Publications by authors named "Dilek Ertoy Baydar"

62 Publications

Pathology Associated with Adherent Perirenal Fat and its Clinical Effect.

Int J Clin Pract 2021 Jun 13:e14518. Epub 2021 Jun 13.

Hacettepe University, School of Medicine, Department of Urology, Ankara, Turkey.

Introduction: The dissection of perirenal fat is of critical importance to kidney surgery and ease of dissection is more important when using minimally invasive approaches. This study aimed to determine the clinical, radiological, and pathological significance of adherent perirenal fat(APF).

Materials And Methods: This prospective study included 22 patients scheduled for partial nephrectomy and 40 patients for donor nephrectomy. Intra-operative fat dissection time was recorded and the complexity of perirenal fat dissection was surgeon-classified as easy, moderate, and difficult. Perirenal fat and subcutaneous fat thickness was measured. Measurement of perirenal fat depth, and the Hounsfield unit(HU) for both perirenal and subcutaneous fields was performed using computed tomography(CT) images. All specimens were submitted for histopatological analysis. Researchers in each arm were blinded to other researchers' data.

Results: Mean age of the patients was 51.3±12.7years. Mean perirenal fat dissection time was 15.0±13.5min. Patient demographics, BMI, nor occupational status differed between the 3 complexity of perirenal fat dissection groups. Radiological findings showed that there was a significant correlation between perirenal fat depth and complexity of perirenal fat dissection(p<0.05), but not with HU measurements or subcutaneous fat thickness. Surgeon classification of the complexity of perirenal fat dissection was in accordance with the duration of dissection(p<0.05). Perinephric fat contained more fibrous tissue in the patients with histologically proven APF than in those without(p<0.05).

Conclusions: APF is a challenge during kidney surgery. Difficult dissection prolongs the duration of perirenal fat dissection and surgery. Perirenal fat thickness measured via pre-operative CT might be used to predict APF.
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http://dx.doi.org/10.1111/ijcp.14518DOI Listing
June 2021

Ga-PSMA-11 Positron Emission Tomography/Computed Tomography for Primary Lymph Node Staging Before Radical Prostatectomy: Central Review of Imaging and Comparison with Histopathology of Extended Lymphadenectomy.

Eur Urol Focus 2021 Mar 25;7(2):288-293. Epub 2021 Jan 25.

Department of Urology, Koc University Hospital, Istanbul, Turkey; Martini-Klinik Prostate Cancer Center, University Hospital Hamburg-Eppendorf, Hamburg, Germany; Department of Urology, University Hospital Hamburg-Eppendorf, Hamburg, Germany.

Background: Results from prospective trials have shown higher accuracy of prostate-specific membrane antigen (PSMA)-based positron emission tomography (PET)/computed tomography (CT) in detection of lymph node metastasis (LNM) compared to conventional imaging.

Objective: To evaluate the accuracy of Ga-PSMA-11 PET/CT for LNM detection in patients undergoing radical prostatectomy (RP) and extended pelvic lymph node dissection (PLND).

Design, Setting, And Participants: Between June 2014 and November 2020, 96 patients with Ga-PSMA PET/CT for primary staging underwent RP and extended PLND.

Outcome Measurements And Statistical Analysis: The results from Ga-PSMA PET/CT were compared with histologic data from primary PLND in 96 patients. All Ga-PSMA PET/CT scans were centrally reviewed.

Results And Limitations: Of 96 patients, 15.6% (n = 15) harbored LNMs. The median prostate-specific antigen at Ga-PSMA PET/CT was 8.0 ng/ml (interquartile range 5.5-11.7). The majority of patients had intermediate- (52.1%) or high-risk disease (41.7%). Biopsy grade group 4 and 5 was present in 22.9% and 15.6%, respectively. The Ga-PSMA PET/CT scans identified eight of 15 patients (53.3%) as LN-positive (true positive). The calculated per-patient sensitivity, specificity, positive predictive value, negative predictive value, and accuracy of Ga-PSMA PET/CT in the detection of LNM were 53.3%, 98.8%, 88.9%, 92.0%, and 91.7%, respectively. The per-patient sensitivity and specificity in the detection of LNMs larger than 2 mm were 61.5% and 98.8%, respectively. The main limitation is the retrospective design of the study.

Conclusions: Ga-PSMA PET/CT is accurate in lymph node staging and the results support its use for primary staging of prostate cancer.

Patient Summary: We compared prostate-specific membrane antigen (PSMA)-based positron emission tomography (PET)/computed tomography (CT) findings with histopathology results after extended lymph node dissection and showed that it is accurate in detecting lymph node metastases. Our results support the use of PSMA PET/CT for primary staging of prostate cancer.
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http://dx.doi.org/10.1016/j.euf.2021.01.004DOI Listing
March 2021

Primary ependymoma of the retropubic space in a male patient.

Ultrastruct Pathol 2020 Nov 29;44(4-6):505-510. Epub 2020 Oct 29.

Department of Pathology, Koc University School of Medicine , Istanbul, Turkey.

We report a case of primary intraabdominal ependymoma arising in the retropubic space of a male patient. An incidental intraabdominal mass was discovered in a 51-year-old man. Radiological studies revealed a 10 cm, solid and cystic tumor located in the Retzius fossa. Microscopically, the lesion was characterized by multiple cellular nodules composed of bland small cells forming true and pseudorosettes. No nuclear atypia, necrosis or increased mitotic activity was present. Neoplastic cells positive for AE1/3 and Cam5.2, and expressed patchy GFAP, and paranuclear dot-like to microvesicular EMA and D2-40, while S100, synaptophysin, PAX8, TLE1, WT1, inhibin, calretinin, Melan-A, and HMB45 were negative. Electron microscopy findings supported the diagnosis: 1) Frequent intracytoplasmic vacuoles with short and redundant microvilli and few cilia 2) lung intercellular junctions. The patient is alive with no evidence of disease for 4 years. Pathologists should be aware that rare extraneural ependymomas may occur in the Retzius space, even in a male patient. This entity should be kept in mind especially when the differential diagnosis is metastatic carcinoma with an unusual morphology and immune profile.
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http://dx.doi.org/10.1080/01913123.2020.1836104DOI Listing
November 2020

The role of Tc-99m MIBI scintigraphy in clinical T1 renal mass assessment: Does it have a real benefit?

Urol Oncol 2020 12 26;38(12):937.e11-937.e17. Epub 2020 Aug 26.

Department of Urology, Hacettepe University School of Medicine, Ankara, Turkey.

Introduction: Despite the increasing accuracy of imaging modalities, the rate of benign renal tumors misclassified as malignant before surgery still non-negligible. Tc-99m sestamibi was demonstrated to be a possible reliable agent in discriminating oncocytoma from renal cell carcinoma (RCC). We aimed to study the efficacy of Tc-99m MIBI tumor scintigraphy in evaluating clinical T1 renal masses.

Methods And Materials: Between July 2017 and March 2019, patients with clinical T1 renal mass underwent preoperative Tc-99m sestamibi tumor scintigraphy. Tc-99m sestamibi tumor scintigraphy findings were correlated with the postoperative pathology results.

Results: A total of 90 renal masses were included in the study. Male to female ratio was 67/23. The mean age and tumor size were 55.5 ± 11.4 years and 4 ± 1.4 cm, respectively. In pathological evaluation, 20% (18/90) of masses were reported as benign (10 oncocytomas, 4 angiomyolipomas (AML), 2 chronic sclerosis, 1 fibroma and 1 hydatid cyst). While Tc-99m sestamibi uptake was positive in all oncocytomas; 6 patients with chronic sclerosis, fibroma, hydatid cyst and angiomyolipoma pathologies had no uptake. Except for 5 chromophobe cell RCC and 3 oncocytic papillary RCC masses, malignant lesions had no uptake. In predicting benign pathology, Tc-99m sestamibi tumor scintigraphy had positive and negative predictive value of 60% and 91.3%, respectively. The mean Tc-99m 2-methoxy isobutyl isonitrile lesion/normal renal parenchyma ratio of benign and malignant lesions was 0.6 and 0.37, respectively. A relative uptake of 0.49 was an acceptable cutoff point to discriminate oncocytomas from all other pathologies.

Conclusion: Tc-99m sestamibi tumor scintigraphy has a beneficial role in the assessment of clinical T1 renal mass. Masses with negative uptake harbor high probability of being malignant. While evaluating masses with positive uptake, it should be kept in mind that some malignant pathologies may demonstrate similar results.
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http://dx.doi.org/10.1016/j.urolonc.2020.07.018DOI Listing
December 2020

Secukinumab may be remedy for systemic amyloidosis findings secondary to hidradenitis suppurativa.

Dermatol Ther 2020 11 11;33(6):e14205. Epub 2020 Sep 11.

Koc University, Pathology Clinic, İstanbul, Turkey.

Hidradenitis suppurativa (HS) is a chronic relapsing inflammatory disease of follicular epithelium; many comorbidities occur that disrupt the quality of life of patients. Amyloidosis is one of them. We present a case with systemic amyloidosis secondary to HS and responding positively to secukinumab therapy. Secukinumab may also be an important option for amyloidosis findings in HS patients.
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http://dx.doi.org/10.1111/dth.14205DOI Listing
November 2020

Diagnostic ability of Ga-68 PSMA PET to detect dominant and non-dominant tumors, upgrading and adverse pathology in patients with PIRADS 4-5 index lesions undergoing radical prostatectomy.

Prostate Cancer Prostatic Dis 2021 03 21;24(1):202-209. Epub 2020 Aug 21.

Department of Urology, School of Medicine, Koç University, Istanbul, Turkey.

Background: To evaluate the additive role of Ga-68 PSMA PET as a primary staging tool in patients bearing prostate cancer in single PIRADS 4 or 5 index lesions.

Methods: Eighty-one biopsy-naive patients with preoperative mpMRI and Ga-68 PSMA PET who underwent radical prostatectomy (RP) were evaluated retrospectively. Forty-nine patients had PIRADS 4 and 32 had PIRADS 5 index lesions. The localization, grade, and volumetric properties of dominant (DT) and non-dominant tumors (NDT) in RP were compared to the index lesions of mpMRI and Ga-68 PSMA PET.

Results: The median age and PSA level were 62 (IQR; 59-69) years and 7 (IQR; 2-8) ng/ml, respectively. Ga-68 PSMA PET detected DTs in 100% of the patients including 13 patients in whom mpMR failed. In 45 patients an NDT was reported in RP. Ga-68 PSMA PET accurately detected NDT in 24 of 45 (53.3%) patients. Six patients (12.2%) in PIRADS 4 and 8 (25%) in PIRADS 5 group showed upgrading. In PIRADS 4, Ga-68 PSMA PET localized DT in all patients with upgraded tumors whereas mpMRI missed exact location in 2 of 6 (33.3%). In PIRADS 5 both mpMRI and Ga-68 PSMA PET accurately located all DTs. Overall detection rates of extracapsular extension (ECE) and seminal vesicle invasion (SVI) by mpMRI were 51.1% and 53.8%, respectively. Ga-68 PSMA PET detected ECE and SVI in 27.9% and 30.7%, respectively. When mpMRI and Ga-68 PSMA PET were used in combination detection rates of ECE and SVI increased to 65.1 and 61.5%. Ga-68 PSMA PET-detected six of ten patients with positive lymph nodes whereas mpMRI could not identify any.

Conclusions: Ga-68 PSMA PET has a better diagnostic accuracy in detecting DT, NDT, upgrading, adverse pathology in patients with PIRADS 4 index lesions. However, mpMRI better predicted ECE and SVI than Ga-68 PSMA PET.
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http://dx.doi.org/10.1038/s41391-020-00270-8DOI Listing
March 2021

Desmoplastic small round cell tumor of the kidney: a case report.

Diagn Pathol 2020 Jul 23;15(1):95. Epub 2020 Jul 23.

Department of Urology, Ondokuz Mayis University School of Medicine, Samsun, Turkey.

Background: Desmoplastic small round cell tumor (DSRCT) is a rare, aggressive neoplasm seen in children and young adults, usually manifested by involvement of abdominal serosa. Here, we present an unusual case of primary DSRCT of kidney.

Case Presentation: The patient was an 8-year-old girl with a large renal mass which was confused with primitive neuroectodermal tumor (PNET) in the needle biopsy. The tumor had a variegated histology revealing frequent pseudo-rosette formations, pseudopapillary architecture, rhabdoid, clear or pleomorphic cells in addition to typical small round cell morphology and desmoplasia. It showed immunohistochemical features of DSRCT, and EWSR1 re-arrangement.

Conclusions: Proffering this diagnosis is particularly difficult for tumors of viscera because of the incognizance of the entity in these locations. Moreover, DSRCT is a great mimicker and may get easily confused with more common kidney malignancies of childhood such as Wilms tumor, PNET/EWS, rhabdoid tumor, clear cell sarcoma, and other small round cell tumors as well as renal cell carcinomas. The distinction is critical as the accurate therapeutic approach will require correct diagnosis.
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http://dx.doi.org/10.1186/s13000-020-01015-wDOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7379352PMC
July 2020

A case of adult-onset tubulointerstitial nephritis and uveitis syndrome presenting with granulomatous panuveitis.

Taiwan J Ophthalmol 2020 Jan-Mar;10(1):66-70. Epub 2020 Mar 4.

Department of Pathology, Hacettepe University, Ankara, Turkey.

The tubulointerstitial nephritis and uveitis (TINU) syndrome is a rare disorder that is probably underdiagnosed in clinical practice. Ocular involvement in TINU syndrome not only presents with the nongranulomatous anterior uveitis in 80% of patients but also manifests as intermediate, posterior, or panuveitis. This case report mentions an adult male patient who presented with granulomatous iridocyclitis with panuveitis and mild renal insufficiency. Workup for connective tissue and infectious diseases was negative for the patient. He was diagnosed with TINU syndrome based on the findings of renal biopsy. Both the uveitis and nephritis promptly responded well to steroid treatment, and there was no recurrence during the follow-up of 24 months.
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http://dx.doi.org/10.4103/tjo.tjo_33_18DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7158930PMC
March 2020

Squamous cell carcinoma of the penis: a clinicopathological study from a population with late circumcision.

Rom J Morphol Embryol 2019 ;60(2):521-529

Department of Pathology, School of Medicine, Hacettepe University, Ankara, Turkey;

Squamous cell carcinoma (SCC) of the penis has been subject to only a few studies in populations where late childhood circumcision is performed. To asses clinicopathological features and human papillomavirus (HPV) status of penile SCC in men with late circumcision, eight institutions in the country volunteered to collaborate and 15 cases of penile SCC were collected from their pathology archives. The presence and genotype of HPV were determined in addition to clinicopathological features of the tumors. Findings were correlated with disease outcome. The mean age of the patients evaluated was 66.5 years. Histological subtypes were usual SCC (6∕15), papillary (2∕15), mixed (2∕15), basaloid (2∕15), acantholytic (1∕15), pseudohyperplastic (1∕15), and warty-basaloid (1∕15) carcinomas. HPV was identified in 33.3% of samples; HPV16 was detected in 60% of positive cases and was associated with basaloid and/or warty morphology. Cause-specific 1-year and 2-year survivals were 76.9% and 54.5%, respectively. The usual subtype and nodal metastasis were associated with worse outcome (p=0.045 and p=0.047, respectively). As a conclusion, our results suggest an inclination for penile SCC to develop at a later age in a population with late circumcision than the patients from the regions of high penile cancer incidence. These men seem to have less frequent HPV association and their outcome appears poorer than other populations, although reaching substantial provision is not possible due to our limited case number.
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April 2020

Sonographic diagnosis of large-cell calcifying Sertoli cell tumor.

J Ultrason 2019 28;19(77):161-164. Epub 2019 Jun 28.

Department of Radiology, Faculty of Medicine, Hacettepe University , Ankara , Turkey.

Large-cell calcifying Sertoli cell tumor is a very rare neoplasm of the testis with less than 100 reported cases. It is associated with some genetic syndromes, and it has some features that help to distinguish benign and malign cases. An 11-year-old boy presented with testicular lesions in both testicles. He underwent right radical orchiectomy in another institution and was referred to our hospital for further treatment. The lesions were reported as large-cell calcifying Sertoli cell tumors in our institution. There were multiple hyperechoic lesions with calcifications in the left testis and lesions showed vascularization on Doppler. Sonographic features of these lesions were also suggestive of benign large-cell calcifying Sertoli cell tumor. The lesions were stabile during follow-up. The ultrasonographic appearance of large-cell calcifying Sertoli cell tumor is descriptive and, together with clinical findings, allows differential diagnosis. It can direct patient management, with a more conservative approach. We report a child with large-cell calcifying Sertoli cell tumor who could have been saved from extensive surgery, such as radical orchiectomy, if the tumor had been diagnosed correctly with sonography.

Large-cell calcifying Sertoli cell tumor is a very rare neoplasm of the testis with less than 100 reported cases. It is associated with some genetic syndromes, and it has some features that help to distinguish benign and malign cases. An 11-year-old boy presented with testicular lesions in both testicles. He underwent right radical orchiectomy in another institution and was referred to our hospital for further treatment. The lesions were reported as large-cell calcifying Sertoli cell tumors in our institution. There were multiple hyperechoic lesions with calcifications in the left testis and lesions showed vascularization on Doppler. Sonographic features of these lesions were also suggestive of benign large-cell calcifying Sertoli cell tumor. The lesions were stabile during follow-up. The ultrasonographic appearance of large-cell calcifying Sertoli cell tumor is descriptive and, together with clinical findings, allows differential diagnosis. It can direct patient management, with a more conservative approach. We report a child with large-cell calcifying Sertoli cell tumor who could have been saved from extensive surgery, such as radical orchiectomy, if the tumor had been diagnosed correctly with sonography.
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http://dx.doi.org/10.15557/JoU.2019.0024DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6750321PMC
June 2019

Vascular responses of aortic, renal, and uterine arteries in suramin-induced preeclampsia-like syndrome in rats

Turk J Med Sci 2018 Dec 12;48(6):1328-1339. Epub 2018 Dec 12.

Department of Pharmacology, Faculty of Medicine, Hacettepe University, Ankara, Turkey

Background/aim: Suramin is a potent angiogenesis inhibitor in rodents and attenuates placental development in rat pregnancy. We aimed to produce preeclampsia-like syndrome by suramin administration in rats and to investigate the functional responses in aortic, renal, and uterine arteries.

Materials And Methods: Pregnant and nonpregnant wistar rats received suramin (100 mg/kg, intraperitoneal) or equal volume of saline on days 10 and 11. Blood pressures of rats were observed daily. On the day 20, rats were executed. Protein levels in urine were measured and fetuses, placentas, and kidneys were weighted and evaluated. Thoracic aorta, renal, and uterine arteries were removed for functional studies.

Results: Increased blood pressures and proteinuria were detected in suramin-given pregnant rats. Pathological examination of kidneys showed an acute tubular injury after suramin injection. Numbers and weights of fetuses and placentas were reduced in suramin-given pregnant rats. In functional studies, endothelial dysfunction occurred in uterine and renal arteries but not in the aorta. In this study, we showed that preeclampsia-like syndrome occurred in suramin-given rats.

Conclusion: Our findings, which show that endothelial dysfunction occurred in uterine and renal arteries but not in the aorta, are consistent with the human findings of microvascular changes in preeclampsia.
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http://dx.doi.org/10.3906/sag-1807-254DOI Listing
December 2018

Massive Localized Lymphedema in an Unreported Location (Retroperitoneum).

Diagn Pathol 2018 Nov 20;13(1):89. Epub 2018 Nov 20.

Department of Pathology, Koc University School of Medicine, Topkapi / Zeytinburnu, 34010, Istanbul, Turkey.

Background: Massive localized lymphedema (MLL) is a non-neoplastic benign soft tissue lesion that may be confused with sarcomas or other neoplastic proliferations both clinically and morphologically. Most occur in morbidly obese adults on the lower extremities. The objective of this article is to document a case of MLL in the retroperitoneal cavity which is a previously unreported site for this lesion, and to highlight its unusual clinical features.

Case Presentation: The patient was a non-obese male who had undergone major abdominal surgery due to bladder extrophy 17 years ago. Abdominal ultrasonography detected a large incidental mass in the right renal sinus during his investigation for nephrolithiasis. The lesion extending from renal pelvis down to pelvis was resected and its histopathological findings were compatible with massive localized lymphedema.

Conclusions: Retroperitoneum has to be added to the list of locations that MLL can be found. Liposarcoma will be a challenging differential diagnosis when the lesion is encountered in an unusual site.
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http://dx.doi.org/10.1186/s13000-018-0769-xDOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6247625PMC
November 2018

Ga-labelled PSMA ligand HBED-CC PET/CT imaging in patients with recurrent prostate cancer.

World J Urol 2019 May 27;37(5):813-821. Epub 2018 Aug 27.

Department of Nuclear Medicine, Faculty of Medicine, Hacettepe University, Ankara, Turkey.

Background: Ga-PSMA Positron Emission Tomography/Computerized Tomography (PET/CT) has shown promising results for the detection of recurrent prostate cancer (RPCa). However, the diagnostic value of this method is yet to be validated. The aim of this study was to determine the influence of clinical and biochemical variables on the detection rate of Ga-PSMA PET/CT in patients with RPCa.

Methods: This is a prospective study of 121 patients who underwent Ga-PSMA-PET/CT and conventional imaging (CI) for RPCa. Detection rates were analyzed and correlated with various clinical and biochemical variables such as Gleason score GS), androgen deprivation therapy (ADT), trigger PSA (tPSA), PSA doubling-time (PSAdt) and PSA velocity (PSAv).

Results: Ga-PSMA-PET/CT showed at least one focus of pathological Ga-PSMA uptake in 92/121 (76%) of patients. Nodal metastases (in 47% of patients) were the most common site of recurrent disease followed by bones (36%) and prostate (32%). Out of 121 patients, 57 (47%) had only positive findings on PSMA scan verified by biopsy or follow-up. The majority of these lesion were located in the lymph nodes (31/57, 54,5%), which were below the detection limit of CT. Univariate analysis showed higher detection rate of PET/CT with increasing tPSA, PSAv and short PSAdt. Best cutoff for tPSA, PSAv and PSAdt was 0.5 ng/ml, 2.25 ng/ml/year and 8.65 months, respectively. The detection rate of PSMA-PET/CT was higher in patients with high grade tumors (GS > 7, 23.7% vs 76.3%) and in patients who were on ADT during of PSMA scan (76.3% vs 96%). In multiple logistic regression analysis, PSAdt and concurrent ADT were identified as predictors of positive Ga-PSMA-PET/CT.

Conclusion: Ga-PSMA-PET/CT is useful for re-staging patients with RPCa and has improved performance compared with CI for disease detection. Detection rates are improved in patients on ADT and with short PSAdt.
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http://dx.doi.org/10.1007/s00345-018-2460-yDOI Listing
May 2019

Reduced immunohistochemical PTEN staining is associated with higher progression rate and recurrence episodes in non-invasive low-grade papillary urothelial carcinoma of the bladder.

Virchows Arch 2018 Jun 24;472(6):969-974. Epub 2018 Jan 24.

Department of Pathology, Hacettepe University School of Medicine, Sihhiye, Ankara, Turkey.

Non-invasive low-grade papillary urothelial carcinoma (NILGPUC) of the bladder is regarded as a relatively indolent disease. However, its propensity for frequent recurrences constitutes a major clinical problem. Additionally, there is a progression risk of 10-15% to either a higher grade and/or a higher stage disease in these tumors. The molecular factors that will predict recurrence and progression in low-grade pTa bladder carcinoma have not yet been elucidated. Herein, we investigated the association of phosphatase and tensin homolog deleted on chromosome 10 (PTEN) alterations with recurrence and progression in NILGPUC using immunohistochemistry. Eighty-one cases of bladder cancer initially diagnosed as NILGPUC in a single institution with follow-up were encountered after searching medical records. Tissue microarrays (TMA) that contained both tumor and non-neoplastic mucosa from each case were constructed using paraffin blocks of transurethral resections. Sections from TMA blocks were stained immunohistochemically for PTEN protein and were evaluable in 76 cases. Any absence of staining was recorded and correlated with clinical findings. Ten patients (13.2%) showed progression and 41 (53.9%) showed recurrence. Reduced PTEN expression was observed in 29 cases (38.1%). Cases with reduced PTEN had higher progression rate compared to cases with intact PTEN (p = 0.026). Tumor relapse was more frequent in cases with reduced PTEN (65.5 vs 46.8%), but this difference was not statistically significant (p = 0.112). On the other hand, decreased PTEN expression was associated with higher number of recurrence episodes (p = 0.002). PTEN seems to have a link with the disease course in NILGPUC of the bladder.
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http://dx.doi.org/10.1007/s00428-018-2302-8DOI Listing
June 2018

Acute renal failure due to small cell neuroendocrine carcinoma of the left kidney: A case report.

Oncol Lett 2017 Nov 15;14(5):6117-6120. Epub 2017 Sep 15.

Department of Urology, Hacettepe University School of Medicine, Ankara 06230, Turkey.

The majority of small cell carcinoma (SCC) cases originate from the lungs. SCC of the kidneys is rare. Among genitourinary tumors, renal cell carcinoma is the most common type of tumor to be associated with paraneoplastic syndromes. The majority of paraneoplastic syndromes disappear following nephrectomy in renal cell carcinoma cases. The present case involved the assessment of a female patient with SCC of the left kidney. The patient was diagnosed with acute renal failure and underwent a laparoscopic left radical nephrectomy. Surgical intervention removed the need for dialysis; the patient was under follow-up observation every week without any requirement for dialysis for 8 months and received adjuvant carboplatin-etoposide chemotherapy. Surgery is an option for dialysis-dependent patients with a renal tumor. The removal of the tumor burden may restore renal function and eliminate paraneoplastic syndromes.
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http://dx.doi.org/10.3892/ol.2017.6948DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5661454PMC
November 2017

Unusual presentations of Carney Complex in patient with a novel PRKAR1A mutation.

Neuro Endocrinol Lett 2017 Aug;38(4):248-254

Hacettepe University, Faculty of Medicine, Department of Endocrinology and Metabolism, Ankara, Turkey.

Carney Complex (CNC) is a multiple neoplasia syndrome characterized by skin tumors and pigmented lesions, myxomas, and various endocrine tumors. The aim of this case report was to describe a case of CNC with a novel PRKAR1A mutation. A man aged 46 years with a medical history of surgery for cardiac myxomas at the age of 39 was admitted to our hospital because of four newly-developed heart masses. The histologic examination confirmed cardiac myxomas. He had many presentations of CNC such as growth hormone (GH) and prolactin (PRL)-secreting mixed pituitary adenoma, benign thyroid nodule, large-cell calcifying Sertoli cell tumor (LCCST), and superficial angiomyxoma. A bilateral adrenalectomy was performed because the laboratory findings suggested primary pigmented nodular adrenocortical disease (PPNAD). The pathologic examination revealed a focal unilateral PPNAD, unilateral nonpigmented adrenocortical nodule, and bilateral adrenal medullary hyperplasia. Two years after the second cardiac operation, an interatrial septum-derived tumor was detected. An atrial myxoma was confirmed with histologic studies. Based on these findings, the patient was confirmed to have CNC. A novel insertion mutation in the type 1A regulatory subunit of the cAMP-dependent protein kinase A gene (PRKAR1A) in exon 2 was detected in our patient through genetic analysis. The presence of multiple myxomas and endocrine abnormalities should be an indication to physicians to further investigate for CNC. Herein, we described a case of CNC with a novel mutation in exon 2 of the PRKAR1A gene with typical and atypical clinical features.
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August 2017

Chronic levetiracetam decreases hippocampal and testicular aromatase expression in normal but not kainic acid-induced experimental model of acute seizures in rats.

Neuroreport 2017 Sep;28(14):903-909

Departments of aPharmacology, Faculty of Pharmacy bPathology cPharmacology, Faculty of Medicine, Hacettepe University, Sihhiye, Ankara, Turkey.

Reproductive disorders are more common in men with epilepsy taking anticonvulsant medications. Antiseizure/anticonvulsant drugs and seizures in medial temporal lobe structures may cause gonadal dysfunction, including infertility, decreased libido, and potency. Levels of circulating bioavailable testosterone are affected by the aromatase enzyme, which converts testosterone into estrogen and may be affected by seizure medications. However, the relationship of anticonvulsant drugs with central aromatase levels is not clear. This study investigated the possible effects of the highly efficient, new-generation antiseizure/anticonvulsant drug levetiracetam on central and gonadal aromatase expression and gonadal tissue functionality at 27 and 54 mg/kg/day doses. Epileptogenesis was generated in male Wistar rats by an intraperitoneal injection of the excitotoxic agent kainic acid. Aromatase levels were 1.5 times higher in the brain cortex of the kainic acid groups after 4 weeks and the hippocampus after 4 and 8 weeks compared with the controls. Decreased basal aromatase levels were observed after 1 week of levetiracetam treatment (27 mg/kg/day). Administration of 27 mg/kg/day levetiracetam did not alter vas deferens contractions at 1, 4, or 8 weeks compared with the controls. No histological changes were observed in the vas deferens, epididymis, or testis after 8 weeks of levetiracetam administration at both doses. Administration of 27 and 54 mg/kg/day levetiracetam downregulated testis aromatase expression at 8 weeks compared with the controls. These results suggest that levetiracetam decreases aromatase levels in the testis and increases the seizure threshold by a possible decrease in systemic estradiol levels.
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http://dx.doi.org/10.1097/WNR.0000000000000843DOI Listing
September 2017

The Influence of Inverted Growth Pattern on Recurrence for Patients with Non-Invasive Low Grade Papillary Urothelial Carcinoma of Bladder.

Balkan Med J 2017 Sep 13;34(5):464-468. Epub 2017 Apr 13.

Department of Pathology, Hacettepe University School of Medicine, Ankara, Turkey.

Aims: To evaluate the impact of a histologically inverted pattern on recurrence in patients with newly diagnosed non-invasive, low-grade papillary urothelial carcinoma of the urinary bladder.

Methods: A total of 81 patients with primary bladder non-invasive, low-grade papillary urothelial carcinoma diagnosed in a single tertiary-care centre who had at least 1-year follow-up after an initial resection were included. All slides from each case were reviewed to determine the growth pattern (exophytic versus endophytic, i.e. inverted) and other histological parameters. Clinical data were retrieved from hospital records.

Results: Disease recurrence occurred in 41 (50.6%) patients. Cases with an inverted pattern showed a lower recurrence rate than those with pure exophytic tumours (37.5% versus 52.1%), a longer time to first recurrence (mean 34 versus 21.5 months) and fewer recurrence episodes (p=0.482, 0.564 and 0.051, respectively). All recurring inverted cases recurred only once during follow-up. No tumour with >80% inverted architecture recurred.

Conclusion: Our results suggest that non-invasive, low-grade papillary urothelial carcinoma of the bladder tends to have a better outcome in terms of disease recurrence if it shows an inverted growth pattern. To indicate the presence and percentage of the inverted pattern in low-grade urothelial carcinomas in the pathology report might be considered as an adjunct to help long-term patient management.
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http://dx.doi.org/10.4274/balkanmedj.2017.0081DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5635635PMC
September 2017

Primary malignant melanoma of the urinary bladder: clinical, morphological, and molecular analysis of five cases.

Melanoma Res 2016 12;26(6):616-624

aDepartment of Pathology, Mersin University School of Medicine, Mersin bDepartment of Pathology, Cukurova University School of Medicine, Adana Departments of cUrology dPathology, Hacettepe University School of Medicine, Ankara, Turkey.

The aim of our study was to evaluate the clinical and morphological features of primary malignant melanomas of the urinary bladder. We obtained information on five such cases from three different institutions. These were three men and two women between 52 and 76 years of age. Three tumors presented with hematuria, one with dysuria, and one was discovered incidentally on imaging studies. All were invasive to muscularis propria on transuretral resections performed for diagnosis. Neoplastic cells showed variable patterns (large cell epithelioid, small cell diffuse, storiform, or mixed) in different tumors. Pigmentation was prominent in all except one case. Each case was labeled diffusely for S-100, HMB-45, and Melan-A. Pan-cytokeratin showed a perinuclear dot-like reaction in two tumors. Three cases showed the BRAF mutation in molecular studies. Two patients were already metastatic at the time of diagnosis. Two patients died, one is alive with disease after 15 months, and two patients are disease free at 1 and 5 years of surveillance.
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http://dx.doi.org/10.1097/CMR.0000000000000300DOI Listing
December 2016

Local recurrence of renal cell carcinoma that simulated multiple renal arteriovenous fistulas after laparoscopic partial nephrectomy: Report of a rare case.

Int J Urol 2016 10 14;23(10):888-891. Epub 2016 Jul 14.

Department of Urology, Faculty of Medicine, Hacettepe University, Ankara, Turkey.

Herein we report a patient who was initially thought to have renal arteriovenous fistulas 3 months after laparoscopic partial nephrectomy for a small renal mass. After timely intervention using selective renal artery embolization, computed tomography 9 months post-surgery showed persistent renal arteriovenous fistulas and nodular lesions in the perirenal fat. The patient then underwent radical nephrectomy, and histopathological examination showed underlying recurrent clear cell renal cell carcinoma invading the intraparenchymal arteries and veins, which was simulating multiple high-flow renal arteriovenous fistulas.
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http://dx.doi.org/10.1111/iju.13165DOI Listing
October 2016

Invasive Squamous Carcinoma and Adenocarcinoma of an Unreconstructed Exstrophic Bladder with HPV Infection.

Curr Urol 2016 May 20;9(2):109-12. Epub 2016 May 20.

Department of Urology, Hacettepe University, Ankara, Turkey.

Bladder exstrophy is a complex abnormality and is traditionally treated within the early years of life. It is associated with an increased risk of bladder cancer, with 95% of the arising tumors being adenocarcinomas and 3 to 5% being squamous cell carcinomas. HPV infections are also associated with an increased risk of bladder cancer. This case represents a patient with bladder exstrophy that gave rise to coinciding squamous cell carcinoma and adenocarcinoma. Final pathology results showed an infection with HPV. We presented the management of the case and discussed the diagnosis and treatment methods for this patient.
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http://dx.doi.org/10.1159/000442863DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4911531PMC
May 2016

Predictors of prostate cancer in ultrasound-guided transperineal saturation biopsy in Turkish men with multiple prior negative biopsies.

Urologia 2016 May 30;83(2):71-6. Epub 2015 Dec 30.

Department of Urology, Hacettepe University School of Medicine, Ankara - Turkey.

Background: Transperineal prostate biopsy (STPB) is associated with an improved cancer detection rate and an increase in anterior and apical prostate cancers compared to standard transrectal biopsy.

Patients And Methods: A total of 48 men with at least two sets of prior prostate biopsies underwent transrectal ultrasound-guided STPB. Prostate rebiopsy indications were serum prostate-specific antigen (PSA) levels greater than 2.5 ng/mL and/or abnormal digital rectal examination and/or presence of high-grade prostatic intraepithelial neoplasia (HGPIN; ≥2 cores) or atypical small acinar proliferation (ASAP) at previous biopsies. The procedure was performed at dorsal lithotomy position under general anesthesia using a perineal 0.5 cm brachytherapy template attached to the transrectal ultrasound probe. Specimens from each zone were sent separately for pathological examination.

Results: Mean PSA level at STPB was 15.9 ng/mL (range 4.03 to 59.57). An average of 54.5 cores was obtained. Prostate adenocarcinoma was detected in 15 of 48 (31%) patients. Mean percentage of malignant cores was 11.9%. Multivariate logistic regression analysis revealed that age and presence of ASAP or HGPIN at previous biopsies were independent predictors of prostate cancer (p<0.05). No major complications, including sepsis and severe urinary or rectal bleeding, were observed in any of the patients. Five patients (10%) developed acute urinary retention after the procedure requiring urethral catheterization.

Conclusions: Considerable number of patients with negative multiple biopsies were diagnosed with prostate cancer. STPB is a well-tolerated procedure with minimal morbidity, which can be considered for the diagnosis of prostate cancer in patients with previous negative biopsies.
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http://dx.doi.org/10.5301/uro.5000159DOI Listing
May 2016

Changes in composition and sulfation patterns of glycoaminoglycans in renal cell carcinoma.

Glycoconj J 2016 Feb 14;33(1):103-12. Epub 2015 Dec 14.

Department of Chemistry and Chemical Biology, Center for Biotechnology and Interdisciplinary Studies, Rensselaer Polytechnic Institute, 110 Eighth Street, Troy, NY, 12180, USA.

Glycosaminoglycans (GAGs) are heterogeneous, linear, highly charged, anionic polysaccharides consisting of repeating disaccharides units. GAGs have some biological significance in cancer progression (invasion and metastasis) and cell signaling. In different cancer types, GAGs undergo specific structural changes. In the present study, in depth investigation of changes in sulfation pattern and composition of GAGs, heparan sulfate (HS)/heparin (HP), chondroitin sulfate (CS)/dermatan sulfate and hyaluronan (HA) in normal renal tissue (NRT) and renal cell carcinoma tissue (RCCT) were evaluated. The statistical evaluation showed that alteration of the HS (HSNRT = 415.1 ± 115.3; HSRCCT = 277.5 ± 134.3), and CS (CSNRT = 35.3 ± 12.3; CSRCCT = 166.7 ± 108.8) amounts (in ng/mg dry tissue) were statistically significant (p < 0.05). Sulfation pattern in NRT and RCCT was evaluated to reveal disaccharide profiles. Statistical analyses showed that RCCT samples contain significantly increased amounts (in units of ng/mg dry tissue) of 4SCS (NRT = 25.7 ± 9.4; RCCT = 117.1 ± 73.9), SECS (NRT = 0.7 ± 0.3; RCCT = 4.7 ± 4.5), 6SCS (NRT = 6.1 ± 2.7; RCCT = 39.4 ± 34.7) and significantly decreased amounts (in units of ng/mg dry tissue) of NS6SHS (RCCT = 28.6 ± 6.5, RCCT = 10.2 ± 8.0), NS2SHS (RCCT = 44.2 ± 13.8; RCCT = 27.2 ± 15.0), NSHS (NRT = 68.4 ± 15.8; RCCT = 50.4 ± 21.2), 2S6SHS (NRT = 1.0 ± 0.4; RCCT = 0.4 ± 0.3), and 6SHS (NRT = 60.6 ± 17.5; RCCT = 24.9 ± 12.3). If these changes in GAGs are proven to be specific and sensitive, they may serve as potential biomarkers in RCC. Our findings are likely to help us to show the direction for further investigations to be able to bring different diagnostic and prognostic approaches in renal tumors.
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http://dx.doi.org/10.1007/s10719-015-9643-1DOI Listing
February 2016

Primary sclerosing epithelioid fibrosarcoma of kidney with variant histomorphologic features: report of 2 cases and review of the literature.

Diagn Pathol 2015 Oct 9;10:186. Epub 2015 Oct 9.

Department of Urology, Hacettepe University Hospital, Ankara, Turkey.

The authors present two cases of primary sclerosing epithelioid fibrosarcoma (SEF) of the kidney. Both patients had a mass in the upper part of the left kidney without any primary extrarenal neoplastic lesions. Grossly, the tumors were solid masses both measuring 7.5 cm in the greatest diameter. Histologically, one of the lesions exhibited a predominantly lobular growth of round or oval small uniform epithelioid cells in variable cellularity. Circular zones of crowded tumor cells alternating with hypocellular collagenous tissue in a concentric fashion around entrapped native renal tubules were distinctive. The second case was distinctive with significant cytological atypia in the neoplastic cells and prominent reactive proliferations in the trapped renal tubules. Immunohistochemically, vimentin, bcl-2 and MUC4 were diffusely positive in both. They were negative for S-100 protein, CD34, and desmin, whereas CD99 were positive in one lesion. Fluorescence in situ hybridization assay using dual staining probes detected EWSR1-CREB3L1 fusion in each lesion, which is characteristic molecular findings of SEF. One patient presented widespread distant metastases at the time of diagnosis. In the other, no tumor deposits were detected other than primary. Both patients have been alive with 30 and 10 month follow-ups, respectively. These tumors are 6th and 7th cases of primary renal SEF in the literature confirmed by FISH study, which exhibit unique and remarkable histomorphologic features.
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http://dx.doi.org/10.1186/s13000-015-0420-zDOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4599747PMC
October 2015

Nonsecretory Multiple Myeloma and AL Amyloidosis Presenting with Nephrotic Range Proteinuria.

Case Rep Nephrol 2015 21;2015:635974. Epub 2015 May 21.

Division of Hematology, Department of Internal Medicine, Ufuk University School of Medicine, 06520 Ankara, Turkey.

Nonsecretory multiple myeloma (NSMM) is the absence of a detectable monoclonal protein in serum and urine of a multiple myeloma (MM) patient and immunoglobulin light chain (AL) amyloidosis is a significantly rare complication. A case of NSMM with AL amyloidosis and nephrotic range proteinuria is presented. Sharing clinical, therapeutic, and prognostic characteristics with MM, real challenge may be during initial diagnosis of NSMM and assessment of treatment response. In elderly patients with unexplained renal dysfunction, MM should be in the differential diagnosis and the absence of a monoclonal protein should not rule out MM but should remind us of the possibility of NSMM.
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http://dx.doi.org/10.1155/2015/635974DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4454745PMC
June 2015

Tip lesion variant of primary focal and segmental glomerulosclerosis: clinicopathological analysis of 20 cases.

Ren Fail 2015 Jun 10;37(5):858-65. Epub 2015 Apr 10.

a Department of Pathology , Karadeniz Technical University, School of Medicine , Trabzon , Turkey .

The glomerular tip lesion (GTL) is a distinctive histopathologic lesion which is regarded as a variant of focal and segmental glomerulosclerosis (FSGS). The prognostic significance of GTL among other FSGS variants has been disputed. In order to define the clinical features and outcome of GTL, we retrospectively reviewed the presenting clinical features, laboratory and biopsy findings and surveillance in our cohort of GTL, which consisted of 20 adults with native kidneys (mean age 46 years) with follow-up data ranging from 3 to 137 months. At presentation, mean urine protein, serum albumin and cholesterol levels were 5.17 g/d, 2.6 g/dL and 312.9 mg/dL, respectively, and none had renal insufficiency. Microscopic hematuria was detected in five patients. At biopsy, glomerular segmental lesions consisted of GTL without perihilar or collapsing lesions. GTL was observed in a variable proportion of glomeruli from 2.6% to 100%. Mesangial proliferation was seen in nine cases, at a moderate degree in two and mild in the rest. Three biopsies showed mild, two showed moderate interstitial fibrosis/tubular atrophy. Eleven patients received steroids alone and eight received sequential therapy with steroids and a cytotoxic agent. At a mean follow-up of 40.6 months, 17 patients (85%) achieved complete remission of nephrotic syndrome, 15% had partial remission. Four of 17 suffered from recurrences. No patient progressed to end-stage renal disease. Serum albumin at diagnosis was the only predictor of a recurrence (p = 0.037). Microscopic hematuria correlated with incomplete remission (p = 0.045). Our study demonstrates a clearly favorable prognosis in patients with FSGS-GTL variant.
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http://dx.doi.org/10.3109/0886022X.2015.1033635DOI Listing
June 2015

Ureteritis cystica: A rare entity in children.

Indian J Urol 2014 Oct;30(4):443-4

Department of Urology, Hacettepe University School of Medicine, Ankara, Turkey.

Ureteritis cystica (UC) is a benign condition. Although it can often be diagnosed with imaging techniques, we report a case of a child for whom we planned nephrectomy and ureteral augmentation cystoplasty, but abandoned the cystoplasty due to extensive UC in the ureter.
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http://dx.doi.org/10.4103/0970-1591.139592DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4220386PMC
October 2014

Rethinking about tubulocystic carcinoma of the kidney after taking into account the existence of tubulocystic chromophobe renal carcinoma.

Turk Patoloji Derg 2014 ;30(2):155-7

Hacettepe University, School of Medicine, Department of Pathology, ANKARA , TURKEY.

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http://dx.doi.org/10.5146/tjpath.2014.01245DOI Listing
April 2015

Renal Carcinoid Tumor Metastatic to the Uvea, Medial Rectus Muscle, and the Contralateral Lacrimal Gland.

Ophthalmic Plast Reconstr Surg 2015 Jul-Aug;31(4):e91-3

*Ocular Oncology Service, Department of Ophthalmology, and †Department of Pathology, Hacettepe University School of Medicine, Ankara, Turkey.

Renal carcinoid tumor is an exceedingly rare malignancy. A 57-year-old man with a renal carcinoid tumor discovered after metastasizing to intraocular and bilateral orbital structures is described. The patient presented with a blind painful OS and a right superotemporal subconjunctival mass. Imaging studies revealed a large left intraocular tumor, a mass in the left medial rectus muscle, and right lacrimal gland enlargement. The OS was enucleated, and incisional biopsies were performed from the other 2 lesions. Histopathological studies demonstrated metastatic neuroendocrine tumor with chromogranin and synaptophysin positivity. Systemic work up revealed a right renal mass and multiple hepatic metastatic lesions. Radical nephrectomy was performed, and octreotide, capecitabine, and temozolomide were administered. Removal of the primary tumor and the eye that had no prospect for useful vision and further treatment with octreotide, capecitabine, and temozolomide provided a disease progression-free period of 24 months and allowed the patient to function normally.
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http://dx.doi.org/10.1097/IOP.0000000000000112DOI Listing
February 2016