Is it possible that we can increase the lymph node number in cases with rectum tumor receiving neoadjuvant therapy?

Background: Though the recommended sampled lymph node number in colorectal carcinomas is at least 12, due to shrinkage after preoperative neoadjuvant chemoradiotherapy (NCRT), it can be difficult to attain that number. Aim: Our aim is to increase the lymph node number by applying alcohol fixation on the formalin-fixed resection materials of the patients that received or not received neoadjuvant therapy and to evaluate the changes in staging due to obtained lymph nodes. Settings and Design: Non-randomized controlled trial. Materials and Methods: Lymph node dissection was performed in the resection materials with rectum tumor which were formalin- and afterwards, alcohol-fixed. The number of lymph nodes obtained by both of the methods and status of metastasis were evaluated statistically. Results: Of the total 76 rectal tumors, 57 had and 19 had not received NCRT. The number of lymph node was adequate in 89.5% cases with no NCRT and in 63.2% cases with NCRT. While no change was observed after the alcohol fixation in the cases fulfilling adequacy criterion among those with no NCRT (p = 1.000), the adequacy rate increased from 63.2% to 87.7% in those with NCRT (p < 0.001). Although statistically insignificant, there was a change in pN stage in eight cases. In three of them, the stage varied from pN0 to pN1c, and in five cases, from pN1a to pN1b. Conclusion: Using solutions as alcohol during fixation might facilitate the identification of metastatic lymph nodes, might change the stage of the disease and therefore, might affect the patient-based therapy.

Anti-inflammatory activity of curcumin in a model of L-arginine-induced acute pancreatitis in rats.

BACKGROUND: Acute pancreatitis (AP) is a pathology characterized by activated digestive enzymes to digest pancreatic tissue and inflammation. This study aimed to investigate the effect of curcumin, which has antioxidant and anti-inflammatory properties, on AP and its effectiveness at different doses. METHODS: Forty Sprague Dawley albino male rats, 12 weeks old, weighing 285-320 g, were used in the study. The rats were divided into control, curcumin, AP, low (100 mg/kg), and high (200mg/kg) dose curcumin groups. An experimental pancreatitis model was created with 5 g/kg L-arginine and samples (amylase, lipase, IL-1ß, IL-6, TNF-alpha, CRP, histopathological) were taken after 72 hours. RESULTS: There was no difference between the groups in terms of the weight of the rats (p=0.76). In the AP group, it was observed that the experimental pancreatitis model was successfully created after examination. Laboratory and histopathological examination results in the curcumin-administered groups were regressed compared to the AP group. The decrease in laboratory values was higher in the high-dose curcumin group than in the low-dose (p<0.001). CONCLUSION: Laboratory and histopathological changes occur in AP according to clinical severity. The antioxidant and anti-inflammatory effects of curcumin are known. In the light of this information and according to the results of our study, it has been shown that curcumin is effective in the treatment of AP, and the effect of curcumin increases with the dose increase. Curcumin is effective in treating AP. However, while high-dose curcumin was more effective in inflammatory response than low-dose, it showed similar histopathological results. KEY WORDS: Acute, Curcumin, Cytokines, Inflammation, Pancreatitis.

Analysis of Survival in Complete Pathological Response after Long-Course Chemoradiotherapy in Patients with Advanced Rectal Cancer.

BACKGROUND: Neoadjuvant chemoradiotherapy prior to surgery is the standard treatment for locally advanced rectal cancer. This consists in the patient's complete pathological response being achieved with no residual tumor presence in the resected specimen, which results in survival improvement. METHODS: This retrospective study aimed to examine the rate of complete pathological response in patients with advanced rectal cancer treated with neoadjuvant long-course chemoradiotherapy and to examine the survival differences between the different tumor regression grade (TRG) scores. RESULTS: A total of 154 patients were operated prior to long-course chemoradiotherapy with a total of 50 Gy plus FOLFOX protocol. Complete pathologic response was achieved in 29 (18.8%) patients. There was no statistical difference for the different pathologic responses according to gender, type of surgery, and number of harvested lymph nodes. Mean survival for all the groups was 37.2 months. Survival within a different TRG score exhibited statistical significance (p = 0.006). Overall, the survival rate during the follow-up period was of 81.8%. CONCLUSIONS: The complete pathological response rate in this study was of 18.8%. High tumor regression grade scores (TRG0 and TRG1) had a survival rate of over 90% during follow-up. Multivariate analysis identified perineural invasion and tumor regression grade as independent factors that affect survival.

The Role of Ductal Lavage Cytology in the Diagnosis of Breast Cancer.

BACKGROUND: Nipple discharge is a common finding which may be a symptom of breast cancer, but it is mostly caused by benign causes. A surgical biopsy followed by a histopathological examination is considered to be the gold standard for the diagnosis of pathological nipple discharge. Non-surgical diagnostic methods should be considered to reduce the need for intervention. Ductal lavage cytology (DLC) is performed by washing and examining the ductal discharge. The usefulness of examining spontaneous discharge is controversial. This study's aim is to evaluate the usefulness in surgical decision-making of ultrasonography (USG), mammography (MMG), magnetic resonance imaging (MRI), ductography, and DLC in patients with pathological nipple discharge. METHODS: Between 2011 and 2018, we retrospectively analyzed 141 patients with pathological nipple discharge who were planned to undergo a surgical procedure and were found to have pathology. In our study, the diagnostic efficiency of DLC for breast cancer diagnosis was compared with USG, MMG, MRI, and ductography. RESULTS: USG was performed in all patients, MMG in 51, MRI in 56, ductography in 46 patients, and cytological samples were taken from 63 patients. Twelve of 17 patients with malignant pathology were reported cytologically as suspected malignancy. The sensitivity of DLC was 70.5% (95% CI: 0.489-0.922), and its specificity was 94.1% (95% CI: 0.862-1.020). CONCLUSION: Numerous studies report that cytology is not adequate for final diagnosis. Negative cytology does not exclude the possibility of malignancy, and positive results do not help in the differential diagnosis.

What does the Data of 354,725 Patients from Turkey Tell Us About Cervical Smear Epithelial Cell Abnormalities? - The Epithelial Cell Abnormality Rate is Increasing - Quality Control Studies and Corrective Activity are Musts.

OBJECTIVE: There is no other screening program close to the success rate of PAP test. Cervical cytology constitutes a large workload so that quality control in cervical cytology is important for the quality assurance of pathology laboratories. MATERIAL AND METHOD: In this study, we collected the cervical cytology results from all over Turkey and discussed the parameters influencing the quality of the PAP test. The study was conducted with Turkish gynaecopathology working group and 38 centers (totally 45 hospitals) agreed to contribute from 24 different cities. The study was designed to cover the cervical cytology results during 2013. The results were evaluated from the data based on an online questionnaire. RESULTS: The total number of Epithelial Cell Abnormality was 18,020 and the global Epithelial Cell Abnormality rate was 5.08% in the total 354,725 smears and ranging between 0.3% to 16.64% among centers. The Atypical squamous cells /Squamous intraepithelial lesion ratios changed within the range of 0.21-13.94 with an average of 2.61. When the centers were asked whether they performed quality assurance studies, only 14 out of 28 centers, which shared the information, had such a control study and some quality parameters were better in these centers. CONCLUSION: There is an increase in the global Epithelial Cell Abnormality rate and there are great differences among centers. Quality control studies including the Atypical squamous cells/Squamous intraepithelial lesion ratio are important. Corrective and preventive action according to quality control parameters is a must. A cervical cytology subspecialist in every center can be utopic but a dedicated pathologist in the center is certainly needed.

Zosteriform collagen nevus in a young boy.

Zosterifom connective tissue nevus is a rare kind of connective tissue nevi composed of collagen, elastin, or glycosaminoglycan, which was first reported by Steiner 1944. Herein, we report a young boy with a collagen nevus that presented in a zosteriform distribution.

Diagnostic and therapeutic value of ductoscopy in nipple discharge and intraductal proliferations compared with standard methods.

BACKGROUND: Fiberoptic ductoscopy is a practical and direct approach that allows the visualization of intraductal breast disease. The aim of this study was to assess the efficacy of ductoscopy in the diagnosis and management of intraductal lesions. METHODS: Data on 357 ductoscopic investigations from patients with nipple discharge were collected prospectively. Seventy-five patients were diagnosed as having intraductal papillary lesions and these cases were evaluated by final histopathology (55 solitary, 14 multiple papillomatosis, 6 premalignant or malignant lesions). Results of classical diagnostic studies using ultrasonography, mammography, and galactography were compared with those of ductoscopy and pathology. RESULTS: The sensitivities of investigation methods for papillomas in this study were 72 % in ultrasonography, 62.9 % in mammography, 81.4 % in galactography, and 86.6 % in ductoscopy. With ductoscopic papillomectomy (DP), almost 30 % of patient with solitary papilloma did not require further extensive surgery. CONCLUSION: Since there is an increased risk of malignancy, surgical excision is recommended for multiple, larger papillomas and for papillomas with atypia and in addition for papillomas where diagnostic tools produce suspicious findings. On the other hand DP is a minimally invasive intervention and can aid in the follow-up of lesions proven to have no atypia.