The value of maspin and PD-L1 expression and peritumoral lymphocytic infiltration in breast tumors.

OBJECTIVE: Breast cancer is the most common type of cancer in women worldwide. Our aim is to evaluate the importance of immunotherapy in breast cancer cases by using PD-L1 expression and to determine the effect of Maspin expression and lymphocytic density on predicting the prognosis. METHODS: A total of 200 breast cancer cases with different histological types were included in the study. The expression of PD-L1 and Maspin in these tumors were evaluated, and the lymphocytic infiltration density was examined. RESULTS: Expression of PD-L1 in tumor cells was significantly higher in "medullary carcinoma" and grade 3 tumors. Expression of PD-L1 in inflammatory cells was increased in the group of "other types" and grade 3 tumors. Maspin expression was observed in 93 cases and was higher in "lobular carcinoma" and high grade tumors. In our study, a significant correlation was found between lymphocytic density score and histological grade and PD-L1 expression. CONCLUSION: In our study, PD-L1 expression was detected in breast cancer, and was associated with triple negativity and high grade. Our results show that the Maspin expression and lymphocyte density are associated with the prognosis (Tab. 5, Fig. 4, Ref. 44).

Surgical management of anorectal foreign bodies.

PURPOSE: Anorectal foreign bodies (AFBs) inserted into anus constitute one of the most important problems needing surgical emergency due to its complications. We describe our experience in the diagnosis and treatment of AFBs retained in the rectosigmoid colon. MATERIALS AND METHODS: Between the years 2006 and 2015, a total of 11 patients diagnosed with AFBs were admitted to an emergency room and general surgery clinics. They were diagnosed and treated in four different hospitals in four different cities in Turkey. Information on the AFBs, clinical presentation, treatment strategies, and outcomes were documented. We retrospectively reviewed the medical records of these unusual patients. RESULTS: Eleven patients were involved in this study. All patients were male with their mean age was 49.81 (range, 23-71) years. The time of the presentation to the removal of the foreign bodies ranged between 2 h and 96 h with a mean of 19.72 h. Ten patients inserted AFBs in the anus with the purpose of eroticism but one patient's reason to relieve constipation. The objects were one body spray can, two bottles, three dildos, two sticks, one water hose, one corncob, and one pointed squash. Three objects were removed transanally after anal dilatation under general anesthesia. Eight of the patients required laparotomy (milking, primary suture, and colostomy). Five of the patients had perforation of the rectosigmoid colon. Abdominal abscess complicated extraction in one patient after the postoperative period. The hospitalization time of the patients was 6.18 (1-16) days. None of the patients died. CONCLUSIONS: A careful assessment is a key point for the correct diagnosis and treatment of AFBs. Clinical conditions of patients and type of AFBs are important in the choice of treatment strategy. If the AFBs are large, proximally migrated or the patients with an AFB have acute abdomen due to perforation, pelvic abscess, obstruction, or bleeding, surgery is needed as soon as possible. There are different types of surgical approaches such as less invasive transanal extraction under anesthesia and more invasive abdominal routes such as laparotomy or laparoscopy. The stoma can be done if there is colonic perforation. In the management of AFBs, the priority must be less invasive methods as possible.