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Adequacy of surgical margins, re-excision, and evaluation of factors associated with recurrence: a retrospective study of 769 basal cell carcinomas
(Elsevier Science Inc, 2023) Urun, Yildiz Gursel; Can, Nuray; Bagis, Merve; Solak, Sezgi Sarikaya; Urun, Mustafa
Background: Achieving adequate surgical margins and preventing recurrence are important in the treatment of basal cell carcinoma (BCC). Objectives: The objectives of this study were to evaluate the adequacy of surgical margins and the re-excision rates in patients with primary BCC who underwent standard surgical treatment using our proposed algorithm and to define the risk factors in patients with recurrent BCC. Methods: The medical records of patients who were histopathologically diagnosed with BCC were reviewed. An algorithm created based on previous literature was used to determine the distribution of optimal surgical margins adequacy and re-excision rates. Results: Statistically significant differences were observed between the cases with and without recurrence in age at diagnosis (p = 0.004), tumor size (p = 0.023), tumor location in the H zone of the face (p = 0.005), and aggressive histopathological subtype (p = 0.000). When the tumors were evaluated for adequacy of deep and lateral surgical margins and re-excision rates, higher rates of adequate excision (457 cases, 68.0%) and re-excision (43 cases, 33.9%) were noted for tumors in the H or M zone. Study limitations: Inadequate follow-up of newly diagnosed patients in terms of recurrence and metastasis and the retrospective application of our proposed algorithm are the limitations of the present study. Conclusions: Our results showed that if BCC was detected at an early age and at an early stage, recurrence was lower. The H and M zones were the regions with the highest rates of optimal surgical outcomes. (c) 2023 Sociedade Brasileira de Dermatologia. Published by Elsevier Espan & SIM;a, S.L.U. This is an open access article under the CC BY license (http://creativecommons.org/licenses/by/4.0/).
Avoiding Liver Injury with Papaverine and Ascorbic Acid Due to Infrarenal Cross-Clamping: an Experimental Study
(Soc Brasil Cirurgia Cardiovasc, 2017) Huseyin, Serhat; Guclu, Orkut; Yuksel, Volkan; Erkul, Gulen Sezer Alptekin; Can, Nuray; Turan, Fatma Nesrin; Canbaz, Suat
Objective: Ischemia-reperfusion injury after acute ischemia treatment is a serious condition with high mortality and morbidity. Ischemia-reperfusion injury may result in organ failure particularly in kidney, lung, liver, and heart. In our study, we investigated the effects of papaverine and vitamin C on ischemia-reperfusion injury developed in the rat liver after occlusion-reperfusion of rat aorta. Methods: 32 Sprague-Dawley female rats were randomized into four groups (n=8). Ischemia was induced with infrarenal aortic cross-clamping for 60 minutes; then the clamp was removed and reperfusion was allowed for 120 minutes. While the control group and the ischemia-reperfusion group did not receive any supplementary agent, two other groups received vitamin C and papaverine hydrochloride (papaverine HCL). Liver tissues were evaluated under the light microscope. Histopathological examination was assessed by Suzuki's criteria and results were compared between groups. Results: In ischemia-reperfusion group, severe congestion, severe cytoplasmic vacuolization, and parenchymal necrosis over 60% (score 4) were observed. In vitamin C group, mild congestion, mild cytoplasmic vacuolization and parenchymal necrosis below 30% (score 2) were found. In papaverine group, moderate congestion, moderate cytoplasmic vacuolization and parenchymal necrosis below 60% (score 3) were observed. Conclusion: An ischemia of 60 minutes induced on lower extremities causes damaging effects on hepatic tissue. Vitamin C and papaverine are helpful in reducing liver injury after acute ischemia reperfusion and may partially avoid related negative conditions.
Bethesda Kategori ÖBA/ÖBFL için Malignite Oranları: Tek Merkez Deneyimi
(2016) Can, Nuray; Salt, Semra Aytürk; Taştekin, Ebru; Sezer, Yavuz Atakan; Çelik, Mehmet; Puyan, Fulya Öz; Usta, Ufuk
Amaç: Tiroidnodüllerinin prevelansı yüksek olmasına rağmen, bu nodüller için malignite oranları düşüktür. Bu nedenle, cerrahi yaklaşım gerektiren malign nodülleri, benign nodüllerden ayırmak çok önemlidir. Ultrasonografi, ultrasonografi eşliğinde ince iğne aspirasyonu ve ayrıca Tiroid Sitopatolojisi için Bethesda Raporlama Sistemi tiroid nodüllerinin değerlendirilmesinde fayda sağlamaktadır. Ancak, bu sistem 'Önemi Belirsiz Atipi/ Önemi Belirsiz Foliküler Lezyon (ÖBA/ÖBFL)' olarak adlandırılan problemli bir kategori içermektedir. Bu kategori için son zamanlarda bildirilen malignite yüzdeleri %5 ile %96,7 arasında değişmektedir. Bu çalışmada merkezimizde incelenen ilk ince iğne aspirasyon tanısı ÖBA/ÖBFL olan tiroid nodüllerindeki malignite oranlarının sunulması amaçlanmaktadır. Yöntem: Yedi yıl süresince, Trakya Üniversitesi Tıp Fakültesi Patoloji Anabilimdalı'nda (Edirne, Türkiye) incelenen hastaların tanıları (ince iğne aspirasyon ve tiroidektomi) geriye dönük olarak değerlendirildi. Bulgular: İnce iğne aspirasyon sitolojisinde ÖBA/ÖBFL tanısı alan 153 hastadan 68'inde (%44,4) histopatolojik tanı papiller tiroid karsinomu, 1'inde (%7) foliküler karsinom ve 1'inde (%7) de medüller karsinom idi. Tartışma ve Sonuç: Tiroid Sitopatolojisi için Bethesda Raporlama Sistemi bazı tanı kategorilerinde standardizasyon sağlamışsa da, ÖBA/ÖBFL kategorisi hala subjektif sitolojik kriterleri barındırmakta ve farklı çalışmalarda oldukça değişken histolojik malignite oranları bildirilmektedir. Bu nedenle, immünositokimya ve özellikle moleküler testler gibi yardımcı yöntemlerin kullanılması tiroid nodüllerinin preoperatif tanısında faydalı olabilir.
BRAF V600 Mutation Profile of Metastatic Melanoma in the Thrace Region of Turkey
(De Gruyter Poland Sp Zoo, 2018) Can, Nuray; Tastekin, Ebru; Deniz Yalta, Tulin; Sut, Necdet; Korkmaz, Selma; Usta, Ufuk; Oz Puyan, Fulya
Objective: BRAF is the most common mutation in melanoma. The most common subtype is BRAF V600E, followed by V600K. Initially, the authors aimed to investigate whether clinicopathological features of melanoma are associated with BRAF mutations. We then aimed to present the relationships between the clinicopathological features and the mutated subtype (V600E vs V600K). Material and Method: 61 patients with metastatic malignant melanoma (affecting the lymph node or other distant sites) were selected. Patient data regarding age at the time of diagnosis, sex, metastatic site (lymph node, distant metastasis or both) and primary tumour site were obtained from the hospital's database. Tissue samples containing at least 30% tumour cells were isolated from the specimens of 61 patients (24 samples from primary tumours and 37 from metastatic foci) for BRAF analysis. Comparisons between the BRAF V600 mutation and clinicopathological and histopathological features were performed. Results: BRAF V600 mutation was detected in 34 (55.7%) patients. The subtype was BRAF V600E in 22 (64.7%) patients, BRAF V600K in 11(32.4%) patients and BRAF V600R in 1(2.9%) patient. The crucial results of the present study may be summarized as follows: i) BRAF V600 mutation was more common in older patients and tumors with BRAF V600 mutation revealed necrosis and LVI more commonly than wild-type tumors, ii) BRAF V600K mutation was more common in older patients and BRAF V600K mutated tumors exhibited ulceration more commonly than tumors with BRAF V600E mutation (close to significant). Conclusion: The BRAF V600 mutation may have interactions with prognostic clinicoptahological features of melanoma including necrosis and lymphovascular invasion. V600K mutation may be more common than expected and may have different associations with properties of the tumor such as tumor ulceration and patient age. Investigation of the mutated subtype of the BRAF gene may therefore reveal more detailed data about the management of melanoma and may also prevent missing of candidates for BRAF inhibitor therapies.
A case of chronic ulcer due to subcutaneous arteriolosclerosis in an obese patient mimicking pyoderma gangrenosum
(Pagepress Publ, 2018) Ficicioglu, Sezin; Can, Nuray; Tutug, Busem
The differential diagnosis of chronic ulcers covers a wide range of diseases and poses a diagnostic challenge. Subcutaneous ischemic arteriolosclerosis can lead to local ischaemia and ulceration as a result of arteriolar narrowing and reduction of tissue perfusion. This pathophysiological feature can be seen in eutrophication (nonuremic calciphylaxis) in morbid obesity, hypertensive ischemic leg ulcer (Martorell ulcer) and calciphylaxis in chronic renal insufficiency. All of the ulcers happened in this way can be wrongly diagnosed as pyoderma gangrenosum because of clinical similarity and inadequate biopsies. We report a case of chronic ulcer due to subcutaneous arteriolosclerosis in morbid obesity, wrongly diagnosed as pyoderma gangrenosum. It can be detrimental to misdiagnose the ulcers due to subcutaneous arteriolosclerosis as pyoderma gangrenosum since they need a diametrically different approach.
CD56, CD57, HBME1, CK19, GALECTIN-3 AND P63 IMMUNOHISTOCHEMICAL STAINS IN DIFFERENTIATING DIAGNOSIS OF THYROID BENIGN/MALIGN LESIONS AND NIFTP
(Vesalius Univ Medical Publ, 2019) Tastekin, Ebru; Keskin, Elif Usturali; Can, Nuray; Canberk, Sule; Mut, Ayse Nur Usturali; Erdogan, Ezgi Genc; Asa, Nurtac
Detection of thyroid carcinoma has been steadily increased in the past few decades. After the recognition of NIFTP, also gain importance to differentiate benign tumors (follicular adenoma) from follicular patterned variants of papillary thyroid carcinoma (invasive and infiltrative follicular variant papillary thyroid carcinoma), and low-risk lesions of thyroid (NIFTP). Follicular patterned proliferations of thyroid still persists as a battle for pathologists. In this study, we aimed to analyze the most commonly used immunohistochemical stains HBME1, CK19, Galectin-3, adding the new ones CD56, CD57, and p63. Study groups were; nodular hyperplasia, follicular adenoma, NIFTP, infiltrative follicular variant PTC, classical variant PTC (CVPTC) and follicular carcinoma. Each group consisted of twenty cases. The sections were stained with CD56, CD57, p63, CK19, HBME1 (Mesotel cell), Galectin-3 antibody. Although the expression of CD56 was high in benign follicular lesions, FC could not be excluded in this group. CD57 was high in malignant follicular group and NIFTP. Interestingly, p63 was found highly expressed in FVPTC, which might be promising to predict invasiveness in follicular group of lesions. CK19, Galectin-3 and HBME1 were found quietly prominent in CVPTC in concordance with the previous reports.
Clinical, Dermoscopic and Histopathological Evaluation of Basal Cell Carcinoma
(Mattioli 1885, 2023) Urun, Yildiz Gursel; Ficicioglu, Sezin; Urun, Mustafa; Can, Nuray
Introduction: Dermoscopy aids in identifying histopathological subtypes and the presence of clinically undetectable pigmentation in basal cell carcinoma (BCC). Objectives: To investigate the dermoscopic features of BCC subtypes and better understand nonclassical dermoscopic patterns. Methods: Clinical and histopathological findings were recorded by a dermatologist who was blinded to the dermoscopic images. Dermoscopic images were interpreted by two independent dermatologists blinded to the patients' clinical and histopathologic diagnosis. Agreement between the two evaluators and with histopathological findings was evaluated using Cohen's kappa coefficient analysis. Results: The study included a total of 96 BBC patients with 6 histopathologic variants: nodular (n=48, 50%), infiltrative (n=14, 14.6%), mixed (n=11, 11.5%), superficial (n=10, 10.4%), basosquamous (n=10, 10.4%), and micronodular (n=3, 3.1%). Clinical and dermoscopic diagnosis of pigmented BCC showed high agreement with histopathological diagnosis. The most common dermoscopic findings according to subtype were as follows: nodular BCC: shiny white-red structureless background (85.4%), white structureless areas (75%), and arborizing vessels (70.7%); infiltrative BCC: shiny white-red structureless background (92.9%), white structureless areas (78.6%), arborizing vessels (71.4%); mixed BCC: shiny white-red structureless background (72.7%), white structureless areas (54.4%), and short fine telangiectasias (54.4%); superficial BCC: shiny white-red structureless background (100%), short fine telangiectasias (70%); basosquamous BCC: shiny white-red structureless background (100%), white structureless areas (80%), keratin masses (80%); micronodular BCC: short fine telangiectasias (100%).
Clinicopathological and molecular analyses of uterine carcinosarcomas using next-generation sequencing: A single-center experience
(Wolters Kluwer Medknow Publications, 2023) Erdogan, Ezgi Genc; Yalta, Tuelin D.; Can, Nuray; Sut, Necdet; Tastekin, Ebru; Usta, Ufuk; Puyan, Fulya Oz
Background: Uterine carcinosarcomas (UCS) constitute 3-4% of all uterine malignancies and 16% of deaths caused due to uterine neoplasms. Aim: In this study, we aimed to perform DNA-based mutation analysis in 12 genes (KRAS, NRAS, EGFR, C-KIT, BRAF, PDGFRA, ALK, ERBB2, ERBB3, ESR1, RAF1, PIK3CA) to determine the molecular subtypes of UCS using next-generation sequencing (NGS) in patients with aggressive UCS and poor prognosis. We aimed to compare the results of our analysis with clinicopathological data to contribute to the development of targeted therapy approaches related to the molecular changes of UCS. Materials and Methods: In this study, we included 12 cases diagnosed with uterine carcinosarcomas and examined the changes in oncogenes that play a role in UCS pathogenesis. For the analysis of mutation, the clinicopathological data were compared with the variations in the DNA-based gene panel consisting of 12 genes and 1237 variants in the UCS using the NGS method. Results: EGFR mutation was found in 91.7% of the cases, mutation in 41.7%, PDGFRA mutation in 25%, KRAS and PIK3CA mutation in 16.7%, and C-KIT mutation in 8.3% of the cases. Although no statistical significance was found between the detected mutation and clinicopathological data, it was concluded that PDGFRA mutation might be associated with advanced-stage disease development. Conclusion: This study's findings regarding different molecular types of UCS and information on oncogenesis of UCS can provide inferences for targeted therapies in the future by identifying targetable mutations representing early oncogenic events and thereby contribute toward further studies on this subject.
COMPARISON OF CLINICO PATHOLOGICAL FEATURES IN INCIDENTAL AND NONINCIDENTAL PAPILLARY THYROID CARCINOMAS IN 308 PATIENTS
(Vesalius Univ Medical Publ, 2017) Can, Nuray; Ozyilmaz, Filiz; Celik, Mehmet; Sezer, Atakan Y.; Sut, Necdet; Tastekin, Ebru; Ayturk, Semra
Incidental papillary thyroid carcinomas (IPTCs) consist of a significant portion of increasing incidence in papillary thyroid carcinomas. This study investigated the clinicopathological features of IPTCs from different perspectives and by comparing nonincidental PTCs (NIPTCs) in patients who underwent total thyroidectomy and lymph node dissection. Basic results were as follows. IPTC was present in 27.9% of 308 patients. IPTCs were significantly accompanied by lymphocytic thyroiditis (LT), particularly, multinodular hyperplasia (MNH). IPTCs were more common in older patients (51.3 years vs. 47.2 years) and in female patients. IPTCs significantly differed from NIPTCs in terms of smaller tumour size, lymphatic vessel invasion (2.6% vs. 97.4%), extrathyroidal extension (4.3% vs. 95.7%), lymph node metastasis (3.6% vs. 96.4%), multifocality (21.2% vs. 78.8%), bilaterality (5.3% vs. 94.7%), and BRAFV600 mutation (6.7% vs. 93.3%). Older age, bilaterality, encapsulation, and radioactive iodine (RAI) were significantly more common in IPTCs > 5 mm than in those <= 5 mm. In conclusion, IPTCs are more commonly associated with LT and MNH. IPTCs may have a more favourable prognosis than NIPTCs, and tumour size > 5 mm may predict bilaterality and need for RAI. Nevertheless, the patient-based clinical approach in IPTCs may have benefits in the management of IPTCs.
Comparison of clinicopathological features in patients with noninvasive follicular thyroid neoplasm with papillary-like nuclear features and follicular variant papillary thyroid cancer
(Medycyna Praktyczna Sp K Sp Zoo, 2020) Celik, Mehmet; Bulbul, Buket Y.; Can, Nuray; Ayturk, Semra; Tastekin, Ebru; Sezer, Atakan; Ustun, Funda
INTRODUCTION Noninvasive follicular thyroid neoplasm with papillary-like nuclear features (NIFTP) is a newly defined entity accepted as a tumor precursor. OBJECTIVE We aimed to examine the features of patients diagnosed with follicular variant papillary thyroid carcinoma (FVPTC), which are classified as NIFTP in the recent classification. This study compares clinical, radiological, histopathological, and molecular features of NIFTP and FVPTC. PATIENTS AND METHODS A total of 247 patients with FVPTC were retrospectively examined and pathology specimens were reviewed. RESULTS Patients were divided into 2 groups (NIFTP group: 107 patients; FVPTC group: 140 patients). There was a difference in terms of the percentage of pathologic nodules with irregular borders detected on preoperative neck ultrasonography (NIFTP group: 6.5%, FVPTC group: 15.7%; P = 0.02). Central lymph node dissection specimens of 50 patients in the NIFTP group were normal, while 4 of 70 patients (5.7%) in the FVPTC group had lymph node metastasis (P = 0.14). In addition, multivariable analysis (binary logistic regression) showed that FVPTC was positively associated only with irregular borders and extrathyroidal extensions (P = 0.02 and P <0.001, respectively). CONCLUSIONS We suggest that patients diagnosed with NIFTP according to the new classification are considered low risk, and margin characteristics of the nodule detected on preoperative ultrasonography may be helpful in the differential diagnosis.
A Comprehensive Approach to the Thyroid Bethesda Category III (AUS) in the Transition Zone Between 2nd Edition and 3rd Edition of The Bethesda System for Reporting Thyroid Cytopathology: Subcategorization, Nuclear Scoring, and More
(Humana Press Inc, 2024) Bagis, Merve; Can, Nuray; Sut, Necdet; Tastekin, Ebru; Erdogan, Ezgi Genc; Bulbul, Buket Yilmaz; Sezer, Yavuz Atakan
Significant interobserver variabilities exist for Bethesda category III: atypia of undetermined significance (AUS) of The Bethesda System for Reporting Thyroid Cytopathology (TBSRTC). Thus, subcategorization of AUS including AUS nuclear and AUS other is proposed in the recent 3rd edition of TBSRTC. This study investigated the impact of the nuclear features/architectural features/nuclear score (NS) (3-tiered)/subcategories and subgroups on risk of malignancy (ROM) in thyroid fine-needle aspirations (FNA). 6940 FNAs were evaluated. 1224 (17.6%) cases diagnosed as AUS were reviewed, and 240 patients (initial FNAs of 260 nodules and 240 thyroidectomies) were included. Subcategories and subgroups were defined according to TBSRTC 2nd and 3rd editions. Histological diagnostic groups included nonneoplastic disease, benign neoplasm, low-risk neoplasm, and malignant neoplasm. Overall, ROM was 30.7%. ROM was significantly higher in FNAs with nuclear overlapping (35.5%), nuclear molding (56.9%), irregular contours (42.1%), nuclear grooves (74.1%), chromatin clearing (49.4%), and chromatin margination (57.7%), and these features were independent significant predictors for malignancy. FNAs with NS3 had significantly higher ROM (64.2%). Three-dimensional groups were significantly more frequent in malignant neoplasms (35.7%). ROM was significantly higher in AUS-nuclear subcategory (48.2%) and in AUS-nuclear and architectural subcategory (38.3%). The highest ROM was detected in AUS-nuclear1 subgroup (65.2%). ROM was significantly higher in the group including AUS-nuclear and AUS-nuclear and architectural subcategories, namely high-risk group than the group including other subcategories, namely low-risk group (42.0%vs 13.9%). In conclusion, subcategorization may not be the end point, and nuclear scoring and evaluation of architectural patterns according to strict criteria may provide data for remodeling of TBSRTC categories.
Cutaneous Horn: A Very Rare Presentation of Nail Unit Squamous Cell Carcinoma
(Lippincott Williams & Wilkins, 2021) Sarikaya Solak, Sezgi; Can, Nuray; Gursel Urun, Yildiz; Goktay, Fatih
[Abstract Not Available]
Effect of Dual Mesh Wrap on The Stability of Colonic Anastomosis
(Aves, 2021) Albayrak, Dogan; Turkes, Bayram; Can, Nuray; Cakcak, Ibrahim Ethem; Kahya, Eyup; Oguz, Serhat; Hoscoskun, Zeki
BACKGROUND/AIMS Colon anastomotic leakage is the cause of significant morbidity and mortality in surgery. Therefore, we aimed to demonstrate experimentally the effect of the conventional method of wrapping them through colo-colonic anastomosis performed by dual patch on anastomotic healing and security. MATERIAL and METHODS The study was conducted at the Experimental Animal Research Unit of the Medical Faculty of Trakya University, Edirne, Turkey. A total of 20 Wistar Albino adult rats were used. The rats were divided into 2 groups: 10 rats in the control group and 10 rats in the dual patch group. All rats underwent partial segmental colon resection, and colo-colonic anastomosis was performed in a single layer with 5/0 polypropylene. For rats in the dual patch group, the anastomosis was wrapped up with a 1-cm-wide dual patch. In the control group, there was no operation on the anastomosis. At 7 days after the procedure, the degree of peritoneal adhesion model previously prepared according to Evans devices laparotomy was used to observe all the rats and colon burst pressure. Both histopathological examination and the examination of the perianastomotic area were performed. RESULTS In the rats that were treated with dual mesh, there was a statistically significant increase in anastomotic line burst pressure (P<.05), a statistically significant increase in collagen amount (P<.05), and a statistically significant decrease in abdominal adhesions (P<.05). CONCLUSION As a result, the colo-colonic anastomosis of winding dual patch, without causing intra-abdominal adhesions, improves security by increasing the anastomosis bursting pressure.
Effects of IVIG and Pulse Steroid Therapy in a Case of Allopurinol Induced DRESS Syndrome
(Aves Press Ltd, 2018) Korkmaz, Selma; Gunay, Elif; Can, Nuray; Ficicioglu, Sezin; Piskin, Suleyman
Drug Reaction with Eosinophilia and Systemic Symptoms (DRESS) is a drug reaction that causes peripheral eosinophilia and primarily renal and hepatic insufficiency and dysfunction of other visceral organs with skin rash as noticeable symptom. Early diagnosis and discontinuation of the culprit drug along with rapid treatment are required to reduce mortality rate. Herein, a case of allopurinol-induced DRESS syndrome is presented in which the patient was resistant to medium dose systemic steroid therapy and was treated with pulse steroid and IVIG treatment successfully. Pulse steroid therapy may be an alternative treatment option in refractory DRESS syndrome.
The first case of peripheral T cell lyphoma with a CSF3R variant resulted in relapsing febrile neutropenia and aplastic anemia
(Springer Heidelberg, 2022) Kirkizlar, Onur; Can, Nuray
Colony-stimulating factor 3 receptor (CSF3R) gene mutations have been previously identified in chronic neutrophilic leukemia, atypical chronic myeloid leukemia, chronic myelomonocytic leukemia, de novo acute myeloid leukemia, and severe congenital neutropenia, although there is limited data regarding lymphoid malignancies. Here, we present the first case of peripheral T cell lymphoma with CSF3R variant that developed persistent neutropenia in the follow-up visit and aplastic anemia after autologous hematopoietic stem cell transplantation. Next-generation sequencing (NGS) was performed on bone marrow aspiration (Qiagen clinical insight-QCI (TM)). CSF3R single nucleotide variant (transcript variant 4), 46.0% (of 1081 reads) of variant allele fraction on exon 16 (lying to intronic region), nucleotide NM_172313.3, g36932463A > g, c.2041-35 T > C was identified by NGS. The case study presented here is an example of use of NGS in diagnosis, classification, prognostic or response indicator of hematologic malignancies, and identification of targeted therapy options in clinical practice. Additional work is needed to understand the clinical significance of this mutation.
Follicular morphological characteristics may be associated with invasion in follicular thyroid neoplasms with papillary-like nuclear features
(Assoc Basic Medical Sci Federation Bosnia & Herzegovina Sarajevo, 2017) Can, Nuray; Celik, Mehmet; Sezer, Yavuz Atakan; Ozyilmaz, Filiz; Ayturk, Semra; Tastekin, Ebru; Sut, Necdet
The newly proposed nomenclature and diagnostic criteria for encapsulated follicular variant of papillary thyroid carcinoma (EFVPTC), the noninvasive follicular thyroid neoplasm with papillary-like nuclear features (NIFTP), could improve the consistency and accuracy of diagnosing this entity. Diagnosis of NIFTP requires evaluation of the complete tumor border or capsule. The presence of tumor invasion in follicular thyroid neoplasms with papillary-like nuclear features has been recently discussed by many authors. In this study, we examined the predictive value and association of follicular morphological characteristics with the tumor invasion. In addition, we analyzed the association between tumor encapsulation and molecular profile in EFVPTC/NIFTP cases. A total of 106 cases of FVPTC were included in the study. The tumors were grouped based on the presence of tumor capsule and characteristics of tumor border, as 1) completely encapsulated tumors without invasion, 2) encapsulated tumors with invasion, 3) infiltrative tumors without a capsule. Clinicopathological features, histomorphological features [ nuclear criteria, minor diagnostic features, follicles oriented perpendicular to tumor border/capsule (FOPBC)] and molecular alterations in BRAF, NRAS, and KRAS genes were evaluated. FOPBC were significantly more frequently seen in encapsulated tumors with invasion (p = 0.008). The nuclear features were not associated with the presence of encapsulation and characteristics of tumor border. BRAF mutation was more frequent in infiltrative tumors, while NRAS mutation was more frequent in encapsulated tumors, but the results were not statistically significant (p = 0.917). In conclusion, FOPBC histomorphological feature may be associated with tumor invasion in EFVPTC/NIFTP. Additionally, BRAF/KRAS/NRAS mutation analysis may prevent inadequate treatment in these patients.
Gastrik karsinomlar ve metaplazilerde homeobox gen ekspresyonu ve helikobakter pilori ilişkisi
(Trakya Üniversitesi Tıp Fakültesi, 2010) Can, Nuray; Kutlu, Kemal
Gastrik adenokarsinom, mide mukozasının glandüler diferansiyasyon gösteren malign epitelyal tümörüdür. Gastrik metaplaziler, preneoplastik lezyonlar olarak kabul edilmektedir. Çalışmamızda mide karsinomlarında ve metaplazilerinde `Pancreatic-duodenal homeobox1', Trefoil faktör 2 ve 3, müsin tip 5AC ve 6 antikorlarının ekspresyonları ve Helikobakter Pilori ile ilişkileri araştırıldı. 2006-2009 yılları arasında mide karsinomu tanısı almış 70 gastrektomi olgusu Lauren Sınıflaması'na göre tiplendirildi. Olgularda tümöre ait özellikler, metaplazi durumu ve Helikobakter Pilori varlığı kaydedildi. Tüm parametreler birbirleriyle ve immünohistokimyasal belirteçler ile istatistiksel olarak karşılaştırıldı. Çalışmamızda, heriki tip tümörün çevresinde, intestinal metaplazi yanısıra psödopilorik metaplazinin bulunduğunu ancak difüz tip adenokarsinomlarda psödopilorik metaplazinin tek başına veya intestinal metaplaziyle beraber daha sık bulunduğunu gördük. Tümör çevresinde intestinal metaplazi ve psödopilorik metaplazi beraber olan her iki tip tümörde, yüksek `Pancreatic-duodenal homeobox1' ekspresyonu istatistiksel olarak anlamlıydı (p<0,05). Lenf nodu metastazı olmayan vakalarda, olanlara göre Trefoil faktör2'nin yüksek ekspresyonu istatistiksel olarak anlamlıydı (p<0,05). Metaplazilerde Helikobakter Pilori pozitifliği ile artan `Pancreatic-duodenal homeobox1' pozitifliği mevcuttu. Psödopilorik metaplazide Trefoil faktör3 pozitifliğinin bulunması ve `Pancreaticduodenal homeobox1' pozitifliği ile aynı vakalarda örtüşmesi dikkat çekiciydi. Sonuç olarak, hem her iki tip mide adenokarsinomunda, hem de intestinal metaplazi ve psödopilorik metaplazide Homeobox gen `Pancreatic-duodenal homeobox1' ekspresyonu mevcuttur. Gastrik metaplazilerde `Pancreatic-duodenal homeobox1' ekspresyonu Helikobakter Pilori infeksiyonu ile artmaktadır. İntestinal metaplazi gibi psödopilorik metaplazi de gastrik adenokarsinomlar için önemli bir preneoplastik lezyon olabilir. `Pancreatic-duodenal homeobox1', gastrik kanserler için erken bir işaret olabilir, hem tanısal parametre olarak kullanılabilir hem de gen tedavilerinde hedef oluşturabilir. Bu konuda moleküler teknikler ve prospektif insan ve hayvan çalışmaları önemli birer araç olabilirler.
Gastrointestinal Tract Multiple Lymphomatous Polyposis Presented As Mantle Cell Lymphoma
(Trakya Üniversitesi, 2019) Akay, Fatih Erkan; Can, Nuray; Cezik, Mert; Kırkızlar, Hakkı Onur; Soyluoğlu, Fatma Selin; Öz Puyan, Fulya
Aims: Mantle cell lymphoma is a mature B cell non-Hodgkin lymphoma which may be presented with the involvement of the gastrointestinal tract as multiple lymphomatous polyposis. The aim of this case report is to increase the awareness of including lymphomatoid polyposis as an entity in the differential diagnosis of multiple polyposis of the gastrointestinal tract. Case Report: A 69-year-old male patient was admitted to the Trakya University Emergency Department with acute abdominal pain. His cli-nical findings were anorexia that started 3-4 months ago together with constipation and nausea causing him to lose 10-15 kg in 7-8 months, with denial of other parameters of B-symptoms (fevers and night sweats). Endoscopic biopsies that were taken from bulbus and duodenum were investigated and he was diagnosed with mantle cell lymphoma. The patient went through an ileoce-cal resection due to his intussusception that caused abdominal pain in the first place. Conclusion: Although being an infrequent disease, gastrointestinal lymphomatoid polyposis should be an entity comprised in differential diagnosis for multiple polyposis of the gastrointestinal tract. On the other hand, there is still not a therapeutic protocol with a definitive cure for gastrointestinal tract mantle cell lymphoma. Elderly patients in high risk group such as our patient should be given treatment by taking their conditions into consideration. Keywords: Mantle cell lymphoma, polyp, non-Hodgkin lymphoma
High prevalence of high-risk cutaneous squamous cell carcinoma in the thrace region of Turkey
(Wolters Kluwer Medknow Publications, 2020) Solak, Sezgi Sarikaya; Yondem, Haydar; Urun, Yildiz Gursel; Cezik, Mert; Can, Nuray
Background: The characteristics of cutaneous squamous cell carcinoma (cSCC) may show differences according to the geographic distribution and ethnicity. Although most cSCCs are treated with surgical excision or other local interventions, high-risk cSCCs may have poor outcome. In the present study, we aimed to evaluate the clinicopathological characteristics and determine the high-risk features of cSCCs in the Thrace region of Turkey where the information on cSCCs is scarce. Methods: We retrospectively investigated the biopsy-proven cSCCs diagnosed between the years 2014 and 2018, in a tertiary university hospital and evaluated the high-risk features. Results: A total of 211 cSCCs were included. Men with cSCC were significantly younger than women with cSCC (P <.001). Almost one-half of the tumors (n = 103) were located on the lower lip. Patients with a cSCC on the lower lip were younger than those with a cSCC on the other sites. All patients with a cSCC on the ears were men. Twenty-eight percent of patients had tumor size more than 20 mm and 28% had tumor thickness more than 6 mm. Immunosuppression was present in 7.6% of patients. A total of 177 (83.9%) patients had high-risk cSCC. The local recurrence rate was 6.2%, and the metastasis rate was 5.2%. Conclusions: The Thrace region has significant number of cSCC, and high-risk features are very frequent. Clinicians should carefully evaluate the cSCCs in terms of high-risk features.
Histopathological Evidence of Lymph Node Metastasis in Papillary Thyroid Carcinoma
(Humana Press Inc, 2015) Can, Nuray; Tastekin, Ebru; Ozyilmaz, Filiz; Sezer, Yavuz Atakan; Guldiken, Sibel; Sut, Necdet; Sarikas, Nurtac
Prophylactic lymph node dissection is still controversial due to the potentially surgery-related morbidity in management of papillary thyroid carcinomas. So, some histopathological predictors for lymph node metastasis in thyroidectomy specimens may reveal importance. The objective of this study was to define histomorphological indicators of lymph node metastasis in the patients who had been performed thyroidectomy without lymph node dissection. Clinicopathological features of patients archived in Department of Pathology at Trakya University Medical Faculty were reviewed. A total of 211 patients who had been diagnosed as papillary carcinoma and had been performed total thyroidectomy/lobectomy with central/cervical lymph node dissection were included in the study. Clinical features (age, gender, preoperative/postoperative clinical, and laboratory findings) and histopathological features (histological variant, tumor size, focality, extrathyroidal extension, tumor border, lateral tubular growth, intraglandular dissemination, stromal and lymphocytic tumor response, lymphocytic thyroiditis, lymphovascular invasion, lymph node metastasis, number of metastatic lymph nodes, extranodal extension, size of the metastatic foci) were evaluated. Male gender, conventional variant, tumor size greater than 10 mm, multifocality, extrathyroidal extension, lateral tubular growth, intraglandular dissemination, lymphocytic and stromal tumor response, and absence of lymphocytic thyroiditis were predictive, and older age (>= 45 years) and follicular variant PTC were protective for lymph node metastasis. In order to optimize the management of papillary thyroid carcinomas, pathologists should search for the clues of lymph node metastasis particularly intraglandular dissemination, lateral tubular growth, tumor border and lymphocytic/stromal tumor response, multifocality, concomitant lymphocytic thyroiditis besides the actual prognostic criteria especially in younger aged male patients.

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