Correlation of TIRADS scoring in thyroid nodules with preoperative fine needle aspiration biopsy and postoperative specimen pathology.

INTRODUCTION: The aim of our study is to determine the value of Thyroid Imaging Reporting and Data Systems (TIRADS) scoring in predicting malignancy in thyroid nodules by examining its relationship with fine needle aspiration biopsy and postoperative histopathological results. MATERIALS AND METHODS: In this study, patients who underwent surgery after ultrasonographic examination and fine needle aspiration biopsy for thyroid nodules at the General Surgery Clinic of Çukurova University Faculty of Medicine between January 2014 and November 2021 were retrospectively analyzed. The thyroid ultrasonography and fine needle aspiration biopsy of the included patients were performed by a clinician with 15 years of experience. The ultrasonographic features of the nodules were re-evaluated by the same clinician, and the American College of Radiology (ACR) TIRADS score was determined. Fine needle aspiration biopsy results were grouped according to Bethesda criteria. Postoperative histopathological examination results were divided into two groups: benign and malignant. The ACR TIRADS score was compared with fine needle aspiration biopsy and histopathological results. The performance of the ACR TIRADS score in predicting malignancy was determined. RESULTS: 79.8% of the 397 patients were female, and the mean age was 50.9 ± 12.8 years. The mean diameter of the nodules was 27.4 ± 15.8 mm. There was a significant, positive, but weak correlation between ACR TIRADS and Bethesda (p < 0.001) (r = 0.33). When the ACR TIRADS score was compared with histopathological results, it was found that the rate of malignancy increased as the TIRADS score increased (p < 0.001). The rates of malignancy diagnosis were 0% for TR1, 13.2% for TR2, 21.7% for TR3, 50.3% for TR4, and 72.4% for TR5. The area under the receiver operating characteristic curve for TIRADS in predicting malignancy was 0.747 (95% CI: 0.699-0.796, p < 0.001). TIRADS can distinguish malignancy with 75% accuracy. The optimal cutoff point was determined as TR4 with 80.3% sensitivity and 60.8% specificity. CONCLUSION: The ACR TIRADS scoring system is an effective risk classification system for thyroid nodules, providing 75% accuracy in predicting malignancy, with 80.3% sensitivity and 60.8% specificity values.

Preoperative Immunonutrition and Postoperative Outcomes in Radical Pancreaticoduodenectomy Patients.

BACKGROUND/AIMS: This study aimed to compare the patient groups who received and did not receive immunonutrition in terms of mortality and morbidity in patients who underwent radical pancreaticoduodenectomy. MATERIALS AND METHODS: Two groups were formed from 40 patients who underwent radical pancreaticoduodenectomy in our clinic in 2021. The patients in study group were given enteral immunonutrition support for 5 days preoperatively. For this purpose, a standard enteral immunonutrition product containing arginine, omega-3 fatty acids, and RNA (dietary nucleotides) was used. Patients' data of demographical, laboratory, postoperative complications, and current clinical status were analyzed. RESULT: Mortality developed in 5 (25 %) patients in the treatment group and 4 (20 %) patients in the control group in the following months (P > .05). The estimated survival rate in the treatment group was 21.8 ± 2.8 months in the treatment group 19.1 ± 1.7 months in the control group (P > .05). The length of hospital stay was 12.89 ± 3.3 days in the treatment group, while it was 16.47 ± 6.83 days in the control group (P < .05). In the postoperative follow-ups, delayed gastric emptying symptoms developed in 3 patients in the treatment group, while the same complication was observed in 9 patients in the control group (P < .05). Surgical site infections occurred in 4 patients in the treatment group and 9 patients in the control group (P < .05). CONCLUSION: It was observed that preoperative oral immunonutrition before pancreaticoduodenectomy was effective in reducing the risk of delayed gastric emptying after surgery and the length of hospital stay.

A Multicenter Study of Genotype Variation/Demographic Patterns in 2475 Individuals Including 1444 Cases With Breast Cancer in Turkey.

Objective: Breast cancer (BC) is the most common cancer type in women and may be inherited, mostly in an autosomal dominant pattern. The clinical diagnosis of BC relies on the published diagnostic criteria, and analysis of two genes, BRCA1 and BRCA2, which are strongly associated with BC, are included in these criteria. The aim of this study was to compare BC index cases with non-BC individuals in terms of genotype and diagnostic features to investigate the genotype/demographic information association. Materials and Methods: Mutational analyses for the BRCA1/BRCA2 genes was performed in 2475 individuals between 2013-2022 from collaborative centers across Turkey, of whom 1444 with BC were designated as index cases. Results: Overall, mutations were identified in 17% (421/2475), while the percentage of mutation carriers in cases of BC was similar, 16.6% (239/1444). BRCA1/BRCA2 gene mutations were detected in 17.8% (131/737) of familial cases and 12% (78/549) of sporadic cases. Mutations in BRCA1 were found in 4.9%, whereas 12% were in BRCA2 (p<0.05). Meta-analyses were performed to compare these results with other studies of Mediterranean-region populations. Conclusion: Patients with BRCA2 mutations were significantly more common than those with BRCA1 mutations. In sporadic cases, there was a lower proportion with BRCA1/BRCA2 variants, as expected, and these results were consistent with the data of Mediterranean-region populations. However, the present study, because of the large sample size, revealed more robust findings than previous studies. These findings may be helpful in facilitating the clinical management of BC for both familial and non-familial cases.

Analysis of appendiceal neoplasms in 1,423 appendectomy specimens: a 10-year retrospective cohort study from a single institution.

OBJECTIVE: This study aimed to reveal the incidence, clinicopathological, and oncological outcomes of appendiceal neoplasms. METHODS: This is a retrospective cohort study from a single institution. Patients with a pathological diagnosis of malignancy who underwent appendectomy between January 2011 and 2021 were included in the study, and groups were formed according to pathological type. Clinical, pathological, and oncological results were compared in these groups. RESULTS: The incidence of neoplasia was 2.38% (n=34) in a cohort of 1,423 appendectomy cases. Of the cases, 56% (n=19) were female. The median age in the entire cohort was 55.5 (range: 13-106) years. In the cohort, the rate of neuroendocrine tumor mucinous cystadenoma adenocarcinoma, and low-grade appendiceal mucinous neoplasm, according to the American Joint Committee on Cancer classification of appendiceal neoplasms, was 32.3% (n=11), 26.4% (n=9), 26.4% (n=9), and 14.7% (n=5), respectively. Neuroendocrine tumor patients (median age: 35 years) were younger than the other groups (p=0.021). Secondary complementary surgery was performed in 66.7% (n=6) of adenocarcinoma patients and 27.3% (n=3) of neuroendocrine tumor patients. Right hemicolectomy was performed in all neuroendocrine tumor patients requiring secondary surgery, while right hemicolectomy was performed in three adenocarcinoma patients and cytoreductive surgery and hyperthermic intraperitoneal chemotherapy in three adenocarcinoma patients. After a median follow-up of 44.4 months (95% confidence interval: 18.6-70.1), the mean survival rate was 55% in appendiceal adenocarcinoma patients compared to 100% in neuroendocrine tumor patients. CONCLUSION: Appendiceal neoplasms are rare but remain an important cause of mortality. Appendiceal adenocarcinomas are associated with poorer oncological outcomes compared to other neoplasms.

The role of C-reactive protein ratio in predicting mortality in patients with Fournier gangrene.

PURPOSE: This study aimed to determine the C-reactive protein (CRP) ratio for the survival of patients with Fournier gangrene (FG). METHODS: Fifty-two patients with FG between January 2011 and September 2018 were retrospectively analyzed. Data on clinical presentation, Fournier Gangrene Severity Index (FGSI), CRP ratio, management, and outcome were analyzed. The CRP ratio was calculated as preoperative CRP/postoperative CRP value that measured 48 hours after surgical intervention. Possible alternative cutoff points for the FGSI and CRP were determined by receiver operating characteristic (ROC) analyses. The risk factors related to the prognosis were evaluated by univariate and multivariable logistic regression analyses. RESULTS: The mean CRP ratios were 6.7±6.6 in the survivor group and 1.2±0.8 in the nonsurvivor group (P=0.001). FGSI was significantly higher in the non-survivor group compared to survivor group (8.5±2.5 vs. 3.5±2.2, P=0.001). There was a negative correlation between FGSI and CRP ratio (r=-0.51). ROC analysis determined the cutoff value as 1.78 for CRP (sensitivity, 86%; specificity, 82%; area under the ROC curve, 0.90) to predict death. The incidence of death for patients with CRP ratio of ≤1.78 increased 26.7 fold for those with CRP ratio of >1.78 (95% confidence interval [CI], 4.8-146.5; P=0.001). In the multivariable logistic regression model, CRP ratio (odds ratio [OR], 10.3; 95% CI, 1.5-72.2; P=0.019) and FGSI (OR, 17.8; 95% CI, 2.6-121.1; P=0.003) were independent risk factors for death. CONCLUSION: The CRP ratio is a simple method to use to predict mortality in FG.

Tumor-derived CTF1 (cardiotrophin 1) is a critical mediator of stroma-assisted and autophagy-dependent breast cancer cell migration, invasion and metastasis.

Macroautophagy/autophagy is an evolutionarily conserved cellular stress response mechanism. Autophagy induction in the tumor microenvironment (stroma) has been shown to support tumor metabolism. However, cancer cell-derived secreted factors that initiate communication with surrounding cells and stimulate autophagy in the tumor microenvironment are not fully documented. We identified CTF1/CT-1 (cardiotrophin 1) as an activator of autophagy in fibroblasts and breast cancer-derived carcinoma-associated fibroblasts (CAFs). We showed that CTF1 stimulated phosphorylation and nuclear translocation of STAT3, initiating transcriptional activation of key autophagy proteins. Additionally, following CTF1 treatment, AMPK and ULK1 activation was observed. We provided evidence that autophagy was important for CTF1-dependent ACTA2/α-SMA accumulation, stress fiber formation and fibroblast activation. Moreover, promotion of breast cancer cell migration and invasion by activated fibroblasts depended on CTF1 and autophagy. Analysis of the expression levels of CTF1 in patient-derived breast cancer samples led us to establish a correlation between CTF1 expression and autophagy in the tumor stroma. In line with our in vitro data on cancer migration and invasion, higher levels of CTF1 expression in breast tumors was significantly associated with lymph node metastasis in patients. Therefore, CTF1 is an important mediator of tumor-stroma interactions, fibroblast activation and cancer metastasis, and autophagy plays a key role in all these cancer-related events.Abbreviations: ACTA2/α-SMA: actin, alpha 2, smooth muscle CAFs: cancer- or carcinoma-associated fibroblasts CNT Ab.: control antibody CNTF: ciliary neurotrophic factor CTF1: cardiotrophin 1 CTF1 Neut. Ab.: CTF1-specific neutralizing antibody GFP-LC3 MEF: GFP-fused to MAP1LC3 protein transgenic MEF LIF: leukemia inhibitory factor IL6: interleukin 6 MEFs: mouse embryonic fibroblasts MEF-WT: wild-type MEFs OSM: oncostatin M TGFB/TGFß: transforming growth factor beta.

Analysis of appendiceal neoplasms in 1,423 appendectomy specimens: a 10-year retrospective cohort study from a single institution

SUMMARY OBJECTIVE: This study aimed to reveal the incidence, clinicopathological, and oncological outcomes of appendiceal neoplasms. METHODS: This is a retrospective cohort study from a single institution. Patients with a pathological diagnosis of malignancy who underwent appendectomy between January 2011 and 2021 were included in the study, and groups were formed according to pathological type. Clinical, pathological, and oncological results were compared in these groups. RESULTS: The incidence of neoplasia was 2.38% (n=34) in a cohort of 1,423 appendectomy cases. Of the cases, 56% (n=19) were female. The median age in the entire cohort was 55.5 (range: 13-106) years. In the cohort, the rate of neuroendocrine tumor mucinous cystadenoma adenocarcinoma, and low-grade appendiceal mucinous neoplasm, according to the American Joint Committee on Cancer classification of appendiceal neoplasms, was 32.3% (n=11), 26.4% (n=9), 26.4% (n=9), and 14.7% (n=5), respectively. Neuroendocrine tumor patients (median age: 35 years) were younger than the other groups (p=0.021). Secondary complementary surgery was performed in 66.7% (n=6) of adenocarcinoma patients and 27.3% (n=3) of neuroendocrine tumor patients. Right hemicolectomy was performed in all neuroendocrine tumor patients requiring secondary surgery, while right hemicolectomy was performed in three adenocarcinoma patients and cytoreductive surgery and hyperthermic intraperitoneal chemotherapy in three adenocarcinoma patients. After a median follow-up of 44.4 months (95% confidence interval: 18.6-70.1), the mean survival rate was 55% in appendiceal adenocarcinoma patients compared to 100% in neuroendocrine tumor patients. CONCLUSION: Appendiceal neoplasms are rare but remain an important cause of mortality. Appendiceal adenocarcinomas are associated with poorer oncological outcomes compared to other neoplasms.

Effects of Transcutaneous Electrical Nerve Stimulation on Mastectomy Pain, Patient Satisfaction, and Patient Outcomes.

PURPOSE: Mastectomy is one of the most painful surgical procedures. Postoperative pain guidelines recommend transcutaneous electrical nerve stimulation (TENS) as a reliable non-pharmacological analgesic method. The aim of this study was to investigate the effects of TENS on postoperative pain and outcomes in patients undergoing modified radical mastectomy (MRM). DESIGN: A single-center, single-blind, prospective, randomized-controlled study. METHODS: This single-center, single-blind, randomized-controlled study included a total of 80 patients who underwent MRM at general surgery clinic of a tertiary center were included. The pain management of the patient outcomes were evaluated using the Turkish Revised American Pain Society Patient Outcome Questionnaire (APS-POQ-R-TR). FINDINGS: The pain levels of the intervention group were lower than the control group. There were significant improvements in the patient outcomes such as mobilization, position, sleep, anxiety, and fear in the intervention group. CONCLUSIONS: Our study results suggest that TENS reduces MRM pain. Thus, TENS can be recommended as a useful analgesic method in MRM.

Modified techniques versus Hadfield's procedure in patients with periductal mastitis.

BACKGROUND: Periductal mastitis (PM) is a rare disease characterized by chronic inflammation of the terminal mammary ducts. Complete removal of terminal lactiferous ducts with Hadfield procedure is a previously defined technique in treatment but carries various complications risks. This study aims to evaluate the effectiveness of modified techniques in the treatment of PM. METHODS: Twenty women who underwent surgery due to PM between January 2012 and December 2019 were retrospectively analyzed. Types of PM were determined. All patients were operated on with three different incisions [Hadfield's operation with periareolar incision (n:11), periareolar combined radial incision (n:7), and round block incision (n:2)]. RESULTS: The mean age was 37.5 ± 6.5 years (range: 24-49). Sixty percent of patients had type 3 PM. In Hadfield's procedure, NAC retraction (n:2), seroma (n:1), and hematoma (n:1) were seen. In the periareolar incision combined radial incision group only one patient had complications (seroma) and none in the round block method. Follow-up was 12 ± 1.5 months and disease relapse occurred in two patients in the Hadfield group. Patients who underwent round block were more satisfied with the appearance of the nipple. CONCLUSIONS: In the treatment of PM, the main principle of surgical treatment is the excision of the affected canal with a clear margin. Apart from the classical Hadfield procedure, the round block method and periareolar combined radial incision techniques can be performed in the treatment of PM.

Risk Factors in the Development of Rectus Sheath Hematoma and Treatment Modalities.

Background: In this study,we aim to present the clinical features of patients with rectus sheath hematoma(RSH), as well as the condition's therapeutic management and results. Methods: The study included patients who were diagnosed with and received treatment for spontaneous RSH between the years 2010 and 2020. The demographic and clinical features of the patients, as well as follow-up parameters, were analyzed retrospectively. Results: Our study included 53 patients. The number of female patients was twice as many as the number of male patients. The median age was 65.7 +-14.68 years, and 63.3% of the patients were over the age of 65. The most frequently used anticoagulant was warfarin (30.1%), and it was most often used for heart diseases (54.7%). The international normalized ratio value at the time of admission to the hospital was 1.93+1.18, and the hemoglobin value was 11.2 gr/dl. The average hematoma diameter was 74 mm, and the most common stage was typeI (75.6%). Of the patients, 90.6% were followed up conservatively. The average duration of hospital stay was 15.1 days, and mortality occurred in eight patients during their hospital stay. Conclusion: Spontaneous RSH should be consideredfor elderly female patients who have used anticoagulants. Most patients are followed up medically, but mortality is still high.

The usefulness of drainage-internal capitonnage with/without selective bile duct repair technique for liver hydatid cyst.

PURPOSE: The aim of the present study is to describe the cavity-reducing internal capitonnage technique that we used for the surgical therapy of liver hydatid cyst, and contribute to the literature by presenting the short- and long-term outcomes of the patients who were operated on with this technique. METHODS: A drainage and internal capitonnage technique was performed on 12 cases due to liver hydatid cyst in our clinic between January 2016 and December 2019. RESULTS: The mean age of cases was 36.25 ± 12.5 years, with 7 females and 5 males. All cases had pain in the right upper quadrant, and a sense of fullness in 5 cases. None of the cases had ruptured cysts, jaundice, or other clinical manifestations. The preoperative laboratory findings were normal in 8 cases. Intraoperative biliary-cyst communication was demonstrated in 8 cases (66.7%). Cases were followed up for a mean duration of 38.1 months (range, 24-88 months). CONCLUSION: The drainage/internal capitonnage with/without selective bile duct repair is a technique that can be performed with very low morbidity and mortality rates in experienced hands, especially for centrally located hydatid cysts.

Should tall cell thyroid cancers be evaluated differently from well-differentiated thyroid cancers?

OBJECTIVE: In this study, we aimed to investigate the clinical features of Papillary thyroid carcinoma(PTC) Tall cell variant(TCV), long-term outcomes and surgical experience in papillary thyroid carcinoma. MATERIAL-METHOD: 33 patients who were operated in our clinic between August 2012 and March 2018 and diagnosed as TCV in their pathology evaluation were included in the study. The demographic and clinical features of the patients, pathological features of the tumor and long-term results were examined. RESULTS: A total of 33 patients were included in our study. The mean age was 55.2(18-85) years. The female sex was more dominant (75.8%). The most common presenting complaint was swelling in the neck (75.7%).Total thyroidectomy was performed in 84.8% and completion thyroidectomy after lobectomy was performed in 15.2%. Neck dissection was performed in 33% of the patients. The mean tumor diameter was 3.6 (1-10) cm. The tumor was multifocal in 36.3% of the patients. The capsule invasion rate of the tumors was present in 69.7% of the patients, extrathyroidal rate was 39.4%, Metastatic lymph nodes were detected in 30.3% of the cases. The mean follow-up duration was 39.3+22.4(5.25-78.63) months. 39.4% of patients had distant metastasis during follow-up. Disease free survival rate was 57.6%, total survival was 42.4 + 3.8 (34.7-50.0) months. CONCLUSION: TCV is closely associated with larger tumor diameter, multifocal location, extrathyroidal spread and lymph node involvement, We believe that more aggressive surgery should be performed in the treatment of TCV cases and it is important to follow up the patients more closely. KEY WORD: Esophagus cancer, Neutrophil/lymphocyte ratio, Preoperative lymphocyte /neutrophil ratio, Prognosis.

The effect of anorectal manometric examination on the surgical treatment plan in chronic anal fissure.

INTRODUCTION: Although lateral internal sphincterotomy (LIS) is the most preferred surgical treatment for chronic anal fissure, In this study, we aimed to investigate the effect of preoperative anorectal manometry on surgical treatment choice in patients presenting with anal fissure. MATERIAL AND METHODS: Between January-2015 and August-2017 and whose physical examination revealed chronic anal fissure findings were included in the study. Patients were divided into two groups as Group 1 LIS and Group 2 non-LIS. In addition to the demographic characteristics of the patients, anal manometry findings and its effect on surgical treatment options were examined. RESULTS: 20 patients (M/F:13/7) were included in the study. The mean age was 48.3+17.4 in Group 1 and 45.25 +24.45 in Group 2 (p:0.797). In the preoperative manometric examination, resting pressure(mmHg) range was 93.2+15.9 in Group 1, and44+11.2 in Group 2 (30-57) (p:0.001). Endurance to squeezing time was shorter in Group 2 (p:0.0138). There were no differences between the groups in terms of mean squeezing pressure, rectal sensation, and rectoanal inhibitor reflex (p>0.05). Of the four patients with low sphincter pressures, 3 underwent botulinum toxin injection and 1 underwent advancement flap instead of LIS. There was no significant difference between preoperative and postoperative CCFI scores in the LIS group (0.6±1.8 vs. 1.2±1.85, p>0.05). CONCLUSION: In the treatment of chronic anal fissure, non-LIS methods were selected in 20% of the patients with the help of preoperative anal manometric examination. Manometric examination is important to minimize the risk of incontinence and to determine the choice of treatment correctly. KEY WORDS: Anal fissure, Anal incontinence, Anal manometry.

A prospective comparative study of ultrasonography, contrast-enhanced MRI and 18F-FDG PET/CT for preoperative detection of axillary lymph node metastasis in breast cancer patients.

AIM: We aimed to evaluate; (i) the accuracy of ultrasonography (US), contrast-enhanced magnetic resonance imaging (cMRI) and 18F-fluorodeoxyglucose positron emission tomography/computed tomography (18F-FDG PET/CT) for detection of axillary lymph node metastases (ALNMs), (ii) the role of late prone imaging, and (iii) the effect of PET/CT on preoperative staging of breast cancer. MATERIAL AND METHODS: From June 2015 to January 2019, 236 breast cancer patients were preoperatively exam ined using US, cMRI, and PET/CT and whom underwent pathological evaluations of axillary lymph nodes were analyzed. The sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV), and accuracy (ACC) of US, cMRI, and PET/CT for ALNMs were determined. RESULTS: There were 235 female and one male in our study. The mean age was 55,6±11,3 years. Of 158 patients who were histopathologically evaluated, 85 patients (36%) were negative and 73 patients (30.9%) were positive for ALNMs. The remaining 78 patients who were only radiologically evaluated with US and/or cMRI, 24 patients (10.2%) were negative and 54 patients (22.9%) were positive for ALNMs. The sensitivity, specificity, PPV, NPV, and ACC of PET/CT were 80.0%, 92.2%, 92.0%, 80.3%, and 85.7%, re spectively. The axillary lymph node, which was suspicious in supine imaging, remained in the suspicious group again in prone imaging in PET/CT. CONCLUSIONS: There is no single absolute modality for de tecting ALNMs in breast cancers to replace sentinel lymph node biopsy or axillary lymph node dissection. If ALNM is suspected based on PET/CT, axillary lymph node dissection without sentinel lymph node biopsy might be a better option because it is related to high possibilities of ALNM. KEY WORDS: Axillary lymph node metastasis, Magnetic resonance imaging, Ultrasonography, 18F-FDG PET/CT.

Is radioguided occult lesion localization (ROLL) an effective and reliable method in thyroid cancer and parathyroid redo surgery?

OBJECTIVE: The aim of this study is to share the efficacy of the radionuclide occult lesion localization (ROLL) technique in secondary neck exploration in patients who had undergone neck exploration due to thyroid or parathyroid pathology and to share our clinical experience. MATERIAL AND METHOD: Data of 25 patients who underwent secondary neck exploration for recurrent thyroid cancer and parathyroid adenoma between January 2016 and December 2018 at the General Surgery Clinic of Balcali Hospital, Çukurova University Faculty of Medicine were collected retrospectively. On the operation day, 0.5 mCi Tc-99m macroaggregate albumin was injected into the lesion under ultrasound guidance (USG). Nerve monitoring was used in all patients. RESULTS: Twenty-five patients (21 females, 4 males) were included in the study. The mean age of the patients was 54.5 (24-79) years. Five patients were operated for parathyroid adenoma, 6 patients for papillary cancer after subtotal thyroidectomy, 13 patients for papillary cancer recurrence, 2 patients for medullary cancer recurrence, 2 patients for papillary cancer cervical lymph node metastasis and 1 patient for anaplastic cancer recurrence.Mean operative time was 100.6 min (60-160 min). Two patients had transient hypocalcemia and no other complications were seen. Parathyroid hormone (PTH) levels in patients with hyperparathyroidism, Thyroglobulin (Tg) levels in patients with recurrent papillary cancer, were significantly lower than preoperative levels (p<0.05). CONCLUSION: We believe that ROLL technique reduces the complication rate by decreasing dissection time and width. We recommend using it for thyroid cancer and parathyroid redo surgery. KEY WORDS: Parathyroid redo surgery, Radioguided surgery, Thyroid cancer.

Primary actinomycosis of the breast in postmenopausal women.

INTRODUCTION: Actinomycosis is a chronic infection caused by actinomyces species characterized by an abscess formation, tissue fibrosis, and draining sinuses. Primary actinomycosis of the breast is rare. PATIENTS AND METHODS: In this paper we present a 64-year-old postmenopausal woman. For the diagnosis of primary actinomycosis of the breast, mammography, ultrasonography, MRI, and histopathologic examinations are required. Microbiological culture and histopathology are of the most importance during the process of diagnosis. In our case, at the intersection of the sternum and the lower inner quadrant of the right breast, there was a 1 cm wide fistula opening, and an abscess. A. israelii has been isolated from the microbiological culture taken from the lesion RESULTS: An optimal surgical resection of infected tissues has been performed as the treatment with the wound left open for tertiary healing The patient was given sulbactam 4*1 gr/day intravenously for 4 weeks post-op.. Recurrence was not detected during the yearly follow up procedures CONCLUSIONS: Actinomycosis should be considered when differentially diagnosing clinical instances of suppurative or granulomatous infections of the breast and mass regions that can't be ruled out as malignancies. Early diagnosis will save the patient from unnecessary surgical operations and ineffective antibiotic treatments. KEY WORDS: Actinomycosis, Breast abscess, Breast diseases.

Jejunal diverticulosis complicated with perforation: A rare acute abdomen etiology.

INTRODUCTION: Jejunal diverticulosis is a rare intestinal pathology with an incidence of 0.5-1%. While most cases are asymptomatic, 30-40% of the cases may become symptomatic with chronic abdominal pain, malabsorption, hemorrhage, diverticulitis, obstruction, abscess formation and, rarely, diverticula perforation. It is generally localized on the mesenteric side and it develops from the entry points of the vessels into the jejunum. CASE PRESENTATION: Case 1 - A 36-year Case 2 a 75 old female patient patient was admitted to the emergency department with the complaint of widespread abdominal pain, Case 1 8 diverticules, one with diverticule perforation, was observed in the jejunum segment between the 50th and 90th centimeters after the Treitz Ligament. Case 2 - In the diverticulum 100 cm distal from the Treitz ligament, mesenteric perforation area of 4-5 mm were observed. RESULTS: Segmentary small bowel resection and side-by-side anastomosis were performed in these cases. In the histopathological examination, the Diverticula were seen to be pseudodiverticullar lesions including herniation of the mucosa and submucosa. CONCLUSION: Jejunoileal diverticulosis is a rare disease with life-threatening complications such as perforation, obstruction and bleeding, it is usually asymptomatic or presents with nonspecific symptoms. It should be considered in the differential diagnosis of acute abdomen.

Psoriasis, a rare disease of the nipple-areola A case report.

BACKGROUND: Psoriasis is a chronic inflammatory skin disease with an incidence of 1-3%. Psoriasis usually occurs in the scalp, knee, elbow, sacral region and joints. The nipple-areola complex involvement is rarely encountered in the literature. CASE REPORT: 31-year-old female patient, who presented at the dermatology outpatient clinic with a lesion characterized by bright, pearlescent-white squamous lesions on an erythematous plaque, limited to the nipple-areola complex for the past three years, and who was diagnosed with "Psoriasis" following incisional biopsy. CONCLUSIONS: The benign or malignant distinction should be made for lesions observed in the nipple-areola complex. It should not be forgotten that psoriasis may also be present in the differential diagnosis of dermatitis-like benign lesions that do not respond to long-term and various drug treatment, although they are rare. KEY WORDS: Complex Benign lesions, Breast, Nipple areola, Psoriasis.

Primary gastric tuberculosis mimicking gastric cancer.

A 42-year-old female patient with no previous known diseases who had complaints of postprandial epigastric pain and weight loss and who could not be diagnosed by endoscopic biopsy, although gastric cancer was suspected radiologically and endoscopically, was diagnosed with primary gastric tuberculosis by laparotomy and frozen section. Following anti-tuberculosis treatment, a complete clinical, radiological, and endoscopic response was achieved.