Age-adjusted Charlson Comorbidity Index is a valuable prognostic tool in operable soft tissue sarcoma of trunk and extremities.

BACKGROUND: Advanced age and presence of comorbidities affect prognosis and treatment decisions in patients with soft tissue sarcoma (STS). However, coeffect of age and comorbidities is still unknown. We aimed to investigate prognostic value of age-adjusted Charlson Comorbidity Index (ACCI) in trunk and extremity STS operated with curative intent. HYPOTHESIS: Preoperative ACCI might predict survival outcomes independently in patients with STS of trunk and extremities. PATIENTS AND METHODS: The study included 151 patients and ACCI was calculated for each patient. We categorized the patients into two groups according to median ACCI. We retrospectively collected data about clinicopathologic and treatment-related factors, and evaluated potential prognostic factors for disease-free survival (DFS) and overall survival (OS) using univariate and multivariate analyses. RESULTS: Median age was 50 (18-86) years. There were 89 male and 62 female patients. Lower extremities were the most common tumor sites (73.5%). Most of the patients had high grade tumors (84.1%) and stage 3 disease (66.9%). Radiotherapy and chemotherapy were carried out in 106 and 58 patients, respectively. Overall prevalence of comorbidity was 29.1%. Median ACCI was 3 (2-9). Older age (p<0.001), worse performance status (p<0.001), larger tumor size (p=0.03), higher grade tumors (p=0.03) and advanced stage (p=0.04) were associated with higher ACCI (≥3). Median follow-up time was 32 months, 50.3% of patients had disease recurrence, and 35.8% died. Median DFS (p=0.001) and OS (p=0.001) of patients with low ACCI (<3) were significantly longer than patients with high ACCI. Multivariate analysis determined ACCI as an independent prognostic indicator for both DFS (HR 1.72, p=0.02) and OS (HR 2.02, p=0.04). DISCUSSION: ACCI is a valuable prognostic tool to be used in the preoperative setting of patients with STS. Higher ACCI was found to be independently associated with worse survival outcomes. For each patient with STS, evaluating comorbidities and combining them with age appears to be a critical step in modifying therapy options. LEVEL OF EVIDENCE: IV, retrospective observational study.

Isolated Scapular Lesion of Langerhans Cell Histiocytosis Detected by 18F-FDG PET/CT.

Langerhans cell histiocytosis (LCH) is a rare disease that occurs mainly in pediatric patients and most adult LCH is considered a part of multisystem or multifocal disease. Only 7.3% of cases present as unifocal bone lesion. Herein, we present a case of an isolated scapular lesion of LCH in a 48-year-old man.

Predictive Immune Markers for Disease Progression in Multiple Myeloma and Monoclonal Gammopathy of Undetermined Significance

Objective: Multiple myeloma (MM) and monoclonal gammopathy of undetermined significance (MGUS), the precursor of MM, are plasma cell neoplasms. The evolution of the treatment of MM in recent years has dramatically improved the outcome for these patients. Currently, multidisciplinary studies are being conducted to elucidate the etiopathogenesis of the disease and develop specific treatment agents and prognostic markers. The present study investigates the relationships between immunoexpression of CD138, Pan-Ras, CCL-3, DKK-1, and MUM-1 and disease progression in cases of MM and MGUS. Materials and Methods: Immunohistochemical staining for CD138, Pan-Ras, CCL-3, DKK-1, and MUM-1 were performed on bone marrow biopsy samples from 94 MM and 20 MGUS patients diagnosed between 2011 and 2018. Immunohistochemical results were examined semiquantitatively, and the associations between the immunohistochemical, clinical, and biochemical markers utilized for MM and MGUS patient staging were analyzed. Results: Pan-Ras, DKK-1, and MUM-1 staining results were significantly higher in MM compared to MGUS (p=0.005, 0.001, and 0.001, respectively). The mean CCL-3 expression in patients with MGUS was 23.15%, while it was 18.68% in cases of MM (p=0.413). CCL-3 expression was significantly higher in high-risk MGUS cases compared to other risk groups according to the Mayo Clinic Risk Stratification for MGUS. According to the International Staging System and the Revised International Staging System, CD138 expression was higher among stage II and stage III patients than stage I patients. Conclusion: Differences in Pan-Ras, MUM-1, DKK-1, and CCL-3 expressions between MM and MGUS suggest that these molecules may play a role in the progression of MGUS to MM. CCL-3, an immunohistochemical marker, may be predictive of MGUS progression, while CD138 is associated with more advanced stages of MM.

Calcified Adrenal Metastasis of High-Grade Osteosarcoma on FDG PET/CT.

ABSTRACT: Classic type of high-grade osteosarcoma is the most common type of skeletal malignancy in children and adolescents. Metastasis of osteosarcoma frequently occurs in the lung. Adrenal metastasis of osteosarcoma is extremely rare, with only few reported case in the literature. Herein, we present the case of a 13-year-old boy with adrenal metastasis of high-grade osteosarcoma, which was seen as a solitary calcified hypermetabolic adrenal lesion on FDG PET/CT.

68Ga-PSMA PET/CT in Giant Retroperitoneal Liposarcoma.

Primary retroperitoneal liposarcoma is an extremely rare malignant tumor. Herein, we report a case with an incidentally detected giant retroperitoneal liposarcoma on Ga-PSMA PET/CT during primary staging for prostate cancer.

Locally Aggressive De Novo Spinal Fibromatosis: Case Report and Review of the Literature.

Fibromatosis is a benign lesion, which originates from proliferating fibroblasts. Although fibromatosis is a benign tumor, it is locally aggressive and invasive. Spinal presentation of fibromatosis is very rare, and case reports are the only source of the clinical knowledge. Herein, we describe the oldest patient having spinal fibromatosis with de novo occurrence and aggressive nature. A 68-year-old female patient admitted to our outpatient clinic with low back pain and neurological claudication. On lumbar spine magnetic resonance imaging, she had spinal canal stenosis with a concomitant lesion in the left longissimus muscle. We did our best to resect the tumor, entirely. The pathology result was consistent with spindle cell lesion. The lesion recurred 6 months after the primary surgery. In the second surgery, we did en bloc resection. Pathology and immunohistochemical analysis results were consistent with fibromatosis. After the second surgery, she had adjuvant radiotherapy. There was nothing other than radionecrosis in the operation site, still after 2 years. In conclusion, radiological work-up is usually insufficient to make fibromatosis diagnosis and whole pathological specimen should be carefully evaluated to achieve the accurate diagnosis. Spinal fibromatosis is very rare and its treatment methods have not universally been conceptualized. However, adjuvant therapies are necessary after en bloc resection.

Long-term follow-up of long and flat bone eosinophilic granulomas managed only with biopsy.

OBJECTIVE: We evaluated long-term clinical and radiological follow-up results of patients with long and flat bone eosinophilic granulomas managed only with biopsy. METHODS: Seventeen patients [11 male, 6 female; average age 8.5 years (range: 3.5 to 14 years)] with long and flat bone eosinophilic granulomas were followed after biopsy. Involved bones were femur (5), tibia (3), humerus (2), ulna (1), pelvis (3), scapula (1) and clavicle (1). After confirmation of diagnosis by biopsy, no further surgical intervention was performed. Clinical follow-up was done with preoperative and postoperative MSTS and VAS scores. The healing process was followed with periodic radiographs. Limb-length discrepancy, deformity, and lesion progression or recurrence were recorded. Average follow-up was 65 months (range: 28 to 115 months). RESULTS: Average preoperative MSTS score was 45% (range: 30 to 56.6%), while postoperative 6, 12 and 24 months scores were measured as 76% (range: 70 to 83.3%), 88% (range: 73.3 to 93.3%) and 94% (range: 86.6 to 100%) respectively. Average VAS score, which was 8.4 (range: 6 to 10) preoperatively, had a tendency to decrease postoperatively, and was measured as 3.5 (range: 2 to 5), 2.2 (range: 1 to 3.5) and 1.1 (range: 0 to 2) at 3, 6, and 12 months. Even though the majority of lesions demonstrated complete radiographic healing at 12 months, the healing process extended to 24 months for flat bones. No patients experienced limb-length discrepancy or deformity. All lesions regressed following biopsy and no recurrence was seen. CONCLUSION: Eosinophilic granuloma has a spontaneous healing potential, and confirming the diagnosis by biopsy is sufficient to obtain good functional and radiological results without any further intervention.

Aplastic anemia associated with oral terbinafine: a case report and review of the literature.

Onychomycosis (OM) is a common fungal infection of the toenails and/or fingernails that is highly prevalent in the general population and also responsible for significant morbidity. OM is caused by dermatophytes, nondermatophytic molds, or yeast. Today systemic antifungal agents are considered as the gold standard for all types of OM. Here we report a case of aplastic anemia associated with oral terbinafine use and a review of the literature on hematological toxicities associated with terbinafine.

Placental ultrastructural changes and apoptosis in pregnancies with meconium stained amniotic fluid.

OBJECTIVE: The cause of meconium stained amniotic fluid in term healthy pregnancies is not clearly understood yet. The aim of this study was to investigate the placental ultrastructural changes and placental apoptosis in pregnancies complicated with meconium stained amniotic fluid. MATERIAL AND METHOD: The study group was composed of mothers (n: 13) and their term, appropriate for gestational age newborns with meconium stained amniotic fluid but without meconium aspiration syndrome. The control group consisted of mothers (n: 24) and their term appropriate for gestational age babies. We studied placental ultrastructural changes by transmission electron microscopy and placental apoptosis by transmission electron microscopy and the TUNEL method. RESULTS: The incidence of placental apoptosis by the TUNEL method was significantly higher in the study group compared to the control group. Transmission electron microscopy investigation revealed more remarkable ultrastructural changes in the study group compared to the control group. CONCLUSION: The increased apoptosis and ultrastructural findings in placentas with meconium stained amniotic fluid may be related to the placental adaptation to the hypoxic fetuses.

Histopathologic response to highly purified liquid silicone injected intradermally in rats' skin.

BACKGROUND: This study aimed to assess and compare the tissue response to small- and large-volume injections of pure liquid silicone in rats. METHODS: The study used 25 Sprague-Dawley rats. Two different injection sites were determined for a single rat, and 5000 centistoke liquid silicone was injected subdermally using 0.2-0.3 ml (small volume) and 1 ml (large volume) injections. After the injections, 15 animals were killed at 4 weeks and 10 animals at 10 weeks. Tissue responses were evaluated under a light microscope. RESULTS: At week 4, the numbers of lymphocytes and neutrophils were higher in the small-volume injection group. At week 10, the number of neutrophils decreased, and the numbers of macrophages and foreign body giant cells increased in the small-volume injection group, whereas the intensity and type of infiltrate in the large-volume injection group did not change significantly. The thickness of the fibrous capsule was greater in large-volume injection group at weeks 4 and 10. The thickness of the fibrous capsule did not change significantly in either group through time. CONCLUSIONS: Purified high-density liquid injectable silicone causes a low-grade and well-tolerated inflammatory response during the long term and can be used when given as small-volume injections.

Micronodular T-cell/histiocyte-rich B-cell lymphoma of the spleen in a case of small lymphocytic lymphoma: a Richter's transformation.

Abstract A case of micronodular T-cell/histiocyte-rich B-cell lymphoma of the spleen who had a prior diagnosis of small lymphocytic lymphoma is presented. Micronodular T-cell/histiocyte-rich B-cell lymphoma of the spleen was first described in 2003, and very few cases have been reported since then. This is the first reported case supervening in a patient with pre-existing chronic lymphocytic lymphoma. We review its clinical, pathologic, and immunohistochemical features and the difficulties we encountered during diagnosis.

Cyclooxygenase-2 expression and connection with tumor recurrence and histopathologic parameters in gastrointestinal stromal tumors.

Tissue cyclooxygenase-2 (COX-2) is a rate-limiting enzyme in prostaglandin synthesis and has been shown to have roles in carcinogenesis and tumor progression. Evaluation of COX-2 overexpression in malignancies has been performed mostly on tumors of epithelial origin, and little is known about its presence in mesenchymal tumors, especially gastrointestinal stromal tumors (GIST). COX-2 has been reported to be widely expressed in GIST and has been suggested as a potential diagnostic marker. We evaluated the overexpression and roles of COX-2 in tumorigenesis in GIST with regard to its relation to prognostic parameters and tumor recurrence. We studied the presence of COX-2 expression immunohistochemically and its relation to clinicopathologic prognostic variables in 41 cases of GIST. COX-2 was overexpressed in 21 (51%) of 41 tumors. The extent of overexpression was greater in tumors that recurred after surgical resection. COX-2 overexpression was also higher in tumors with coagulative necrosis, high mitotic index and an infiltrative pattern of growth. The observation of greater COX-2 expression levels in GIST with unfavorable histopathologic variables is contrary to previous reports and consistent with the reported roles of COX-2 in carcinogenesis of epithelial malignancies.

[A case of osteolipoma of the head and neck area]. / Bir olguda bas-boyun bölgesi osteolipomu.

Osteolipoma is a rare benign tumor which is especially uncommon in the head and neck region. Only seven cases of osteolipoma have been reported in the medical literature in last ten years. Although osteolipomas are benign and do not recur, resection can be difficult because of their tendency to adhere to the neighboring tissues. A case of osteolipoma in the back of the neck in a 34-year-old woman is presented and discussed in the light of the literature. It should be considered that a lipomatous mass with a long history in the head and neck area as well as in other areas may be an osteolipoma which may cause difficulties in surgical excision.