Publications by authors named "Esra Erden"

67 Publications

Ruptured Tentorium Originating Masson Tumor.

Asian J Neurosurg 2021 Jan-Mar;16(1):200-203. Epub 2021 Feb 23.

Department of Neurosurgery, Faculty of Medicine, Ankara University, Ankara, Turkey.

Intravascular papillary endothelial hyperplasia (IPEH) also known as Masson's tumor, is a benign, slow growing, vascular lesion which is seen very rarely and only a few cases have been reported intracranially in the literature. It has been reported at many sites, but the posterior fossa involvement is very rare. The preoperative diagnosis is very difficult, as there is no enough cases to achieve a clear understanding about the details of its radiological findings. Differential diagnosis have to be made especially from angiosarcoma and meningioma. It is curable by total surgical removal. In this article we presented the characteristic clinical, radiological, perioperative and pathological findings in a case of IPEH in an unusual location, origin and behavior. To best of our knowledge, we presented the first case of IPEH originating from tentorium.
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http://dx.doi.org/10.4103/ajns.AJNS_249_20DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8202391PMC
February 2021

Hepatocellular adenomas in the Turkish population: reclassification according to updated World Health Organization criteria.

Histopathology 2021 Jul 12;79(1):23-33. Epub 2021 Apr 12.

Department of Pathology, Gazi University, Ankara, Turkey.

Aims: Hepatocellular adenoma (HCA) is an uncommon liver neoplasm, and studies of HCA subtypes have been primarily limited to France, the USA, and Japan. The aim of this study was to describe the clinicopathological features of HCA subtypes in Turkey.

Methods And Results: The resection specimens of 59 cases diagnosed as 'hepatocellular adenoma' collected from 15 institutions were reviewed to confirm the diagnosis and to classify them according to the current World Health Organization 2019 classification. Immunostaining for glutamine synthetase, liver fatty acid-binding protein, C-reactive protein, β-catenin and reticulin was performed. Of the 59 cases, 48 (81%) were diagnosed as HCA. We identified 24 (50%) hepatocyte nuclear factor 1α (HNF1α)-inactivated HCAs, five (10%) inflammatory HCAs, 15 (32%) β-catenin-activated HCAs, three (6%) β-catenin-activated inflammatory HCAs, and one (2%) unclassified HCA. HCA patients were predominantly female (female/male ratio of 5:1); they had a median age of 34 years and a median tumour diameter of 60 mm. In the β-catenin-activated HCA group, nine cases (19%) showed cytoarchitectural atypia, and were also referred to as atypical hepatocellular neoplasms. In the β-catenin-activated HCA group, three cases (6%) showed focal areas supportive of transition to HCA. The original diagnosis of HCA was changed to well-differentiated hepatocellular carcinoma in nine cases and to focal nodular hyperplasia in two cases.

Conclusion: In our series, the major HCA subtype was HNF1α-inactivated HCA. We found a low incidence of inflammatory-type HCA. Our data also showed that β-catenin-activated hepatocellular neoplasms, including cases with atypical histology, constituted a relatively high proportion of the cases. These findings are in contrast to those of most other studies of HCA subtypes.
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http://dx.doi.org/10.1111/his.14330DOI Listing
July 2021

The Contribution of Additional Sampling in Cholecystectomy Materials: A Multicenter Prospective Study.

Turk Patoloji Derg 2020 ;36(3):188-194

Department of Pathology, İzmir Tepecik Education and Research Hospital, İZMİR, TURKEY.

Objective: Cholecystectomy materials are frequently encountered in routine practice. The aim of this study was to determine the true frequency of gallbladder lesions, the diagnostic consistency, and standardization of reports after macroscopic sampling and microscopic evaluation based on previously defined criteria.

Material And Method: 14 institutions participated in the study within the Hepato-Pancreato-Biliary Pathology Study Group. Routinely examined cholecystectomies within the last year were included in the study in these institutions. Additional sampling was performed according to the indications and criteria. The number of blocks and samples taken in the first macroscopic examination and the number of blocks and samples taken in the additional sampling were determined and the rate of diagnostic contribution of the additional examination was determined.

Results: A total of 5,244 cholecystectomy materials from 14 institutions were included in the study. Additional sampling was found to be necessary in 576 cases (10.98%) from all institutions. In the first macroscopic sampling, the mean of the numbers of samples was approximately 4 and the number of blocks was 2. The mean of the numbers of additional samples and blocks was approximately 8 and 4, respectively. The diagnosis was changed in 144 of the 576 new sampled cases while the remaining 432 stayed unaltered.

Conclusion: In this study, it was observed that new sampling after the first microscopic examination of cholecystectomy materials contributed to the diagnosis. It was also shown that the necessity of having standard criteria for macroscopic and microscopic examination plays an important role in making the correct diagnosis.
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http://dx.doi.org/10.5146/tjpath.2020.01483DOI Listing
July 2021

Effects of adipose derived stromal vascular fraction on diabetic neuropathy: an experimental study.

J Plast Surg Hand Surg 2019 Dec 26;53(6):335-340. Epub 2019 Jun 26.

Plastic Reconstructive and Aesthetic Surgery Department, Ankara Yildirim Beyazıt University, Ankara, Turkey.

The stromal vascular fraction (SVF) obtained from inguinal adipose tissue was injected into the sciatic nerve region in diabetic rats. The effects of the SVF on the sciatic nerve and functional, electrophysiological and histopathological changes were examined in this study. Rats were divided into five groups; a non-diabetic control group, and four diabetic groups. In the first diabetic rat group, the SVF was obtained from inguinal adipose tissue. The remaining diabetic groups included a sham control group, a phosphate-buffered saline (PBS) injection group and an SVF injection group. Injections were made into the sciatic nerve region. Electromyography and walking track analyses were conducted on all groups at the beginning of the experiment. Diabetes was induced a single dose of streptozotocin. Walking track analysis and electromyography measurements were repeated in week 8. SVF or PBS was injected into the right sciatic nerve region on week 8 of experiment group rats. Walking track analysis and electromyography were repeated in week 12 and all sciatic nerves were examined histopathologically. In the diabetic SVF group, the sciatic functional index calculated from walking track analysis in week 12 was better than week 8. Additionally, the myelin sheaths of the right sciatic nerve were thicker and more uniform and the nerve fibers were thicker than those of the left, untreated sciatic nerve. No statistical differences were detected in electromyographic measurements. The adipose-derived SVF may be beneficial for nerve regeneration in diabetic neuropathy.
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http://dx.doi.org/10.1080/2000656X.2019.1632205DOI Listing
December 2019

The Prognostic Roles of the Ki-67 Proliferation Index, P53 Expression, Mitotic Index, and Radiological Tumor Invasion in Pituitary Adenomas.

Endocr Pathol 2019 Mar;30(1):49-55

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

The fourth edition of the World Health Organization (WHO) classification of pituitary tumors recommended evaluation of tumor proliferation and invasion to identify aggressiveness. We aimed to assess the prognostic roles of the Ki-67 proliferation index, mitotic index, P53 expression, and cavernous sinus invasion in pituitary adenomas (PAs). Among the 601 patients who underwent transnasal/transsphenoidal adenomectomy from 2001 to 2016, 101 patients (16.8%) who had tumors with a high (≥ 3%) Ki-67 index (group A) and a control group consisting of 43 patients with a low (< 3%) Ki 67 index who were matched for age, gender, and tumor type were included. Mitotic index and P53 expressions were evaluated. Patient characteristics, histopathology reports, pre/postoperative magnetic resonance imaging (MRI), and follow-up data were assessed retrospectively. The frequency of macroadenomas and mean tumor size were greater in group A when compared to group B (67.4 vs. 94.1%, p< 0.01 and 25 ± 10.6 vs. 18 ± 11 mm, p< 0.01, respectively). Invasion to cavernous sinus was found in 53 (36.8%) patients and was more frequent in group A (p<0.01). The mean number of surgery was higher in group A than group B (p< 0.05). The mean follow-up period was 46.6 ± 34 months. The postoperative MRIs and follow-up data for at least 24 months were available in 117 patients. Recurrence risk was higher in group A than group B (p = 0.03). Tumors with high Ki-67 proliferation index were grouped as 3-5, 6-10, 11-15, and > 15%. The risk of recurrence was not different between groups of high Ki-67 index. The optimal cutoff point of the Ki-67 proliferation index that predicted recurrence was 2.5% with 84.6% sensitivity and 47.4% specificity. The cavernous sinus invasion on MRI was associated with recurrence (p = 0.03). Tumor size and recurrence risk were not associated with P53 expression. High P53 expression was related with cavernous sinus invasion (p = 0.03). The mitotic index was not associated with recurrence risk and tumor invasion. Recurrence risk was higher in tumors with ≥ 2 histopathological atypia criteria (p = 0.01). High Ki-67 index with a 2.5% cutoff point and cavernous sinus invasion on MRI are reliable markers for predicting recurrence in PAs. Recurrence risk is also higher in tumors with two histopathological aggressiveness criteria. Strict follow-up and more aggressive treatment approaches may be necessary for invasive-proliferative PAs.
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http://dx.doi.org/10.1007/s12022-018-9563-2DOI Listing
March 2019

Lacrimal gland tumors in Turkey: types, frequency, and outcomes.

Int J Ophthalmol 2018 18;11(8):1296-1302. Epub 2018 Aug 18.

Ocular Oncology Service, Wills Eye Hospital, Thomas Jefferson University, Philadelphia, PA 19107, USA.

Aim: To evaluate the clinical, radiological, and treatment features of lacrimal gland tumors.

Methods: Retrospective review of 99 eyes of 92 patients with lacrimal gland tumors diagnosed and managed in a single institution between January 1999 and March 2017. Clinical and radiological features, histopathology, treatment methods, and prognosis were evaluated.

Results: The mean patient age was 40.3 (range: 7-80)y. The diagnosis was made histopathologically in 91 (91.9%) tumors and on a clinical and radiological basis in 8 (8.1%) tumors. Final diagnoses included idiopathic orbital inflammation (pseudotumor) in 46 (46.5%) lesions, pleomorphic adenoma in 14 (14.1%), adenoid cystic carcinoma in 12 (12.1%), granulomatous inflammation in 10 (10.1%), lymphoma in 5 (5.0%), benign reactive lymphoid hyperplasia in 3 (3.0%), dacryops in 3 (3.0%), carcinoma ex pleomorphic adenoma in 2 (2.0%), adenocarcinoma in 1 (1.0%), dermoid cyst in 1 (1.0%), cavernous hemangioma in 1 (1.0%), and leukemic infiltration in 1 (1.0%). Non-epithelial tumors comprised 64.6% (=64) of all lacrimal gland tumors, epithelial tumors 32.3% (=32), dermoid cyst 1% (=1), cavernous hemangioma 1% (=1), and leukemic infiltration 1% (=1). There were in total 78 (78.8%) benign and 21 (21.2%) malignant tumors.

Conclusion: Overall, 65% of lacrimal gland tumors were of non-epithelial origin and 32% of epithelial origin. By histopathology and clinical evaluation, 79% of lacrimal gland tumors were benign. The most common lacrimal gland tumors include idiopathic orbital inflammation (46.5%), epithelial (32.3%), and lymphoproliferative (8.1%) lesions.
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http://dx.doi.org/10.18240/ijo.2018.08.08DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6090115PMC
August 2018

Ectopic rhabdoid meningioma of the orbit in a child: case report and review of the literature.

J Neurosurg Pediatr 2018 08 4;22(2):151-157. Epub 2018 May 4.

2Pathology, Ankara University Faculty of Medicine, Ankara, Turkey.

In August 2016, an 11-year-old boy presented to the authors' institution with a right orbital tumor that was located superotemporally (superolaterally) and adherent to the sclera. The patient's past medical history revealed that he had undergone 2 previous craniotomies elsewhere in June 2008 and July 2010 for a superomedially located orbital lesion that had been histopathologically diagnosed as a neurothekeoma. After the second craniotomy, the patient underwent adjuvant intensity modulated radiotherapy (IMRT) to the right medial orbit. At the authors' institution, total excision of the orbital tumor was performed via an anterior conjunctival orbitotomy. Histopathological examination revealed a rhabdoid meningioma. Review of the histopathology obtained at the time of previous tumor excisions showed that the lesion was misdiagnosed as neurothekeoma and instead represented a meningioma from the beginning. The patient was started on a regimen of oral sunitinib and remained free of recurrence at 1.5 years of follow-up. Ectopic meningioma of the orbit is a rare entity. Rhabdoid meningioma is a rarely seen subtype of meningioma, accounting for 1%-3% of all intracranial meningiomas. To the best of the authors' knowledge, this is the first case of an ectopic orbital rhabdoid meningioma reported in the literature. They suspect that tumor seeding during the previous surgeries might have played a role in the occurrence of the tumor in an orbital location not targeted by IMRT.
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http://dx.doi.org/10.3171/2018.1.PEDS17557DOI Listing
August 2018

Endoscopic removal of a suprasellar dermoid cyst in a pediatric patient: a case report and review of the literature.

Childs Nerv Syst 2018 08 20;34(8):1583-1587. Epub 2018 Mar 20.

Ibni Sina Hospital, Department of Neurosurgery, Ankara University School of Medicine, Sihhiye, 06100, Ankara, Turkey.

Introduction: Dermoid cysts (DCs) are unusual benign congenital intracranial tumors that typicallyarise in the midline and form as a result of abnormal sequestration of ectodermal cells during neural tubeformation. In all age groups, endoscopic approaches are preferable for the removal of sellar lesions. A 6-year-old girl with recurrent meningitis underwent endoscopic endonasal surgery forsellar DC.

Conclusion: To the best of our knowledge, we present the first case of a suprasellar DC in a pediatric patient that was removed endoscopically.
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http://dx.doi.org/10.1007/s00381-018-3777-yDOI Listing
August 2018

Do the Well Known Prognostic Parameters in Pancreatic Ductal Adenocarcinoma Really Reflect Survival?

Turk Patoloji Derg 2018 ;34(2):127-133

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

Objective: Pancreatic ductal adenocarcinoma is an aggressive tumor with short survival. In this study we aimed to investigate the effect of well-known prognostic parameters on survival in these tumors.

Material And Method: A total of 56 pancreatic ductal adenocarcinoma cases diagnosed between 2005 and 2014 were included in the study. Survival data were obtained and histopathological parameters were re-evaluated in each patient.

Results: Tumor size (p=0.029), mitotic count (p=0.030), lymph node metastasis (p=0.003), metastatic lymph node ratio (p < 0.001) and ampullary invasion (p=0.044) had a statistically significant relationship with survival. However, there was no relationship between survival and tumor grade, lymphovascular and perineural invasion, and peripancreatic soft tissue invasion.

Conclusion: Our results showed that existent 2010 WHO pancreatic ductal adenocarcinoma grading parameters excluding mitotic count are subjective and not applicable. Considering that almost all of the tumors in our series were larger than 2 cm, we think that the 2 cm cut-off in tumor size is insufficient to make the tumor stage pT2. Peripancreatic soft tissue invasion, which is a common finding in pancreatic ductal adenocarcinoma, should also not be assessed like adjacent tissue invasion and make the tumor reach pT3 stage independent of tumor size. It is clear that the existent WHO tumor grading and pT staging parameters need to be revised and the mitotic count, which correlates with survival, should be presented in pathology reports.
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http://dx.doi.org/10.5146/tjpath.2017.01414DOI Listing
October 2018

A Retrospective Evaluation of the Epithelial Changes/Lesions and Neoplasms of the Gallbladder in Turkey and a Review of the Existing Sampling Methods: A Multicentre Study.

Turk Patoloji Derg 2018 ;34(1):41-48

Department of Medical Pathology, Gazi University School of Medicine, Ankara, Turkey.

Objective: As there is continuing disagreement among the observers on the differential diagnosis between the epithelial changes/lesions and neoplasms of the gallbladder, this multicentre study was planned in order to assess the rate of the epithelial gallbladder lesions in Turkey and to propose microscopy and macroscopy protocols.

Material And Method: With the participation of 22 institutions around Turkey that were included in the Hepato-Pancreato-Biliary Study Group, 89,324 cholecystectomy specimens sampled from 2003 to 2016 were retrospectively evaluated. The numbers of adenocarcinomas, dysplasias, intracholecystic neoplasms/adenomas, intestinal metaplasias and reactive atypia were identified with the review of pathology reports and the regional and countrywide incidence rates were presented in percentages.

Results: Epithelial changes/lesions were reported in 6% of cholecystectomy materials. Of these epithelial lesions, 7% were reported as adenocarcinoma, 0.9% as high-grade dysplasia, 4% as low-grade dysplasia, 7.8% as reactive/regenerative atypia, 1.7% as neoplastic polyp, and 15.6% as intestinal metaplasia. The remaining lesions (63%) primarily included non-neoplastic polypoids/hyperplastic lesions and antral/pyloric metaplasia. There were also differences between pathology laboratories.

Conclusion: The major causes of the difference in reporting these epithelial changes/lesions and neoplasms include the differences related to the institute's oncological surgery frequency, sampling protocols, geographical dissimilarities, and differences in the diagnoses/interpretations of the pathologists. It seems that the diagnosis may change if new sections are taken from the specimen when any epithelial abnormality is seen during microscopic examination of the cholecystectomy materials.
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http://dx.doi.org/10.5146/tjpath.2017.01404DOI Listing
August 2018

Amperometric biosensors based on carboxylated multiwalled carbon nanotubes-metal oxide nanoparticles-7,7,8,8-tetracyanoquinodimethane composite for the determination of xanthine.

Talanta 2017 May 10;167:286-295. Epub 2017 Feb 10.

Ankara University, Faculty of Science, Department of Chemistry, Ankara, Turkey.

A comparison of the analytical performances of two xanthine biosensors, based on the use of different metal oxide nanoparticles (MONPs: CoO or FeO)-modified carboxylated multiwalled carbon nanotubes (c-MWCNTs)-7,7',8,8'-tetracyanoquinodimethane (TCNQ)-chitosan (CHIT) composite, is discussed. Xanthine oxidase (XOD) enzyme was covalently attached to c-MWCNTs/MONPs/TCNQ/CHIT/GCE via N-ethyl-N'-(3-dimethylaminopropyl) carbodiimide (EDC) and N-hydroxy succinimide (NHS) chemistry and the electrode surface was further modified with Nafion in order to minimize the effect of possible interfering substances. The results showed that analytical performance of the FeO based biosensor was better than the CoO based biosensor. The linear working range, limit of detection and sensitivity were found to be 1.9×10-2.3×10M, 0.20μM (S/N=3), 25.07μAmMcm for the FeO based biosensor and 1.9×10-1.2×10M, 0.36μM (S/N=3), 13.24μAmMcm for the CoO based biosensor, respectively. The purposed biosensors were applied in the determination of xanthine in coffee samples, and satisfactory results were obtained.
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http://dx.doi.org/10.1016/j.talanta.2017.02.021DOI Listing
May 2017

Necrotic intraocular retinoblastoma associated with orbital cellulitis.

Surv Ophthalmol 2018 Jan - Feb;63(1):114-118. Epub 2017 Feb 28.

Department of Pathology, Ankara University Faculty of Medicine, Ankara, Turkey.

Orbital cellulitis associated with retinoblastoma is uncommon and is characterized by noninfectious inflammation of the periorbital structures. The underlying mechanism is thought to be necrosis of the intraocular tumor, leading to intraocular and periorbital inflammation. We report 2 retinoblastoma patients who presented with an orbital cellulitis-like picture and discuss clinical characteristics, histopathologic features, and treatment.
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http://dx.doi.org/10.1016/j.survophthal.2017.01.010DOI Listing
December 2017

Coexistence of Mosaic Uniparental Isodisomy and a KCNJ11 Mutation Presenting as Diffuse Congenital Hyperinsulinism and Hemihypertrophy.

Horm Res Paediatr 2016 14;85(6):421-5. Epub 2016 May 14.

Background: Isolated hyperinsulinaemic hypoglycaemia (HH) commonly results from recessively inherited mutations in the ABCC8 and KCNJ11 genes that are located on chromosome 11p15.1. More rarely, HH can feature in patients with Beckwith-Wiedemann syndrome (BWS), a congenital overgrowth disorder, resulting from defects at a differentially methylated region telomeric to the K-ATP channel genes at chromosome 11p15.5.

Subject: We undertook genetic testing in a patient with diazoxide-unresponsive HH diagnosed at birth. Physical examination later revealed hemihypertrophy of the right arm, a feature of BWS.

Results: We identified a novel mosaic, paternally-inherited KCNJ11 mutation(s) in the patient. Further analysis confirmed uniparental disomy (UPD) of chromosome 11, which extended across the KCNJ11 gene at 11p15.1 and the BWS locus at 11p15.5.

Conclusion: These results highlight the importance of considering UPD as a mechanism of disease in patients with HH and a paternally inherited K-ATP channel mutation, especially when additional syndromic features are present.
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http://dx.doi.org/10.1159/000446153DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5079068PMC
April 2017

Experimental Endoscopic Cordotomy in the Sheep Model.

Turk Neurosurg 2016 ;26(2):286-90

Ankara Numune Educational and Training Hospital, Neurosurgery Clinic, Ankara, Turkey.

Aim: Interventional pain therapies are usually based on destruction of the related pain-conducting pathways. Current procedures targeting pain have replaced conventional pain treatment modalities while being less invasive. In this study, we investigated the feasibility of the endoscopic percutaneous cordotomy process on the sheep cervical spinal cord.

Material And Methods: Seven male sheep, Akkaraman® genus, were operated on in the study. The guide was introduced at C1 to C2 vertebrae. The interlaminar area was exposed by a dilator, the dura was identified, and then the working cannula was inserted into the subarachnoid space. The target point of cordotomy was defined by endoscopic visualization as the midpoint between the dentate ligament and ventral root entry zone. After determination of the target point, a carbon dioxide laser (CDL) probe was introduced through the cannula. Ablative lesioning was performed by CDL. Hindlimb withdrawal thresholds were measured using the "Sample Pain Scale". The lesion was demonstrated by magnetic resonance imaging and histopathological examination.

Results: Three sheep had ipsilateral hemiparesis and the response to firm pressure test was not performed on them. Among the remaining four sheep, the pain tolerance test showed that one sheep was at stage 0, two at stage 1, and the last one at stage 3.

Conclusion: Cordotomy might be successfully performed with the endoscopic technique in the sheep model and this should encourage future studies regarding minimal invasive procedures for intractable pain.
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http://dx.doi.org/10.5137/1019-5149.JTN.12229-14.1DOI Listing
October 2016

Ectopic orbital meningioma: report of two cases and literature review.

Surv Ophthalmol 2014 Nov-Dec;59(6):643-8. Epub 2014 Mar 11.

Department of Pathology, Ankara University Faculty of Medicine, Ankara, Turkey.

Ectopic orbital meningioma is a rare tumor usually affecting the medial orbit. We present two cases that occurred in a 56-year-old woman and a 28-year-old man. The tumors in both patients were subtotally excised via orbitotomy surgery and were located in the superior quadrant in one of our patients and in the temporal quadrant in the other. Following histopathologic diagnosis, external beam radiotherapy (EBRT) was administered to one patient and intensity modulated radiotherapy to the other. We identified 12 other well-documented cases of ectopic orbital meningioma previously reported. Ectopic meningioma should be considered in the differential diagnosis of medial as well as lateral and superior orbital tumors. The tumor is usually well circumscribed but can be ill defined in imaging studies. There are intralesional calcifications and sclerosis of adjacent bone in some cases. Ectopic orbital meningioma can recur after incomplete excision. Based on the efficacy of EBRT in optic nerve sheath meningioma, we used this treatment to decrease the risk of recurrence in our two patients and found no tumor recurrence at follow-ups of 24 and 74 months, but one patient had severe vision loss from radiation retinopathy.
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http://dx.doi.org/10.1016/j.survophthal.2014.01.009DOI Listing
July 2015

Evaluation of uncertainty components associated with alpha-particle spectrometric measurements of uranium isotopes in water.

Appl Radiat Isot 2014 Dec 16;94:355-362. Epub 2014 Sep 16.

Turkish Atomic Energy Authority, Sarayköy Nuclear Research and Training Center, 06983 Kazan, Ankara, Turkey.

Qualifications of uncertainties associated with the measurement of specific activity concentration of uranium radioisotope ((238)U) in water samples by alpha-particle spectrometry are presented. Possible sources of uncertainty are identified and quantified in the activity concentration measurements of (238)U isotope; the major source being the statistical counting uncertainty as expected. The combined relative standard uncertainty [Formula: see text] of the measurement was calculated as 1.4Bq kg(-1) (7.9%) for the investigated NPL sample. The accuracy and precision of recommended procedure were checked analysing six spiked water samples supplied from IAEA-proficiency test exercises. The results were evaluated in terms of relative bias, z-score, u-score, trueness and precision. These results show that the activity values and their uncertainties are in good agreement with recommended values.
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http://dx.doi.org/10.1016/j.apradiso.2014.09.002DOI Listing
December 2014

Breast hamartoma: a clinicopathologic analysis of 27 cases and a literature review.

Clinics (Sao Paulo) 2014 Aug;69(8):515-23

Department of General Surgery, Ankara University Medical School, Ankara, Turkey.

Objectives: Breast hamartoma is an uncommon breast tumor that accounts for approximately 4.8% of all benign breast masses. The pathogenesis is still poorly understood and breast hamartoma is not a well-known disorder, so its diagnosis is underestimated by clinicians and pathologists. This study was designed to present our experience with breast hamartoma, along with a literature review.

Method: We reviewed the demographic data, pathologic analyses and imaging and results of patients diagnosed with breast hamartoma between December 2003 and September 2013.

Results: In total, 27 cases of breast hamartoma operated in the Ankara University Medicine Faculty's Department of General Surgery were included in the study. All patients were female and the mean age was 41.8±10.8 years. The mean tumor size was 3.9±2.7 cm. Breast ultrasound was performed on all patients before surgery. The most common additional lesion was epithelial hyperplasia (22.2%). Furthermore, lobular carcinoma in situ was identified in one case and invasive ductal carcinoma was observed in another case. Immunohistochemical staining revealed myoid hamartoma in one case (3.7%).

Conclusion: Breast hamartomas are rare benign lesions that may be underdiagnosed because of the categorization of hamartomas as fibroadenomas by pathologists. Pathologic examinations can show variability from one case to another. Thus, the true incidence may be higher than the literature indicates.
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http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4129555PMC
http://dx.doi.org/10.6061/clinics/2014(08)03DOI Listing
August 2014

Lymphoma Associated with Sjögren's Syndrome.

Turk J Haematol 2013 Dec 5;30(4):416-7. Epub 2013 Dec 5.

Ankara University Medical Faculty, Department of Pathology, Ankara, Turkey.

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http://dx.doi.org/10.4274/Tjh-2013.0156DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3874966PMC
December 2013

Vanishing bile duct syndrome after allogeneic bone marrow transplantation: is it the end of the road?

Turk J Gastroenterol 2013 ;24(4):359-62

Ankara University Medical School, Department of Hematology, Ankara, Turkey.

In this paper, we report the case of a 19-year-old male patient who presented with lymphoblastic phase of chronic myeloid leukemia and received an allogeneic bone marrow transplant from his cousin. The patient experienced severe, steroid-refractory acute graft versus-host disease of skin, gastrointestinal tract and liver that required further immunosuppression. However, hepatic graft-versus-host disease was complicated with vanishing bile duct syndrome, characterized by progressive destruction of small intrahepatic bile ducts, which was refractory to all available therapies and eventually led to end-stage liver disease. The pathogenesis and treatment of graft-versus-host disease after allogeneic hematopoietic cell transplantation is discussed with an emphasis on liver transplantation for intractable hepatic graft-versus-host disease.
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http://dx.doi.org/10.4318/tjg.2013.0604DOI Listing
August 2014

Retinoblastoma in Turkey: results from a tertiary care center in Ankara.

J Pediatr Ophthalmol Strabismus 2013 Sep-Oct;50(5):296-303. Epub 2013 Aug 6.

Purpose: To evaluate the presentation patterns and results of management of retinoblastoma at a tertiary care center in Ankara, Turkey, with special emphasis on globe conservation rate in unilateral and bilateral intraocular retinoblastoma.

Methods: Patients were grouped according to the International Classification of Retinoblastoma. For intraocular retinoblastoma, group E and some group D eyes underwent primary enucleation. Secondary enucleation was performed after failure of chemoreduction, focal treatments, external beam radiotherapy (EBRT), and intra-arterial chemotherapy used in various combinations. For extraocular retinoblastoma cases, treatment consisted of enucleation/exenteration or orbital biopsy, high-dose chemotherapy, and EBRT to the orbit and metastatic sites.

Results: During the study period from October 1998 to May 2010, 165 of 192 (85.9%) patients had intraocular disease and 27 (14.1%) patients had extraocular disease. In total, primary or secondary enucleation was performed in 70 of 94 eyes with unilateral retinoblastoma (74.5%) and in 34 of 142 eyes with bilateral retinoblastoma (23.9%). The overall globe conservation rate was 69.6%. Only one patient in the intraocular retinoblastoma group died of metastatic retinoblastoma to the central nervous system. Twenty of 27 patients (74.1%) with extraocular retinoblastoma were found to have metastasis to the central nervous system, bone, bone marrow, and/or lymph nodes. At a mean follow-up of 28.0 months (median: 12 months; range: 1 to 120 months), survival was 33.3% despite intensive treatment.

Conclusions: The overall risk of enucleation was 75% in eyes with unilateral retinoblastoma and 24% in eyes with bilateral retinoblastoma. Extraocular retinoblastoma carries a 75% risk of systemic metastasis and 67% risk of death.
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http://dx.doi.org/10.3928/01913913-20130730-02DOI Listing
May 2014

Potential proteomic biomarkers in assessing liver fibrosis using SELDI-TOF MS.

Turk J Gastroenterol 2012 Feb;23(1):46-53

Background/aims: The accurate assessment of the severity of liver fibrosis is of paramount importance in determining treatment strategies, response to treatment and prognosis in patients with chronic liver disease. The aim of this study was to investigate potential proteomic biomarkers for assessing stages of hepatic fibrosis.

Methods: Serum samples of 83 patients with chronic liver disease (using METAVIR index, 17 F0, 30 F1, 6 F2, 9 F3, and 21 F4 patients) and 29 healthy controls were analyzed using surface-enhanced laser desorption/ionization time-of- flight mass spectrometry on IMAC30 ProteinChip arrays. Discriminatory peaks between groups were identified using Mann-Whitney U non-parametric test. Comparison of mild (F0, F1) and severe fibrosis (F2, F3, F4) was performed using tree classification (cross-validation) with the Biomarker Patterns Software, version 5.0 (Ciphergen Biosystems, US).

Results: No statistically significant discriminatory peak was evident between F0, F1 and F2 fibrosis. More than 30 peaks were found to be discriminatory between patients with cirrhosis (F4) and all other stages of liver fibrosis, including F2 and F3. Six surface-enhanced laser desorption/ionization proteomic features were found to be discriminative for mild (F0, F1) vs. advanced (F2, F3, F4) fibrosis (AUROC ≥0.8, p<0.05, Mann-Whitney test). The decision tree (m/z 4280, 10453 and 6376) yielded a sensitivity of 83.3% (30/36), a specificity of 85.1% (40/47), a positive predictive value of 81.1%, and a negative predictive value of 86.9%, with an AUROC of 0.94.

Conclusions: The results of this study revealed discriminatory peaks between the protein profiles of patients with cirrhosis and other stages of liver fibrosis. Potential proteomic biomarkers can be notably determined for discriminating mild and advanced fibrosis using surface-enhanced laser desorption/ionization time-of- flight mass spectrometry.
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http://dx.doi.org/10.4318/tjg.2012.0415DOI Listing
February 2012

Incidental gallbladder cancer diagnosed during or after laparoscopic cholecystectomy in members of the Turkish population with gallstone disease.

Turk J Gastroenterol 2011 Oct;22(5):513-6

Department of General Surgery, Ankara University, School of Medicine, Ankara, Turkey.

Background/aims: Gallbladder cancer is a rare neoplasm. We report our experience with gallbladder cancer that was incidentally diagnosed during or after laparoscopic cholecystectomy performed for gallstone disease.

Material And Methods: This study included all laparoscopic cholecystectomies due to gallstone disease undertaken from May 1999 to June 2010. Exclusion criteria were suspicion of malignancy and/or existence of gallbladder polyps detected with ultrasonography preoperatively. Patients with incidentally diagnosed gallbladder cancer were recorded, and the clinical and demographic characteristics of these patients were reviewed.

Results: Of 5,382 patients in whom laparoscopic cholecystectomy was attempted, 5,164 were included in this study. Incidental gallbladder cancer was found in five patients, with a mean age of 66.2 years. The histological tumor stages were adenocarcinoma in situ in one patient, pT1b in one patient, pT2 in one patient, and pT3 in two patients. Two patients who underwent laparoscopic cholecystectomy alone underwent no additional surgery because of the low stage of the tumors. The three remaining patients, whose laparoscopic cholecystectomies were converted to open surgeries, underwent cholecystectomy, excision of the liver bed and lymph node dissection. The overall median survival time was 32 months.

Conclusion: The incidence of incidental gallbladder cancer has been reported to vary, up to 2.85%. In this single-center study, the rate of incidental gallbladder cancer was found to be 0.09%. Female gender and advanced age are demographic risk factors for gallbladder carcinoma. Although gallbladder cancer is well known for its poor prognosis, tumors that are incidentally diagnosed are often found at an early stage and have a better prognosis.
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http://dx.doi.org/10.4318/tjg.2011.0250DOI Listing
October 2011

Pegylated interferon alfa-2B for chronic delta hepatitis: 12 versus 24 months.

Hepatogastroenterology 2011 Sep-Oct;58(110-111):1648-53

Department of Gastroenterology, Ankara University School of Medicine, Ankara, Turkey.

Background/aims: The aim of this study was to evaluate the efficacy of pegylated interferon (PEG-IFN) alfa-2b for short (one year) and long (two years) terms of treatment for chronic hepatitis D.

Methodology: Eighteen patients with chronic hepatitis D were administered PEG-IFN alfa-2b 1.5μg/kg twice weekly for 1 month, after which they were randomly assigned (2:1) to receive PEG-IFN alfa-2b 1.5μg/kg/wk for an additional 23 months (n=11; group 1) or 11 months (n=7; group 2). All patients were followed-up for 6 months after completing therapy.

Results: In group 1, there was no significant difference between HDV-RNA and ALT levels at follow-up compared with baseline (p=0.219 and p=0.624, respectively). However, in group 2, HDVRNA levels, but not ALT levels, were significantly lower at the end of follow-up (EOF) than at baseline (p=0.016 and p=0.237, respectively). Three patients, all in group 2, had undetectable hepatitis B surface antigen (HBsAg) at the end of followup (EOF). However, there was no patient who had undetectable HBsAg in group I (p=0.043). There were statistical differences for all 18 patients in terms of baseline levels of HDV-RNA compared to end of treatment (EOT) (p=0.021) and EOF (p=0.003).

Conclusions: Extending therapy from 12 to 24 months conferred no additional advantage in terms of HDV-RNA suppression and ALT normalisation.
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http://dx.doi.org/10.5754/hge10126DOI Listing
January 2012

CD40 ligand deficiency with grade III liver fibrosis, transplanted by a treosulphan-based conditioning regimen.

Exp Clin Transplant 2011 Oct;9(5):349-52

Ankara University, School of Medicine, Department of Pediatric Immunology-Allergy, Ankara, Turkey.

X-linked Hyper IgM is characterized by an absence of the CD40 ligand on activated T lymphocytes resulting in defects of both cellular and humoral immunity. Patients usually present with recurrent bacterial and opportunistic infections. Chronic liver disease is seen in about 75% of patients as a complication. Here, we report a 3.5-year-old boy with X-linked Hyper IgM referred to our clinic for bone marrow transplant. He was transplanted from an HLA-identical sibling donor using a new conditioning agent, treosulphan, together with cyclophosphamide. Since 6 months of age, he has had recurrent respiratory infections, and his XHIGM was diagnosed when he was 1.5 years old. The diagnosis was confirmed by sequence analysis of the CD40L gene. On physical examination, growth failure, bilateral fine crackles in both lungs, and hepatosplenomegaly were detected. The results of his liver function tests were abnormal, and a liver biopsy showed grade III fibrosis and compensated cirrhosis. After conditioning with treosulphan (12 g/m(2)/d x 3 d) and cyclophosphamide (50 mg/kg/d x 4 d), bone marrow from his HLA-identical sister was infused. CD40L expression on activated lymphocytes of the patient was 84% on day +21. His posttransplant period was uneventful. He is now at posttransplant 2 years, with full donor chimerism, and mild, chronic, graft-versus-host disease on his tongue. In conclusion, treosulphan is a new agent for conditioning regimen with less toxicity in patients with severe liver disease.
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October 2011

Gamma-glutamyltranspeptidase in predicting sustained virological response in individuals with chronic hepatitis C.

Hepatogastroenterology 2011 Jul-Aug;58(109):1301-6

Department of Gastoenterology, Diskapi Education and Research Hospital, Ankara, Turkey.

Background/aims: Serum gamma-glutamyltranspeptidase (GGT) levels often increase in chronic hepatitis C. We aimed to identify whether GGT levels can predict sustained virological response (SVR) in patients with chronic hepatitis C and to investigate other potential predictive factors associated with SVR in patients with chronic hepatitis C treated with pegylated interferon and ribavirin at a single center.

Methodology: We evaluated 112 consecutive patients with histologically proven chronic hepatitis C who were treated with pegylated interferon and ribavirin. As potential predictors of SVR to combination therapy, we analyzed age, gender, body mass index, pretreatment GGT and alanine transaminase levels, diabetes mellitus, receiving of anti-viral therapy before beginning combination therapy, viral load, and liver histology by use of a multivariate logistic regression model.

Results: SVR to combination therapy was seen in 57.2% of the patients. Variables associated with lower rates of sustained response were liver steatosis (p=0.026), diabetes mellitus (p=0.027), receiving anti-viral therapy before beginning combination therapy (p=0.016), higher GGT levels before therapy (>50IU/mL, p<0.001), and advanced fibrosis stage (p=0.017). On logistic regression analysis, the only independent predictor of SVR was the GGT level before therapy (p=0.003).

Conclusions: Low serum levels of GGT before treatment are associated with higher rates of SVR in patients with chronic hepatitis C treated with pegylated interferon and ribavirin.
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http://dx.doi.org/10.5754/hge10625DOI Listing
January 2012

Serum connective tissue markers as predictors of advanced fibrosis in patients with chronic hepatitis B and D.

Turk J Gastroenterol 2011 Jun;22(3):305-14

Department of Gastroenterology, University of Ankara School of Medicine, Ankara, Turkey.

Background/aims: Liver biopsy to assess fibrosis is invasive and prone to sampling error. While algorithms of serum markers to predict fibrosis stage have been described for chronic hepatitis C, these cannot be applied equally well to hepatitis B.

Methods: We therefore determined 9 serum fibrosis markers, liver biochemical tests and ultrasound parameters in 109 consecutive adult patients with chronic hepatitis B and D. All patients had compensated liver disease. Using the METAVIR score, advanced disease was defined as fibrosis stage ≥F2, and active inflammation as grade ≥A2. A gold standard was created considering splenomegaly and/or platelets <150,000 as indicators of advanced fibrosis irrespective of histology. Area under receiver operating characteristics curves was used for assessment of single markers and odds ratio for their combinations.

Results: Patients with advanced disease were older, had lower albumin, higher gamma glutamyl transferase and lower platelet. Levels of 6 of the 9 fibrosis markers, tissue inhibitor of metalloproteinases-1, procollagen type III aminoterminal propeptide, matrix metalloproteinase-2, laminin, hyaluronan and collagen IV correlated with advanced fibrosis. Markers useful for fibrosis prediction also predicted marked inflammation. Using the gold standard, age, prothrombin time, gamma glutamyl transferase and albumin were independent predictors of fibrosis with odds ratio's of 3.11, 4.18, 3.35 and 5.25, respectively. Their combined use predicted fibrosis with an odds ratio of 228.8. Tissue inhibitor of metalloproteinases-1 and hyaluronan were powerful predictors of fibrosis (Odds ratio's of 8.65 and 8.38). Their combined use revealed an odds ratio of 28.6, when compared with the gold standard.

Conclusion: In conclusion, advanced liver fibrosis in chronic hepatitis B and D may be predicted with use of these two fibrosis markers.
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http://dx.doi.org/10.4318/tjg.2011.0217DOI Listing
June 2011

Efficacy of combined interferon alpha and long-term lamivudine therapy in children with chronic hepatitis B.

Turk J Pediatr 2010 Sep-Oct;52(5):457-63

Department of Pediatric Gastroenterology, Hepatology and Nutrition, Ankara University Faculty of Medicine, Ankara, Turkey.

The aim of this study was to evaluate the efficacy of interferon alpha (IFN-alpha) and long-term lamivudine therapy in children with chronic hepatitis B and to determine the optimal duration of lamivudine therapy. Thirty-eight HBeAg-positive children simultaneously received IFN-alpha2a 5 MU/m2 to 10 MU/m2 for six months and lamivudine (4 mg/kg/day). Lamivudine was administered until anti-HBe seroconversion and was continued for six months in responders. During the five-year study period, we evaluated the efficacy of treatment, occurrence of YMDD mutants and adverse effects. During the study period, alanine aminotransferase (ALT) normalization, clearance of hepatitis B virus (HBV) DNA, HBeAg/anti-HBeAb, HBsAg/anti-HBsAb seroconversion, and histological response were noted in 27 (71.1%), 14 (36.8%), 13 (34.2%), 2 (5.2%) and 10 (47.9%) patients, respectively. Complete response was determined in 34.2% (13/38), and in 69.2% of these responders, response was achieved within 18 months. Breakthrough and YMDD mutant rates were 65.8% and 55.2%, respectively. Breakthrough time was a median 24 months and was associated with low baseline ALT level (p < 0.01). In conclusion, although lamivudine was used for a longer period, the response rate was not higher than in previous reports. We suggest that 18 months' duration of lamivudine treatment is sufficient for combination therapy.
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April 2011

Intestinal malignant melanoma presenting with small bowel invagination: a case report.

Turk J Gastroenterol 2010 Dec;21(4):439-42

Department of Medical Oncology, Ankara University School of Medicine, Ankara.

Gastrointestinal tract metastasis of any malignancy is rare. Cutaneous or ocular malignant melanomas are the most common tumors that metastasize to the gastrointestinal tract. Major symptoms of these metastatic lesions are bleeding and obstruction of the gastrointestinal tract. However, malignant melanoma arising in intestinal mucosa causing intestinal obstruction is a rare clinical entity. Herein, we present a case of primary gastrointestinal tract malignant melanoma who presented initially with iron deficiency anemia, which consequently triggered an invagination of jejunal and ileal segments causing obstruction symptoms, three months later.
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http://dx.doi.org/10.4318/tjg.2010.0133DOI Listing
December 2010

Evaluation of the presence of Helicobacter species in the biliary system of Turkish patients with cholelithiasis.

Turk J Gastroenterol 2010 Dec;21(4):421-7

Department of Microbiology and Clinical Microbiology,Ankara University, Faculty of Medicine, Ankara.

Background/aims: Helicobacter genus and bile-resistant Helicobacter pylori are suggested to have a role in gallstone formation and epithelial cell proliferation in the gallbladder. The aim of this study was to evaluate the presence of Helicobacter species in the gallbladder tissue, bile and gallstones of Turkish patients with cholelithiasis.

Methods: Forty-seven patients with calculous cholecystitis and 3 controls were evaluated for the presence of Helicobacter spp. by culture, polymerase chain reaction, and histological and immunohistochemistry methods.

Results: Escherichia coli (10.6%), Enterobacter amnigenus (6.3%), Klebsiella planticola (2.1%), and Klebsiella ozaenae (2.1%) were isolated from the sample cultures of 8 patients. No other microorganisms, including H. pylori and other Helicobacter spp., were detected. Polymerase chain reaction was negative for Helicobacter spp. and H. pylori. No microorganisms resembling Helicobacter spp. were seen on the histological sections. The association between the presence of bacteria and epithelial cell proliferation index was not statistically significant (p=0.48).

Conclusions: There was no association between the presence of Helicobacter spp. and development of cholelithiasis in our study group. The microorganisms found in the samples did not reveal any significant association with the underlying disease.
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http://dx.doi.org/10.4318/tjg.2010.0130DOI Listing
December 2010

Interferon-alpha-2a and zinc combination therapy in children with chronic hepatitis B infection.

Biol Trace Elem Res 2011 Dec 1;143(3):1302-9. Epub 2011 Feb 1.

Department of Pediatric Gastroenterology, Ankara University, School of Medicine, Ankara, Turkey.

Zinc has been reported to enhance the response to interferon (IFN) or PEG-IFN plus ribavirin therapy, improve liver function, and ameliorate hematologic side effects in patients with chronic hepatitis C. However, the role of zinc supplementation during IFN therapy in chronic hepatitis B infection (CHB) remains unclear. We therefore aimed to report the results of zinc and IFN-alpha-2a therapy in children with CHB. Twenty-two naive, HBeAg-positive children (mean age 10.4 ± 4.4 years) received IFN-α2a (9 MU/m(2) sc) for 6 months plus peroral zinc (7.5 mg/day for <10 years and 10 mg/day for >10 years) for 12 months. Serum zinc, alanine aminotransferase (ALT), complete blood count, hepatitis B virus DNA (HBV DNA), and serological markers were measured. Histological (HR) and sustained response (SR) were evaluated at 6 months after completion of therapy. Normalization of ALT, HBeAg seroconversion, and HBV DNA < 10,000 copies/ml were considered as SR. HR was defined as decrease in Knodell histological activity index (HAI) score by at least 2 points compared to baseline. End of therapy ALT level and log HBV DNA were significantly lower than pretherapy levels (p = 0.001 and p = 0.001, respectively), while zinc level was not different. Portal inflammation score significantly decreased after therapy (p = 0.043), however, total HAI and other HAI components were not different. SR and HR were 25% and 52.9%. In conclusion as a first study investigating the effect of zinc and IFN combination therapy in children with CHB, SR and HR rates were not better than previously reported monotherapy or combination therapies.
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http://dx.doi.org/10.1007/s12011-011-8971-7DOI Listing
December 2011
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