Clinical predictors of ectopic parathyroid adenomas: experience with 421 confirmed parathyroid adenoma localizations.

PURPOSE: This study was designed to evaluate whether patients with ectopic parathyroid adenoma (EPA) have clinical predictors by comparing them with other patients operated on for primary hyperparathyroidism (PHPT) with uniglandular parathyroid adenomas in other localizations. METHODS: The data of PHPT patients who underwent parathyroidectomy in our institution were assessed retrospectively. Abnormal gland localization was confirmed by operative and pathology reports as well as normocalcemia that lasted for at least 6 months postoperatively. The relationships of biochemical and clinical findings of patients with confirmed adenoma localizations were analyzed. In order to determine independent factors that can predict EPAs, binary logistic regression was used. RESULTS: Among 421 patients (83.4% female, mean age 49 ± 13.2 years) enrolled in the study, the most common adenoma localization was the lower left parathyroid gland (36.1%; p < 0.001). Parathyroid adenomas were more common in lower localizations compared to upper localizations and were smaller in size (p < 0.001 and p = 0.004, respectively). In univariate analysis, serum intact parathyroid hormone and calcium levels were found to be higher (p = 0.004 and p = 0.002, respectively), moderate/severe hypercalcemia was more common (p = 0.024), phosphorus levels were lower (p = 0.04), and postoperative transient hypocalcemia was more common (p = 0.013) in cases of EPAs than other localizations. There was no significant difference in adenoma size between EPAs and other classical localizations. In multivariate analysis, only a high serum calcium level was an independent predictor of EPAs (OR 2.017, 95% CI 1.142-3.564, p = 0.016). Receiver-operating characteristic curve analysis yielded an optimal cutoff value of 12.25 mg/dL for serum calcium (88% sensitivity, 63% specificity, and area under the curve: 0.861). CONCLUSION: EPAs can cause a more biochemically distinct PHPT picture compared to parathyroid adenomas in classical localizations. A high calcium level at diagnosis may be a clinical predictor for EPAs and may affect the clinical approach and imaging technique choices. Due to the increased risk of transient hypocalcemia in patients with EPAs, caution should be exercised in postoperative follow-up. Furthermore, in the event of negative preoperative imaging, starting the parathyroid exploration from the lower left region may be a good option for the surgeon.

Use of BRAF immunohistochemistry as a screening test in detecting BRAFV600E mutation in melanomas.

OBJECTIVE: BRAF mutation is detected in 50-70% of melanomas. The molecular methods used to detect BRAF mutations are 80-90% sensitive, specific, and expensive methods. Immunohistochemistry is a relatively common, rapid, relatively inexpensive method in pathology practice compared to molecular techniques. AIMS: We aimed to compare immunohistochemical and molecular methods in our case of malign melanoma in which we investigated BRAF mutation with "real time PCR" method and to investigate the compatibility of molecular test results of BRAF immunohistochemistry results as a preliminary test. METHODS: Selected blocks of 30 patients with metastatic melanoma who came to our department for BRAF mutation detection were subjected to real time PCR molecular method and immunohistochemical study was performed with BRAF primer antibody. RESULTS: BRAF mutation was detected by molecular method in 7 of 30 cases (23.33%). CONCLUSION: In all of these 7 cases, positive immunohistochemical staining was identified (100%). In conclusion, the use of BRAF immunohistochemistry as a screening test in the detection of mutant disease will allow the cost-effective use of molecular testing.

Virchow's node metastasis: an unusual presentation of ovarian cancer.

Ovarian primaries of supraclavicular metastases are extremely rare. The present study reports the case of a 64-year-old female with a left supraclavicular mass without any other symptoms. After performing a fine needle aspiration biopsy for pathological examination and positron emission imaging, she was diagnosed with FIGO Stage IV high-grade serous epithelial ovarian carcinoma. After three cycles of chemotherapy with paxlitaxel and carboplatin, complete response was achieved. There are only a few reports in literature that address patients with the initial symptom of left supraclavicular mass and final diagnosis of ovarian cancer. To the best of the authors' knowledge, this is the first report to describe the successful use of PET/CT to determine the primary site.

Undifferentiated pleomorphic sarcoma with focally rhabdomyosarcomatous differentiation of the ovary.

PURPOSE OF INVESTIGATION: Primary sarcomas account for of 2-3% of all female genital tract cancers and ovaries are unusual sites for sarcomas. The authors aimed to report a case of primary ovarian sarcoma. MATERIALS AND METHODS: A 46-year-old woman presented with abdominal pain and distention. Abdominal MRI revealed a 20-cm-sized complex mass in the right adnexa and ascites. Preoperative CA-125 was 289 U/ml. She underwent optimal debulking surgery and diagnosed with undifferentiated pleomorphic sarcoma with focally rhabdomyosarcomatous differentiation. RESULTS: The patient presented with severe abdominal pain and distention 32 days after the operation and recurrent disease was diagnosed. First cure of adjuvant chemotherapy was administered, but she died 15 days later. CONCLUSION: Coexistence of undifferentiated pleomorphic sarcoma and rhabdomyosarcoma shows highly aggressive behavior and its prognosis is extremely poor. To the best of the authors' knowledge, this is the second case report of the coexistence of these type tumors in the literature.

Efficacy of diffusion-weighted magnetic resonance imaging in the diagnosis and staging of endometrial tumors.

PURPOSE: The goal of this study was to evaluate the efficacy of diffusion-weighted imaging (DWI) in differentiating between benign and malignant endometrial lesions and determinining tumor grade. It also aimed to determine the contribution of the DWI to the diagnosis by detection of the myometrial invasion depth in malignant lesions. MATERIALS AND METHODS: The lesions were classified as benign (n=14) or malignant (n=42) according to the histopathological results and, the mean apparent diffusion coefficent (ADC) values were compared. For determining the myometrial invasion depth of malignant lesions, T2W, DWI and dynamic contrast-enhanced T1-weighted images (DCET1WI) were evaluated individually. RESULTS: The sensitivity, specificity and area under the curve for discriminating between malignant and benign lesions by using cutoff ADC value of 1.10×10(-3)s/mm(2) were 85.7%, 92.8% and 0.95, respectively. According to the histopathological grading, there was no difference for the mean ADC values. For both observers the diagnostic accuracy of MRI in determining the depth of myometrial invasion in malignant lesions was found to be 87.1%, 89.7% and 76.9%, 76.9% for T2WI-DWI and DCET1WI, respectively. CONCLUSION: DWI and ADC measurements can accurately discriminate endometrial cavity lesions as benign or malignant. T2WI-DWI is highly effective in determining the depth of myometrial invasion.

Risk factors associated with malignancy and with triage to surgery in thyroid nodules classified as Bethesda category III (AUS/FLUS).

BACKGROUND: Selection of nodules for surgery diagnosed as Bethesda category III [atypia of undetermined significance/follicular lesion of undetermined significance (AUS/FLUS) category] is very important. We aimed at to define the predictive factors for malignancy and factors associated with triage to surgery. METHODS: The records of all patients with nodules who underwent fine needle aspiration biopsy (FNAB) and classified by Bethesda reporting system as AUS/FLUS between 2011 and 2015 at our institution were reviewed. Univariate and multivariate analysis were performed to select independent factors associated with thyroid cancer and with triage to surgery. Using independent risk factors for malignancy predictive index categories were created. RESULTS: Of the 485 patients who were classified as AUS/FLUS on initial FNAB, 153 underwent surgery with the associated malignancy rate of 22.8%. The malignancy rates for AUS/FLUS patients with and without repeat FNAB were 37.5% and 16.2%, respectively. Multivariate logistic regression analysis revealed that solid structure, microcalcification, hypoechogenicity, increased vascularization, and irregular margin were found to be significant and independent risk factors associated for malignancy, and solid structure, microcalcifications, increased nodule size (≥2 cm) and younger patient age (<65 years) were associated with triage to surgery. CONCLUSIONS: Our findings showed that using predictive factors for malignancy in AUS/FLUS category as risk indices, an important proportion of patients (35%) who had nodules without any risk factors could be spared unnecessary surgery. We suggest that predictive indices should be considered for selection of the patients to triage to surgery.

High body-mass index is not associated with worse clinicopathological characteristics in predominantly obese breast cancer patients.

BACKGROUND: Breast cancer (BC) is the most common cancer among women. A high body-mass index (BMI) is related to increased incidence of BC with poorer prognosis. AIM: The aim of the study was to evaluate the association in patients with BC between BMI at the time of diagnosis and biological characteristics, according to the menopausal status. MATERIALS AND METHODS: This retrospective study comprised a total of 318 women with BC. Clinicopathological differences between normal, overweight and obese patients according to menopausal status were evaluated. RESULTS: Premenopausal women had a significantly lower BMI than postmenopausal patients (28.7 vs. 31.5, respectively; p = 0.00001). No statistically significant association was determined between BMI and clinicopathological characteristics in either the premenopausal or the postmenopausal group (all p values are > 0.05). CONCLUSIONS: There are many conflicting results in literature on this relationship. The results of this study showed that a high BMI is not associated with worse clinicopathological characteristics in a predominantly obese population. In current medical oncology practice, BC should be evaluated on an individual patient basis and the impact of obesity on BC prognosis seems to be difficult to estimate especially in an obese population.

Comparison of connective tissue components in the uterine ligaments between women with and without pelvic organ prolapse.

AIM: Aim of the study was the comparison of the connective tissue components in the uterine ligaments between the women with and without pelvic organ prolapse. METHODS: This study included 15 postmenopausal women without pelvic organ prolapse who underwent total abdominal hysterectomy and bilateral salpingo-oophorectomy for benign pathologies (control group) and 15 postmenopausal women who underwent vaginal hysterectomy because of pelvic organ prolapse (POP group). During the operation, samples for histological examination were taken from the cardinal and sacrouterine ligaments. The contents of collagen type I, collagen type III and elastin, and number and mitotic activity of fibroblasts in uterine ligaments were histopatholocially determined. RESULTS: The collagen type I content for the POP group was significantly higher than that of the control group. Collagen type III content, elastin content, and number and mitotic activity of fibroblasts were not significantly different between the control and POP groups. CONCLUSION: Collagen type I was found to be increased in the uterine ligaments of the POP group. The other connective tissue components did not differ between the two groups.

The effects of hyperbaric oxygen treatment on the healing of tracheal anastomosis following irradiation in rats.

BACKGROUND: After tracheal resection and end-to-end anastomosis, granulation tissue formation and stenosis along the anastomotic line are major problems. This experimental study in rats evaluated the effects of hyperbaric oxygen therapy on the healing of tracheal anastomosis after irradiation. METHODS: Forty-four rats were divided into four groups: Group I (n = 12) underwent tracheal anastomosis after irradiation (30 Gy) and received hyperbaric oxygen treatment; Group II (n = 12) underwent tracheal anastomosis and received hyperbaric oxygen treatment; Group III (n = 11) underwent tracheal anastomosis after irradiation (30 Gy); and Group IV (n = 9) underwent only tracheal anastomosis. Hyperbaric oxygen treatment was administered at 2.5 atmospheres of absolute pressure once a day for 1 week. The rats were sacrificed 28 days after tracheal anastomosis. The cross-sectional area (CSA) of the tracheal lumen was compared between groups. Inflammation, fibrosis, epithelization, alveolar congestion and alveolar hemorrhage were evaluated by histological analysis. RESULTS: The rats in all groups survived the study period, except for two in Group III which died from anastomotic dehiscence. Macroscopically, rats in the hyperbaric oxygen therapy groups showed excellent healing at the anastomosis. In these groups, CSA scores and epithelization were higher than in the other groups. There was local necrosis at the anastomosis in 3 rats in Group III. Fibrosis and alveolar congestion observed in Groups III and IV were significantly higher than in Groups I and II. CONCLUSION: This study suggests that hyperbaric oxygen treatment contributes to the healing of tracheal anastomosis following irradiation and may be a useful supportive treatment after tracheal resection and end-to-end anastomosis.

Efficacy of levamisole on experimental endometriosis.

OBJECTIVE: To investigate the efficacy of levamisole on experimental endometriosis. METHODS: After the implantation of endometrial tissue on abdominal peritoneum, 40 rats were randomized to 1 of 4 equal intervention groups. Levamisole (2 mg/rat) was applied subcutaneously to group "L" once a week. Depot medroxyprogesterone acetate (3 mg/kg) was applied intramuscularly to group "M" twice at 4-week intervals. Leuprolide (0.075 mg/kg) was applied subcutaneously to group "G" twice at 4-week intervals. Saline (0.1 cm(3)/rat) was applied subcutaneously to group "C" once a week for 8 weeks. The efficacy of levamisole was determined by volume measurement and characterizing the histological structure of the implants. RESULT: Volume increase of the implants in group C (P<0.05), and volume decrease in groups M, G, and L was found (P<0.05, P<0.01, and P<0.01, respectively.) Stromal tissue and glandular activity were not different between groups L and G. CONCLUSION: Levamisole was found to be as effective as leuprolide in regression of the volume of endometriotic implants.