed examination.

The expression of miR-181a-5p and miR-371b-5p in chondrosarcoma.

OBJECTIVE: Chondrosarcomas are malignant tumors of chondrocytes that affect bones and joints, and it represents the third most common type of primary bone tumors. Chondrosarcoma is difficult to treat because it is relatively resistant to both chemotherapy and radiation. Thus, surgery remains the best available treatment. It is important to find new diagnostic markers and improve treatment options. BACKGROUND: miRNAs are small non-coding transcripts (19-25 nucleotides) that regulate gene expression via targeting complementary sequences within messenger RNAs (mRNAs). miRNAs have been shown to be involved in regulation of many biochemical pathways. Dysregulated expression of many miRNAs has also been associated with multiple human diseases, such as cancer. PATIENTS AND METHODS: 18 surgical chondrosarcoma specimens were obtained from patients. RNA extractions were performed from decalcified paraffin embedded tissues. The aim of this study was to investigate the expression levels of miR-181a and miR-371b in patients with chondrosarcoma by using RT-PCR and to evaluate the relationship between these miRNAs and chondrosarcoma. RESULTS: miR-181a was found to be upregulated in chondrosarcoma specimens whereas no significant alteration was found for miR-371b expression. CONCLUSIONS: It has been proposed that miRNA expression studies might be used as diagnostic, prognostic marker in cancer. miRNA expression data produced in our study may contribute future chondrosarcoma diagnosis and therapy.

Granular cell tumor of the breast.

Granular cell tumor is a rare benign soft-tissue neoplasm, usually appearing in the tongue, the oral cavity and subcutaneous tissue. Examples of granular cell tumor of breast are encountered in 30-50-year-old women. Herein, we report ultrasonographic and mammographic imaging findings of a 59 years old woman presented with a painless palpable mass, which was diagnosed as granular cell tumor on histopathological analysis.

Neurophysiological and morphological responses to treatment with acetyl-L-carnitine in a sciatic nerve injury model: preliminary data.

We investigated the effects of acetyl-L-carnitine (ALCAR) on the recovery of sciatic nerve injuries in rats. Sprague Dawley rats were randomized to two groups: ALCAR treated (for 14 days) and control. Each group was divided into three subgroups: distal transection, proximal transection, and grafted. Distal latencies, amplitudes, and motor nerve conduction velocities were measured. In the third month, biopsies were taken and examined under light microscopy. Electrophysiological measurements demonstrated that regeneration occurred earlier and was better in the ALCAR group, particularly in the distal transection subgroup. Better results were obtained in the distal transection subgroup in terms of axonal regeneration compared with the proximal transection and grafted subgroups because the regenerating segment was shorter. ALCAR enhanced the quality of neural recovery at the different levels and in different types of repair, and led to a decline in nerve death.

Preliminary study comparing the effects of locally and systemically applied L-carnitine on the healing of full-thickness skin defects.

BACKGROUND AND AIMS: L-carnitine as an endogenous cofactor has a role in the regulation of energy flow between different oxidative sources. The purpose of this study is to investigate that the clinical and histopathologic effects of L-carnitine locally and systemically on secondary healing in wounds of full thickness defects. We also measured the effects of L-carnitine on wound tensile strength as mechanical. MATERIAL AND METHODS: sixty adult male Sprague-Dawley rats were divided into three groups randomly; group 1 (control group, n = 20), group 2 (local experimental group, n = 20), group 3 (systemic experimental group, n = 20). Group 1 was not given any pharmacologic agents. L-carnitine was administered locally in the group 2, and systemically in group 3 for a total of 14 days. The healing days of all groups were recorded. On the 7th, 10th,14th and 21st postoperative days, biopsy specimens, including tissue samples both from healing wound sites and sur-rounding healthy skin were evaluated for neovascularization, inflammation, the amount of collagen deposit, fibroblast migration and re-epithelization. Tensile strength was measured in the samples which completed healing on the 30th day. The results were evaluated by nonparametric Kruskall-Wallis test followed by Mann Whitney-U test. RESULTS: the mean clinical healing days were 18.25 days, 16.5 days, 15 days for the control group, local experimental and systemic group, respectively. The differences between groups were statistically significant (p < 0.005). Mean tensile strength values were 762.10 centinewton (cN), 801.69 cN and 786.13 cN for the control group, local experimental group and systemic experimental group, respectively. There were no statistically significant differences between groups (p > 0.05). There was no statistically significant difference in the histopathologic ex-amination on the 7th, 10th, 14th and 21st days in the neovascularization, inflammation and fibroblast migration. Collagen deposit was most prevalent in the systemic experimental group and was least in the control group. Complete wound closure rate was observed on the 7th day in the systemic administration group, on the 10th day in local administration group and on the 14th day in the control group. Re-epithelization thickness in the systemic carnitine group was more than the other groups. CONCLUSIONS: L-carnitine administered locally or systemically has positive effects on wound healing rate and tensile strength in rats.

Larynx osteosarcoma: case report.

We present the case of a laryngeal osteosarcoma in a 69-year-old man, which generated many diagnostic and treatment difficulties. The patient was admitted to the hospital because of persisting hoarseness and a laryngeal tumor was seen on laryngoscopy. Total laryngectomy was performed and the pathological examination of the resected material showed osteosarcoma of the larynx. Postoperative radiotherapy was planned but the patient declined any treatment. He was readmitted to the hospital 5 months later with a neck tumor and enlarged lymph nodes on the right side of the neck. Chemotherapy started and during treatment metastatic lymph nodes on the left side of the neck and pulmonary metastases were detected.

Wide excision and free flap reconstruction of two cases with adult form of Juvenile Hyalin Fibromatosis localized on the foot.

Juvenile Hyalin Fibromatosis (JHF) or systemic hyalinosis is a rare, sporadic or hereditary disorder characterized by skin lesions, gingival hypertrophy, muscle weakness, and flexion contractures of large joints. There is still dispute in its pathogenesis and treatment. We described two cases with adult form of Juvenile Hyalin Fibromatosis localized in the foot and discussed the local control we achieved by surgery.

Mixed germ cell tumor of the ovary with sarcomatous component.

Germ cell tumors constitute a very complicated group of tumors of the ovary and their histogenesis is not yet clarified. Besides their histological heterogeneity, sarcomatous areas have also been described. A right ovarian mass was found in a 23-year-old female, who was being treated in the hospital for miscarriage. Disseminated omental metastases were detected during abdominal laparotomy. Pathological examination of the dissected material revealed the tumor to be a mixed germ cell tumor (immature teratoma and dysgerminoma) with sarcomatous component. Areas resembling granulosa cell tumor were also encountered. This ovarian tumor with many different histopathological features is presented with a review of the literature. The importance of thorough sampling in determining the type and extent of the malignant components is also emphasized due to their direct relation with the prognosis.

Multiple diffuse fibrosarcoma of bone.

Multiple diffuse fibrosarcoma of bone is a very rare condition, with only 3 cases reported. Its presentation is like that of a multiple myeloma or a metastatic tumor, with multiple osteolytic lesions, and its extent is limited to the bones. Disseminated involvement of the vertebrae was detected in a 26-year-old man, suggesting a metastatic tumor; however, no primary organ or soft-tissue mass was identified. The histopathologic findings of the biopsy material were consistent with fibrosarcoma. Despite treatment, the patient died within 15 months.

Malignant fibrous histiocytoma developing in a burn scar.

Malignant fibrous histiocytoma (MFH) which is usually originated from muscles and deep fascia and rarely from the subcutaneous tissue is the most common soft tissue sarcoma; and it frequently invades the extremities. Occurrence of this tumor on a burn scar of scalp is a very rare entity. In the literature, there were only four reported malign fibrous histiocytoma cases that originated from a burn scar but none of them was at the scalp region. A female patient complaining about a painful mass at the scalp region was admitted to our clinic twenty years after burning with hot water when she was 3 years old. Pathological and clinical features of this rapidly growing malignant fibrous histiocytoma were similar with the other cases reported before. After the diagnosis was clear as a pleomorphic storiform type of MFH, a wide tumor excision was done because of the high risk of local recurrence.

The effect of H. pylori in perforation of duodenal ulcer.

BACKGROUND/AIMS: H. pylori has been described as an opportunistic pathogen attracted by changes in the gastric mucosa caused by inflammation and ulceration. However, the role of H. pylori infection in the perforation of duodenal ulcers has not yet been clearly determined. The aim of this study was to assess the prevalence of H. pylori infection in patients undergoing laparotomy for repair of a perforated duodenal ulcer. METHODOLOGY: Patients who underwent surgery for a perforated duodenal ulcer in our Surgical Unit between January 1994 and July 1996 were included in this study. The study population consisted of eighteen patients with a mean age of 32.7 (21-48) years. All of the patients were male. Patients with chronic duodenal ulcer perforation and with no contraindications for definitive surgery, such as peritonitis, shock (blood pressure <90 mm Hg), age >60 years, or more than a 12-hour elapse from the time of perforation, were treated by bilateral truncal vagotomy and Weinberg pyloroplasty. The ulcer was excised with the pyloric ring. The cut was then extented by about 2 cm on both the gastric and duodenal sides. Two biopsies were taken from the antral mucosa by endoscopic biopsy forceps. The defect was closed transversely. The ulcer specimen and the antral biopsies were fixed separately in 10% formalin solution and sent to the department of Histopathology. The specimens were stained with Hematoxylin-Eosin and examined for H. pylori . Sections of the ulcer specimen were especially investigated for the presence of H. pylori through all layers of the ulcer. RESULTS: H. pylori was found in the antral biopsies of 16 patients (88.8%). In seven of the ulcer specimens (38.8%), H. pylori was present in the mucosa and also extended through the wall of the ulcer. H. pylori was positive in the antral biopsies of all patients with H. pylori present in the ulcer wall. CONCLUSIONS: In our study, H. pylori was present at a high ratio in the antral biopsies of patients with duodenal ulcer perforation. The presence of H. pylori throughout the ulcer wall to a considerable extent emphasizes the fact that eradication of H. pylori is important in the treatment of perforated duodenal ulcer.

Fine needle aspiration of malignant bone lesions.

OBJECTIVE: To determine the role of fine needle aspiration (FNA) cytology in the early diagnosis of malignant bone lesions. STUDY DESIGN: Thirty-eight bone lesions that were considered malignant clinically and radiographically were evaluated by FNA. The results were compared with the histopathology of the subsequent open biopsies. RESULTS: An accuracy rate of 89.5% was achieved by FNA. Eighty-four percent of the cases were consistent with the clinical and radiographic findings. Chondrosarcoma gave the greatest diagnostic difficulty in the differential diagnosis with other chondroid tumors. Giant cell tumor cases also produced some difficulty when the cytology was hemorrhagic and low in cellularity, displaying features of other benign bone lesions containing giant cells. Ewing's sarcoma and multiple myeloma could be identified when interpreted with their coexistent clinical findings. The metastatic carcinoma cases were also easy to define, forming another group with a high rate of accuracy. CONCLUSION: FNA plays a valuable role in the initial diagnosis of malignant bone lesions. Cytologic assessment with the clinical and radiologic findings, together with the experience of the cytopathologist, can yield almost the same diagnostic accuracy in the majority of the lesions.

Compression neuropathy of the peroneal nerve caused by a ganglion.

Peroneal nerve injury usually results from fracture of the fibula neck or direct pressure from an ill-fitting plaster cast. Clinically, these patients present with "drop foot." Compression neuropathy caused by a ganglion is rarely encountered. This report concerns the clinical and radiologic evaluation of a 57-year-old man admitted to our clinic with left drop foot. A mass compressing the peroneal nerve at the level of the fibula neck was excised totally and diagnosed as a ganglion.

Long-term results of choledochoduodenostomy and T-tube drainage.

BACKGROUND/AIMS: In this study, gastric mucosal changes and the other clinical results of patients with choledochoduodenostomy (CDD) and T-tube drainage (TTD) were compared in a follow up period of at least 5 years. MATERIALS AND METHODS: The previous files of these patients were evaluated, physical examination and abdominal ultrasonography (US) and gastroscopic examination were made. Esophagus, stomach and the first two parts of the duodenum and size of the anastomosis in patients with choledochoduodenostomy were examined during gastroscopy. Two biopsies from antrum and corpus of the stomach were taken and sections stained with Hematoxylin and eosin for histopathological examination under light microscope. RESULTS: In total 45 patients, 21 of them with TTD and 24 of them with CDD, were accepted for the study. No difference was present between the mean age, female/male ratio, and interval between the operation date and endoscopic control of both groups (p > 0.05). Common bile duct was evidently wide in the CDD group at the first operation (p < 0.05). In the late postoperative clinical classification of the patients, moderate group was predominant, while incidence of alkaline reflux gastritis was obviously high in the CDD group (p < 0.05). No other difference in the results was present between the two groups (p > 0.05). CONCLUSION: According to our study long-term results of T-tube drainage is superior over choledo-choduodenostomy.