Publications by authors named "Gokhan Gedikoglu"

49 Publications

Comprehensive clinicopathologic characteristics of intraabdominal neurogenic tumors: Single institution experience.

World J Clin Cases 2021 Apr;9(10):2218-2227

Department of Pathology, Hacettepe University, Ankara 06230, Turkey.

Background: Neurogenic tumors are rare but represent an important consideration in the differential diagnosis of abdominal mesenchymal tumors. Reports on their incidence, pathological features and clinical characteristics are scarce.

Aim: To advance the overall knowledge on the histologic, immunohistochemical, clinical and radiologic characteristics of neurogenic tumors through this case series.

Methods: An established database of a nationwide tertiary referral center, covering a 15-year period (2005 and 2020), was retrospectively re-evaluated. Diagnoses of neurogenic tumor cases were confirmed by two experts following review of the macroscopic, histological and immunohistochemical records along with findings from analysis of archived tissue sections for each included patient. Tissue microarrays were constructed for cases lacking necessary immunohistochemical studies. Clinical data and follow-up information were collected from the hospital records and the patients themselves, when available.

Results: The study included 19 cases of intraabdominal neurogenic tumors, representing 12 women and 7 men, between 18 and 86 years of age (median: 51 years). Final confirmed diagnoses were 12 schwannomas, 2 diffuse submucosal neuro-fibromatoses, 2 ganglioneuromas, 2 malignant peripheral sheath nerve tumors, and 1 mucosal Schwann cell hamartoma. Sizes of the tumors were variable, with a median diameter of 4 cm; the two largest (> 10 cm) were schwannomas. The majority of cases were asymptomatic at presentation, but the most frequent symptom was abdominal pain. Gastrointestinal tract lesions were detected with endoscopy and extra-luminal lesions were detected with cross-sectional imaging. All cases were S100-positive and CD117-negative; most cases were negative for desmin, epithelial membrane antigen, smooth muscle actin and CD34. In all but 5 cases, the Ki67 proliferation index was ≤ 1%.

Conclusion: Re-evaluation of 19 cases of abdominal neurogenic tumors demonstrated con-siderable variability in clinicopathologic characteristics depending on location, dimension and histological features.
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http://dx.doi.org/10.12998/wjcc.v9.i10.2218DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8026837PMC
April 2021

Synovial Non-langerhans Cell Histiocytosis of the Shoulder: A Case Report and Review of the Literature.

J Orthop Case Rep 2020 Nov;10(8):6-10

Department of Orthopaedic Surgery and Rehabilitation, Loyola University Medical Center, Maywood, USA.

Introduction: Histiocytoses are rare disorders and most orthopedic surgeons are unfamiliar with this diagnosis. We report a case of synovial non-Langerhans cell histiocytosis (LCH) located in the shoulder, which has not been reported in the literature previously.

Case Report: A 24-year-old female patient presented to our clinic with shoulder pain and decreased range of motion. MRI results suggested pigmented villonodular synovitis. Arthroscopic synovial debridement and biopsy were performed. Histologic examination came back as non-LCH of the shoulder. Hematology/oncology evaluation indicated localized disease and no further treatment was necessary. At the 6th month follow-up, the patient gained full shoulder motion and is symptom free.

Conclusion: This case represents a rare diagnosis of synovial non-LCH which should be considered in the differential diagnosis of synovial diseases. A misdiagnosis could result in inadequate treatment, and coordination with the hematology/oncology department is of utmost importance in the treatment of this neoplastic disease.
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http://dx.doi.org/10.13107/jocr.2020.v10.i08.1834DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7933630PMC
November 2020

Loss of CTNNB1 exon 3 in sclerosing angiomatoid nodular transformation of the spleen.

Virchows Arch 2021 Mar 1. Epub 2021 Mar 1.

Hacettepe University Transgenic Animal Technologies Research and Application Center, Sıhhiye, 06100, Ankara, Turkey.

Sclerosing angiomatoid nodular transformation (SANT) is a rare vascular lesion of the spleen. Although several hypotheses have been suggested, the etiopathogenesis of SANT remains unknown. It is also unclear whether SANT is a reactive or a neoplastic lesion. Since CTNNB1 (β-catenin gene) exon 3 mutations were frequently detected in some rare fibrovascular lesions, we aimed to investigate the presence of oncogenic CTNNB1 mutations in SANT cases. For this purpose, 7 cases of SANT with typical histopathological features were retrieved. First, the presence of CTNNB1 exon 3 alterations was examined with a recently described immunohistochemistry-based method. Then, the findings were confirmed with polymerase chain reaction (PCR), reverse transcription PCR (RT-PCR), and Sanger sequencing. In all cases, immunochemistry of β-catenin gave a staining pattern that was suggestive of exon 3 alteration; however, no missense mutations were found in any case at the CTNNB1 exon 3 hotspot region. Subsequently, we screened for large interstitial deletions of CTNNB1 exon 3 which revealed short PCR products in three cases. Sequencing confirmed that these cases had large interstitial deletions, resulting in loss of the entire exon 3 of CTNNB1. In the remaining four cases, loss of exon 3 was documented at the cDNA level, although genomic deletion was not identified. These results demonstrate that loss of CTNNB1 exon 3 and stabilization of β-catenin with activation of Wnt signaling pathway might have a significant role in the pathogenesis of SANT. Through this study, we provided important evidence for the neoplastic nature and pathogenesis of this disorder.
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http://dx.doi.org/10.1007/s00428-021-03064-yDOI Listing
March 2021

High-grade neuroepithelial tumor with medulloepithelioma-like areas out of the central nervous system in an infant with hemihypertrophy: a unique association.

Turk J Pediatr 2020 ;62(5):836-842

Departments of Pediatric Oncology, Hacettepe University Faculty of Medicine, Ankara, Turkey.

Background: High-grade neuroepithelial tumor with areas resembling medulloepithelioma was diagnosed in an infant with coccygeal and inguinal masses. Hemihypertrophy is associated with Wilms tumor, hepatoblastoma and pancreatic tumors in children.

Case: The authors report on the first case of peripheral HNET associated with hemihypertrophy in an infant, with special discussion on histopathological differential diagnosis and management of this rare and highly malignant tumor.

Conclusions: HNET should be included into the list of hemihypertrophy associated tumors. Complete surgical excision with free margins is essential for the successful treatment of such cases and should be tried in suitable cases at the time of diagnosis. Continued treatment should be decided individually on a case to case basis.
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http://dx.doi.org/10.24953/turkjped.2020.05.017DOI Listing
January 2020

Stereotactic ablative radiotherapy for bone metastasis of gastrointestinal stromal tumor: Case report and review of the literature.

Rep Pract Oncol Radiother 2020 May-Jun;25(3):331-335. Epub 2020 Feb 24.

Hacettepe University Faculty of Medicine, Department of Radiation Oncology, Ankara, Turkey.

Background: Gastrointestinal stromal tumors (GISTs) are the most common mesenchymal tumors of the gastrointestinal tract. These tumors are rare and only make bone metastases at a rate of 5%.

Case Summary: A 31-year-old male with a GIST presented with solitary bone metastasis at the right iliac bone. We performed stereotactic ablative radiotherapy (SABR) and achieved excellent local control. Herein, our case is presented, and a short review of the literature is carried out.

Conclusion: SABR should be considered as a treatment option in GIST with bone metastasis.
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http://dx.doi.org/10.1016/j.rpor.2020.02.013DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7114605PMC
February 2020

Methacrylated gelatin hydrogels as corneal stroma substitutes: study.

J Biomater Sci Polym Ed 2019 12 23;30(18):1803-1821. Epub 2019 Sep 23.

Departments of Biological Sciences, Middle East Technical University (METU) , Ankara , Turkey.

Methacrylated gelatin (GelMA) hydrogels were prepared to serve as corneal stroma equivalents. They were highly transparent (ca. 95% at 700 nm), mechanically strong and withstood handling and had high human corneal keratocyte viability (98%) after 21 days of culture period. In order to test the performance of the cell free GelMA hydrogels a pilot study was carried out using eyes of two white New Zealand rabbits. Hydrogel was implanted in a mid-stromal pocket created and without suture fixation, and observed for 8 weeks under a slit lamp. No edema, ulcer formation, inflammation or infection was observed in both the control (sham) and hydrogel implanted corneas. Corneal vascularization on week 3 was treated with one dose of anti-VEGF application. Hematoxylin and Eosin staining showed that the hydrogel was integrated with the host tissue with only a minimal foreign body reaction. Results demonstrated some degradation in the construct within 8 weeks as evidenced by the decrease of the diameter of the hydrogel from 4 mm to 2.6 mm. High transparency, adequate mechanical strength, biocompatibility and well integration with the host tissue, indicates that this hydrogel is a viable alternative to the current methods for the treatment of corneal blindness and deserves testing on larger number of rabbits and more extensively using microscopy, histology and immune histochemistry.
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http://dx.doi.org/10.1080/09205063.2019.1666236DOI Listing
December 2019

Corneal Relapse of Peripheral T-Cell Lymphoma Under Systemic Chemotherapy.

Cornea 2018 Dec;37(12):1593-1595

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

Purpose: To report a patient who developed unilateral corneal stromal infiltration while undergoing systemic chemotherapy for multinodal peripheral T-cell lymphoma not otherwise specified.

Methods: Clinical, imaging, and immunohistopathological features of a 40-year-old woman who presented with a stromal haze in the right cornea were reviewed.

Results: At initial presentation, her visual acuity in the right eye was 20/40. Slit-lamp examination showed stromal infiltration located mainly in the inferotemporal peripheral cornea without epithelial or limbal involvement. Immunohistochemical examination of the incisional biopsy specimen revealed CD3, CD5, and CD8 neoplastic lymphocytes suggestive of T-cell lymphoma. The corneal lesion and disseminated lymphadenopathy did not respond to various combinations of several cycles of systemic chemotherapy. Remission was achieved only after allogeneic bone marrow transplantation. The corneal infiltrates almost totally regressed within 6 months, and she maintained 20/20 visual acuity thereafter. She did not have any systemic or ocular recurrence during 6 years of posttransplantation follow-up.

Conclusions: In this rare case of systemic multinodal peripheral T-cell lymphoma, corneal stromal infiltration was the only ocular manifestation. Prompt corneal biopsy enabled the appropriate diagnosis. Development and persistence of corneal infiltration despite systemic chemotherapy may be a warning sign for resistance to treatment.
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http://dx.doi.org/10.1097/ICO.0000000000001759DOI Listing
December 2018

An immunohistochemical approach to detect oncogenic CTNNB1 mutations in primary neoplastic tissues.

Lab Invest 2019 01 3;99(1):128-137. Epub 2018 Sep 3.

Departments of Internal Medicine, Human Genetics, and Pathology, University of Michigan Medical School, Ann Arbor, MI, 48109, USA.

The Wnt/β-catenin signaling pathway is dysregulated in different types of neoplasms including colorectal cancer (CRC). Aberrant activation of this signaling pathway is a key early event in the development of colorectal neoplasms, and is mainly caused by loss of function mutations in Adenomatous Polyposis Coli (APC), and less frequently by β-catenin stabilization mutations via missense or interstitial genomic deletions in CTNNB1. In this study, we have defined an immunohistochemical algorithm to dissect Wnt pathway alterations in formalin-fixed and paraffin-embedded neoplastic tissues. Basically, consecutive sections of tumor specimens were stained by immunohistochemistry with two different monoclonal antibodies against β-catenin: one (anti-active β-catenin antibody) recognizes hypo-phosphorylated β-catenin and the other recognizes the total pool of β-catenin. We validated the strategy in the HCT116 CRC cell line which has an in-frame deletion of β-catenin serine 45, and then studied human tumor microarrays containing colon adenomas, CRCs, solid pseudopapillary neoplasms of the pancreas as well as the whole tissue sections of CRCs, desmoid fibromatosis, and pilomatrixoma of the skin. In some tumors, we found strong β-catenin cytoplasmic and/or nuclear staining with the total β-catenin antibody but no staining with the anti-active β-catenin antibody. This was inferred to be an altered/mutant β-catenin staining pattern. All six colon adenomas of the 126 total adenomas studied for the altered/mutant β-catenin staining pattern had presumptively pathogenic point mutations or deletions in CTNNB1. Four of 10 CRCs with the alterated/mutant β-catenin staining pattern studied in depth, from 181 total CRCs from tissue microarray, had pathogenic CTNNB1 mutations. The frequencies of CTNNB1 alterations in non-colonic tumors with altered/mutant β-catenin staining ranged between 46 and 100%. Our results demonstrate that the immunohistochemical approach described here can detect oncogenic forms of β-catenin in primary tissue samples and can also highlight other tumors with presumptive novel defects activating the Wnt/β-catenin pathway.
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http://dx.doi.org/10.1038/s41374-018-0121-9DOI Listing
January 2019

Gastric mucosal metastasis of prostate cancer.

Gastrointest Endosc 2018 10 21;88(4):767-768. Epub 2018 Jun 21.

Department of Internal Medicine, Division of Gastroenterology, Hacettepe University School of Medicine, Ankara, Turkey.

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http://dx.doi.org/10.1016/j.gie.2018.05.008DOI Listing
October 2018

Morphologic and Immunohistochemical Appraisal of Primary Gastric Carcinomas.

Appl Immunohistochem Mol Morphol 2018 Nov/Dec;26(10):e107-e115

Departments of Pathology.

Gastric carcinoma management requires adjustments answering their genetic and morphologic heterogeneity. We aim to assess the expression and significance of a myriad of biomarkers (p53, MLH1, MSH2, PMS2, MSH6, Epstein-Barr encoding region-RNA, c-erbB2, E-cadherin, CEA, chromogranin, Ki-67, CDX2, presenilin-1, cathepsin E, MUC5AC, cyclin-dependent kinase 1) in 117 gastric carcinomas, which we have morphologically subclassified with a simple algorithm. Immunohistochemical stains were applied to 3 tissue microarrays of primary gastric carcinomas (n=117) obtained from resection specimens of untreated patients. These cases represented the morphologic subgroups that emerged from a reclassification attempt carried out according to the predominant (>50%) morphologic component they contained (adenocarcinoma, diffuse infiltrative carcinoma, mucinous carcinoma) and "mixed" carcinoma if none predominated. Cases with unusual morphology were assigned to a "special subtypes" group ("rare" tumors). Correlation of overall survival and staining patterns was carried out. Adenocarcinomas comprised 43.6% (n=51), diffuse infiltrative carcinomas 28.2% (n=33), mucinous carcinomas 6% (n=7), mixed carcinomas 6%, and "rare/other" carcinomas 16.2% (n=19) of the 117 muscle-invasive carcinoma cases. High tumor stage was associated with worse overall survival at multivariate analysis (P=0.000, log-rank). Higher cathepsin E and cyclin-dependent kinase 1 expression was associated with worse overall survival on univariate analysis (log-rank; P=0.050 and 0.001, respectively). Mismatch repair defects were seen in adenocarcinomas and "rare" tumors with MLH1 silencing. These above-mentioned points can lead to the differentiation of metabolic and phenotypic features per gastric carcinoma subtype and may help design targeted approaches.
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http://dx.doi.org/10.1097/PAI.0000000000000618DOI Listing
September 2019

Multiple liver masses mimicking metastatic liver disease in an elderly patient.

Turk J Gastroenterol 2018 01;29(1):119-122

Division of Gastroenterology, Department of Internal Medicine, Hacettepe University School of Medicine, Ankara, Turkey.

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http://dx.doi.org/10.5152/tjg.2018.17336DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6322617PMC
January 2018

Mesenchymal Chondrosarcoma of the Lacrimal Gland.

Ophthalmic Plast Reconstr Surg 2018 May/Jun;34(3):e77-e79

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

A 23-year-old woman presented with right-sided painless proptosis that developed in 12 months. MRI studies demonstrated a well-delineated tumorous enlargement of the right lacrimal gland with homogenous signal intensity and compressing the globe. The tumor was removed totally and in 1 piece with the tentative diagnosis of a pleomorphic adenoma. Pathologic examination revealed biphasic neoplastic elements, which were composed of the cartilaginous matrix and small round cell component. Immunohistopathological examination showed positive CD99 staining and negative reaction to S100, panCK, and CD15. The patient then received a total of 64 Gy orbital radiotherapy in 32 fractionations. There has been no recurrence or metastasis during 14 months of follow up. This case showed that mesenchymal chondrosarcoma may arise from the lacrimal gland and must be considered in the differential diagnosis of lacrimal gland tumors in young adults.
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http://dx.doi.org/10.1097/IOP.0000000000001054DOI Listing
July 2018

Programmed Death Ligand 1 (PD-L1) Expression in Malignant Mesenchymal Tumors.

Turk Patoloji Derg 2017 ;1(1):192-197

Department of Pathology, Research and Application Center, Hacettepe University, Faculty of Medicine, ANKARA, TURKEY.

Objective: Programmed death ligand 1 (PD-L1) found on tumor cells has recently been reported to have a key role in the development and dissemination of many tumors, such as lung and breast carcinomas. In this study, we retrospectively analyzed PD-L1 expression among different types of sarcomas.

Material And Method: Tissue microarrays of 3-4 mm diameter were composed from paraffin blocks of 222 various sarcomas. Slides prepared from microarrays were stained for PD-L1 antibody (Cell Signaling, E1L3N®) using Leica Bond Autostainer. Any membranous staining over 5% of the cells was regarded as positive. Quantitative real-time PCR with TaqMan gene expression assays for PDL1 was performed using whole sections from FFPE tissue of PD-L1 positive cases, by normalizing absolute values to β-actin. Relative expression level of mRNA of PDL1 was calculated and scored using Log102(threshold cycle of b-actin - threshold cycle of PDL1).

Results: Immunohistochemically, PD-L1 expression was present in 34 of 222 (15%) sarcomas. 5/13 (39%) undifferentiated pleomorphic sarcomas, 6/18 (33%) malignant peripheral nerve sheath tumors, 5/16 (31%) dedifferentiated liposarcomas, 4/19 (21%) rhabdomyosarcomas, 2/16 (13%) epithelioid sarcomas, 2/15 (13%) leiomyosarcomas, 3/26 (12%) synovial sarcomas, 1/18 (6%) myxoid liposarcoma, 1/2 (50%) extraskeletal myxoid chondrosarcoma, 1/3 (33%) alveolar soft part sarcoma, 1/3 (33%) parachordoma/myoepithelioma, 1/5 (20%) pleomorphic liposarcoma, 1/7 (14%) angiosarcoma, 1/8 (13%) Ewing sarcoma showed PD-L1 expression. Cases of solitary fibrous tumor/hemangiopericytoma (18), desmoplastic round cell tumor (14), Ewing-like sarcoma (6), epithelioid hemangioendothelioma (5), clear cell sarcoma (4), myxofibrosarcoma (4), low grade fibromyxoid sarcoma (2) were all negative. Tumor-infiltrating hematopoietic cells were positive for PD-L1 in 32 cases (15%) with only 2 cases overlapping with PD-L1 staining in tumoral cells. Sixteen of 34 (47%) immunohistochemically PD-L1 positive cases showed significant but low-level PD-L1 mRNA overexpression.

Conclusion: We have shown PD-L1 expression in a subset of sarcomas, both at the protein and mRNA level. High-grade pleomorphic sarcomas tend to show more frequent PD-L1 expression. Clinical trials are necessary to further assess the effect of anti PD-L1 drugs on sarcomas showing PD-L1 expression.
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http://dx.doi.org/10.5146/tjpath.2017.01395DOI Listing
May 2018

Cyanoacrylate Associated Foreign Body Granulomatous Gastritis: A Report of Three Cases.

Case Rep Pathol 2017 19;2017:2753487. Epub 2017 Jan 19.

Department of Pathology, Faculty of Medicine, Hacettepe University, Sıhhiye, 06100 Ankara, Turkey.

Granulomas are rarely seen in gastric biopsies mostly as an involvement of granulomatous diseases like sarcoidosis, Crohn's disease, infections, neoplasms, and vasculitis. Here, we claim cyanoacrylate as a foreign body type granuloma-causing agent in the stomach after vascular embolisation. We present cyanoacrylate associated gastric changes of three cases: two endoscopic biopsies and one gastric resection. In two cases, cyanoacrylate associated ulcers and granulomatous inflammation were observed in gastric mucosal biopsies following endoscopic examination after 7 months and 6 years of the glue injections, respectively. In the third case, the cyanoacrylate injection was performed 2 months prior to the surgery. Then the patient underwent distal pancreatectomy for pancreatic adenocarcinoma and during the operation a gastric mass was resected with a suspicion of tumoral infiltration. These three cases demonstrated that glue exposure causes active chronic inflammation with foreign body type granulomas, mucosal ulceration, and bleeding in the gastric mucosa. Even further, it can induce mass formation in the injection sites.
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http://dx.doi.org/10.1155/2017/2753487DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5288507PMC
January 2017

Adenomyoma of the duodenum.

Am J Gastroenterol 2015 Aug;110(8):1141

Hacettepe University School of Medicine, Ankara, Turkey.

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http://dx.doi.org/10.1038/ajg.2014.407DOI Listing
August 2015

Primary diffuse pleural rhabdomyosarcoma in an adult patient.

Asian Cardiovasc Thorac Ann 2016 Jan 22;24(1):98-100. Epub 2015 Jul 22.

Department of Chest Diseases, Hacettepe University Medical Faculty, Ankara, Turkey.

Rhabdomyosarcoma is an aggressive malignant tumor of childhood, originating from immature cells that are destinated to form striated skeletal muscle. It usually arises in the head and neck or the extremities. Primary diffuse pleural rhabdomyosarcoma is exceptionally rare. Herein we report a case of primary diffuse pleural rhabdomyosarcoma in a 48-year-old man. The diagnosis was confirmed by percutaneous pleural biopsy. Chemotherapy (cisplatin, ifosfamide, adriamycin, vincristine) was initiated due to the large volume of the tumor. After 3 months, computed tomography of the thorax showed stable radiological findings.
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http://dx.doi.org/10.1177/0218492315596658DOI Listing
January 2016

Heterotopic pancreatic pseudocyst radiologically mimicking gastrointestinal stromal tumor.

Int Surg 2015 Mar;100(3):486-9

1 Department of General Surgery, Hacettepe University Faculty of Medicine, Ankara, Turkey.

Heterotopic pancreas is a relatively common variant of foregut embryologic dystopia that can be described as pancreatic tissue found outside the normal anatomic location, being independent from vascular supply of normal pancreas. Having all features of pancreatic tissue except for the major duct structures, this ectopic tissue may be clinically recognized when pathologic changes take place. Inflammation, hemorrhagic or obstructive states, and eventually malignancy-related problems may become a diagnostic challenge for clinician and finally lead to consequences of misdiagnosis. In this article we will discuss a case of heterotopic pancreatic tissue located in gastric cardia, which was diagnosed preoperatively as gastrointestinal stromal tumor.
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http://dx.doi.org/10.9738/INTSURG-D-13-00242.1DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4370540PMC
March 2015

Intralesional curettage and cementation for low-grade chondrosarcoma of long bones: retrospective study and literature review.

World J Surg Oncol 2014 Nov 10;12:336. Epub 2014 Nov 10.

Department of Orthopaedics and Traumatology, Bozok University, Yozgat, Turkey.

Background: Various treatment strategies for low-grade chondrosarcomas with variable outcomes have been reported in the literature. The aim of this study was to assess the oncological and functional outcomes associated with intralesional curettage followed by adjuvant therapy comprising high-speed burring, thermal cauterization, and bone cementation with polymethylmethacrylate.

Methods: We performed a retrospective review of 21 consecutive patients with intramedullary low-grade chondrosarcoma of long bones treated by intralesional curettage and adjuvant therapy comprising high-speed burring, thermal cauterization, and cementation at our institution from 2007 to 2012.

Results: The average age of the patients was 48.7 (range, 18-71) years. There were 7 male and 14 female patients. The mean follow-up period was 58.4 (range, 26-85) months after surgery. The treated lesions were located in the proximal humerus (n=10), proximal tibia (n=6), and distal femur (n=5). At the average follow-up time point of 58.4 (range, 26-85) months, no patient had developed local recurrence and no distant metastases were observed. The average Musculoskeletal Tumor Society score among all 21 patients was 95% (84-100).

Conclusions: The combination of intralesional curettage, application of high-speed burring, thermal cauterization, and cementation is an effective treatment strategy for low-grade intramedullary chondrosarcoma of long bones. Excellent oncological and functional results can be obtained.
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http://dx.doi.org/10.1186/1477-7819-12-336DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4246483PMC
November 2014

Hybrid carcinoma of the parotid gland: ductal carcinoma and myoepithelial carcinoma.

Kulak Burun Bogaz Ihtis Derg 2014 Jan-Feb;24(1):46-9

Department of Otolaryngology, Medical Faculty of Hacettepe University, 06100 Sıhhiye, Ankara, Turkey.

Hybrid carcinomas are rare neoplasms which are characterized by two different types of tumors localized in a single topographic region of the lesion. Parotid gland is the most common involvement site of hybrid carcinomas among salivary glands. The aggressiveness of the hybrid tumor depends on its high-grade component. In this article, we present a 71-year-old male case with the left parotid gland hybrid carcinoma consisting of salivary duct carcinoma and myoepithelial carcinoma.
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http://dx.doi.org/10.5606/kbbihtisas.2014.03789DOI Listing
October 2015

Giant cell tumour of humerus: an unexpected lesion in a skeletally immature patient with Hodgkin's disease.

J Coll Physicians Surg Pak 2014 Mar;24 Suppl 1:S37-8

Department of Orthopedics and Traumatology, Hacettepe University School of Medicine, Ankara, Turkey.

Giant cell tumour (GCT) of bone is a benign aggressive tumour of the bone. It typically presents in persons aged 20 - 40 years. It is rare in adolescents and children. In most cases, GCT of bone occurs in the metaphyseal and epiphyseal regions of long bones. However, in children with open physes, GCT of bone may be centered in the metaphysis and may abut the physis. GCT is most commonly found in the distal femur, proximal tibia, and distal radius. It is not reported after treatment of a cancer in childhood. To the best of authors' knowledge, the coexistence of giant cell tumour of the bone and Hodgkin disease has not been reported in the literature. We report an atypical case of giant cell tumour of humerus in a skeletally immature child treated for Hodgkin's disease (HD), which had initially presented as a bone cyst radiologically.
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http://dx.doi.org/03.2014/JCPSP.S37S38DOI Listing
March 2014

Hepatic mass caused by Fasciola hepatica: a tricky differential diagnosis.

Am J Trop Med Hyg 2013 Dec 30;89(6):1212-3. Epub 2013 Sep 30.

Departments of Gastroenterology and Pathology, Hacettepe University School of Medicine, Ankara, Turkey.

Fascioliasis is a zoonotic infestation caused by the trematode fasciola hepatica. It presents a wide spectrum of clinical pictures ranging from fever and eosinophilia to ambiguous gastrointestinal symptoms in the acute phase. However, it may often be overlooked, especially in the acute phase, because of uncertain symptoms. Fasciola hepatica can have an initial presentation similar to the presentation of malignancy. Here, we report a case of a hepatic mass caused by fasciola hepatica.
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http://dx.doi.org/10.4269/ajtmh.13-0085DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3854903PMC
December 2013

Alpha-1 antitrypsin deficiency in patients with chronic hepatitis.

Turk J Gastroenterol 2012 ;23(5):569-73

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

Background/aims: Alpha-1 antitrypsin deficiency causes accumulation of mutant alpha-1 antitrypsin molecules in hepatocytes, and is attributed to severe liver injury even in heterozygous state. However, there is a question as to whether alpha-1 antitrypsin deficiency is only a cause of liver injury or has a worsening effect on the underlying liver disease. We aimed to determine the role of alpha-1 antitrypsin deficiency in the ongoing chronic hepatitic process.

Materials And Methods: Fifty-four patients with the diagnosis of chronic hepatitis by liver biopsy (36 chronic hepatitis B virus, 8 chronic hepatitis C virus, 7 non-alcoholic steatohepatitis, 2 primary biliary cirrhosis, and 1 autoimmune hepatitis) and 51 age- and sex-matched control subjects chosen from among healthy blood donors were included in the study. Isoelectric focusing for identifying alpha-1 antitrypsin phenotypes was performed in all patients and control subjects, whereas the histopathological examination was done only in patients.

Results: Alpha-1 antitrypsin-deficient variant was absent in patients and controls. The mean serum alpha-1 antitrypsin level was significantly lower in patients (157.4 ± 33 mg/dl) than controls (134.8 ± 30 mg/dl) (p<0.00). Histological activity index and fibrosis grade in the liver were not related to the serum alpha-1 antitrypsin level (p: 0.276 and 0.902, respectively). Additionally, the serum alpha-1 antitrypsin levels among normal variants of alpha-1 antitrypsin did not differ according to the underlying liver diseases (p: 0.928).

Conclusions: This prospective case-control study could not define any additional effect of alpha-1 antitrypsin deficiency on liver histopathology in chronic hepatitis patients.
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May 2013

Cutoff level to detect heterozygous alpha 1 antitrypsin deficiency in Turkish population.

J Clin Lab Anal 2011 ;25(4):296-9

Department of Internal Medicine, Division of Hepatology, Hacettepe University Medical Faculty, Ankara, Turkey.

Background: Alpha 1 antitrypsin (AT) deficiency is a hereditary disorder leading to the defective defence system against neutrophil elastasis in lung and accumulation of insoluble heterodimer AT molecules in hepatocytes. Knowledge of the prevalence of AT deficiency in each country is important to organize the public health policy. The aim of this study is to determine the prevalence of AT deficiency in Turkish population and to define the cutoff value of AT level in serum to detect heterozygous AT deficient subjects.

Materials And Methods: Serum samples from 1,203 healthy blood donors were used, attending the Blood Bank of Hacettepe Medical Faculty. Isoelectric focusing method for determining PIM, PIS, and PIZ alleles and rate immune nephelometry for measuring the level of AT in serum were used.

Results: Out of 1,203 healthy blood donors enrolled, 1,164 (%96.8) had normal variant PI MM allelee, 9 (%0.7) PI MZ, 7 (%0.6) PI MS, 6 (%0.5) MF, and 17 (%1.4) PI M? (unidentified variants with existing standards). Most individuals (89.6%) with low AT level (cutoff <100 mg/dl) in serum were positive for PI MM allele. The cutoff value to investigate PI MZ was 100.5 mg/dl, which had PPV and NPV of 5.0 and 99.9%, respectively. AT deficiency is a rare hereditary disorder in asymptomatic healthy Turkish blood donors. Although the cutoff value of 100.5 mg/dl for AT level in serum was able to detect heterozygous AT deficiency in the healthy population, this finding should be conformed to case-control studies.
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http://dx.doi.org/10.1002/jcla.20472DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6647731PMC
January 2012

Infantile fibrosarcoma: retrospective analysis of eleven patients.

Tumori 2011 Mar-Apr;97(2):166-9

Hacettepe University, Institute of Oncology, Department of Pediatric Oncology, Ankara, Turkey.

Aims And Background: Infantile fibrosarcomas are soft tissue sarcomas that are diagnosed at or soon after birth. In the present study, we retrospectively evaluated clinical characteristics, treatment modalities and outcome of patients diagnosed with infantile fibrosarcoma at our institution.

Methods: A retrospective review was conducted to evaluate demographic characteristics, presenting features, type and timing of surgery, other treatment modalities and survival characteristics.

Results: Nine males and 2 females were diagnosed with infantile fibrosarcoma between 1970-2008. The initial surgical procedure was subtotal resection in 4 patients, gross-total resection in 3 and biopsy in 4. Neoadjuvant chemotherapy was given to 10 patients. Three patients died, one for the disease and 2 from complications of therapy. Eight patients are under follow-up with no evidence of disease for 1.3 to 13.5 years. None of the patients in the series underwent amputation.

Conclusions: Owing to the chemosensitive nature of the tumor and possibility of spontaneous regression, neoadjuvant chemotherapy should be considered to prevent extensive or mutilating surgery.
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http://dx.doi.org/10.1700/667.7778DOI Listing
July 2011

Morphological and immunohistochemical features of malignant vascular tumors with special emphasis on GLUT1, and FKBP12 expressions.

Turk Patoloji Derg 2011 Jan;27(1):57-67

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

Objective: Angiosarcomas and hemangioendotheliomas are rare malignant vascular neoplasms (MVTs). Here, we reviewed the clinicomorphological characteristics of 27 MVTs with the implementation of two novel immunohistochemical markers: GLUT1, and FKBP12.

Material And Method: MVTs, except for Kaposi's sarcoma, were retrieved from the archive and reviewed. Tumor size, the presence of hemorrhage and necrosis, growth pattern, cellularity, cellular characteristics and mitotic activity were recorded as morphological variables. Immunohistochemically, CD34, CD31, GLUT1, FKBP12, Mdm2, p53, c-kit, and CD99 were applied. Clinical information was gathered from hospital records and computer-based patient data systems.

Results: The median age was 53 years (range 16-77). Extremities (37%) were the most common primary site followed by the head and neck. Five of 16 (31%) low grade and 7 of 11 (64%) high grade tumors were metastasized to varying organs, mainly the liver and lungs. The median survival was 49 months. Ninety percent of high grade tumors were larger than 3 cm. Hemorrhage and necrosis were seen in 85% and 41% of cases, respectively. Nuclear pleomorphism, cellularity and mitotic activity were higher in high grade tumors than in low grade ones (p < 0.0001). While 68% of the cases expressed CD34, 81% of them were positive with CD31. All cases except one low grade tumor were strongly and diffusely stained with FKBP12. Significant GLUT1 expression was observed in 23% of cases, especially in areas showing epithelioid morphology. Either Mdm2 or p53 was positive in over one third of the tumors.

Conclusion: The studied markers were not able to distinguish between low and high grade MVTs. FKBP12 may take a role in the diagnostic panel of MVTs. GLUT1 expression, previously proposed for the diagnosis of infantile hemangioma, should be assessed carefully since almost one quarter of MVTs were also GLUT1 positive.
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January 2011

Sacral mesenchymal chondrosarcoma in childhood: a case report and review of the literature.

Pediatr Hematol Oncol 2010 Oct;27(7):564-73

Department of Pediatric Oncology, Institute of Oncology, Hacettepe University, Ankara, Turkey.

Mesenchymal chondrosarcomas are rare malignant tumors in pediatric age group. The authors present a case of mesenchymal chondrosarcoma located in the sacrum in a 10-year-old-girl that was successfully treated with chemotherapy and radiotherapy after surgical excision. According to the authors' literature search, the patient is the first reported case of pediatric sacral primary mesenchymal chondrosarcoma. Mesenchymal chondrosarcoma cases in pediatric age group published in English literature was reviewed.
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http://dx.doi.org/10.3109/08880018.2010.503333DOI Listing
October 2010

Unilobar tapering cirrhosis in a patient with Caroli syndrome associated with an abnormal common bile duct.

Turk J Gastroenterol 2010 Mar;21(1):63-7

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

Caroli syndrome is a rare condition and is composed of congenital cystic dilatation of the biliary system and congenital hepatic fibrosis. Although many associated conditions are defined and hypothesized to occur concomitantly, due to the rarity of this syndrome, none has proven to be an essential component of this syndrome. In order to investigate a patient presenting with a cholestatic clinical picture, ultrasound, endoscopic retrograde cholangiopancreatography, abdominal computed tomography, liver biopsy, splenoportal venous angiography, and all available liver tests were performed. Upon typical findings, a diagnosis of Caroli syndrome was made and an orthotopic liver transplantation was performed. Investigation of the patient demonstrated multiple intracystic stones mimicking hemangiomatosis in the ultrasound; severe irregularity and narrowing in the main bile duct mimicking sclerosing cholangitis in the endoscopic retrograde cholangiopancreatography; partial portal vein thrombosis with irregularity in the portography; and a unilobar cirrhosis of the left liver lobe while the right lobe demonstrated only congenital hepatic fibrosis in the explanted liver. Caroli syndrome may be associated with main bile duct and portal vein abnormalities. Although the syndrome can be monolobar in nature, a cirrhotic left lobe sparing the right lobe, partially affected by the cirrhotic process, has never been defined. Here, we report a case of Caroli syndrome who had liver transplantation, with very rare and interesting findings of the explanted liver, such as tapering cirrhosis from the left lobe to the right lobe and countless stones in biliary cysts mimicking hemangiomas.
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http://dx.doi.org/10.4318/tjg.2010.0052DOI Listing
March 2010

Primary intracranial myxoma of the lateral skull base: a rare entity in clinical practice.

Turk Neurosurg 2010 Jan;20(1):86-9

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

Myxomas are rare benign tumors arising from mesenchymal tissues throughout the body. These tumors are usually seen in the atrium of the heart and the jawbone. Involvement of the skull base with intracranial extension is extremely rare, and only a few cases of primary intracranial myxomas have been described in the literature. A rare case of primary myxoma of the temporal bone is presented in this article. The patient underwent a skull base surgery with a pre-diagnosis of possible chondrosarcoma. The tumor pathology revealed a diagnosis of myxoma with bone and meningeal involvement. Despite the radical surgery, the tumor showed a local recurrence in three years. A second surgery with subtotal petrosectomy was required. In the article, the etiology, histological and radiological findings as well as treatment options of this rare entity were briefly discussed under the highlights of the relevant literature. Such a localization and intracranial extension of myxomas is extremely unusual in clinical practice; the diagnosis therefore requires a high degree of suspicion and detailed histopathological examination. The differential diagnosis frequently includes chondrosarcomas, chordoma, metastatic tumors of the skull, hemangiopericytoma, meningioma and other neoplasms of the dura and skull base in this location.
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January 2010

Antiangiogenic response after 70% hepatectomy and its relationship with hepatic regeneration and angiogenesis in rats.

Surgery 2010 Feb 11;147(2):288-94. Epub 2009 Dec 11.

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

Background: The aim of this study was to evaluate the antiangiogenic response and its relation to regeneration and angiogenesis after 70% hepatectomy in a rat model.

Methods: Sixty-four Wistar albino rats were included in the study. Animals were allocated into 8 groups (n = 8). After a 70% hepatectomy, liver regeneration, angiogenesis, and antiangiogenic response were evaluated in the remnant liver on days 0, 1, 2, 3, 5, 7, 10, and 14. Regeneration and angiogenesis were determined with immunoreactivity to proliferating cell nuclear antigen and vascular endothelial growth factor. Antiangiogenic response was evaluated by detecting collagen 18 m RNA with reverse transcriptase polymerase chain reaction.

Results: We showed that liver regeneration peaked at day 1, whereas angiogenesis in the periportal and perisinusoidal areas reached their peak values on days 3 and 7, respectively. Both regeneration and angiogenic activity around perisinusoidal hepatocytes returned to basal activity on the day 10. Antiangiogenic response first appeared on day 5, reached a peak on day 10, and returned to basal values on day 14.

Conclusion: Collagen18 mRNA expression is present in the normal liver during the regenerative process. We suggest that the stimulus that causes the cessation of regeneration process may come from hepatocytes, and collagen 18 produced by hepatocytes may modulate this event by inhibiting the angiogenesis.
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http://dx.doi.org/10.1016/j.surg.2009.10.015DOI Listing
February 2010