Publications by authors named "Koray Ceyhan"

39 Publications

A middle mediastinal schwannoma: A rare case report.

Turk Gogus Kalp Damar Cerrahisi Derg 2021 Apr 26;29(2):283-284. Epub 2021 Apr 26.

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

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http://dx.doi.org/10.5606/tgkdc.dergisi.2021.20195DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8167468PMC
April 2021

Contribution of small tissue biopsy and flow cytometry to preoperative cytological categorization of salivary gland fine needle aspirates according to the Milan System: Single center experience on 287 cases.

Diagn Cytopathol 2021 Apr 14;49(4):509-517. Epub 2021 Jan 14.

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

Background: Milan system for reporting salivary gland cytopathology (MSRSGC) was proposed to provide a standardized reporting system for salivary gland fine needle aspiration biopsies. Modified Menghini type semi-automatic aspiration biopsy needles provide small tissue fragments (STFs), as well as cellular smears, and immunohistochemical and molecular studies can be performed using the STFs.

Aims: We aimed to evaluate the contribution of STFs and ancillary techniques to pre-operative diagnosis of salivary gland lesions.

Materials And Methods: In this study, smears of 287 cases with histopathological correlation were re-reviewed and assigned to one of the MSRSGC categories. In the second step, histopathological and immunohistochemical findings in STFs were evaluated together with cytological findings. Final diagnoses were obtained with the inclusion of flow cytometry (FC) results when available. Risk of malignancy (ROM) was calculated for each diagnostic category.

Results: In the evaluation based on smears, a specific diagnosis could be obtained in 64.8% of the cases. ROMs were 0% for nondiagnostic (ND), 5.6% for non-neoplastic (NN), 55% for atypia of undetermined significance (AUS), 0.6% for benign neoplasm (BN), 27.8% for salivary gland neoplasm of uncertain malignant potential (SUMP), and 100% for suspicious for malignancy (SFM) and malignant (M) categories. With the addition of histopathological and immunohistochemical findings and FC results, a specific diagnosis could be obtained in 75.2% of the cases. ROMs were 0% for ND, 4.5% for NN, 53.8% for AUS, 0.6% for BN, 0% for SUMP, and 100% for SFM/M categories.

Conclusions: STFs contribute correct categorization of salivary gland lesions. The major contribution of ancillary methods is in the SUMP category.
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http://dx.doi.org/10.1002/dc.24698DOI Listing
April 2021

Transretinal biopsy via 23-gauge pars plana vitrectomy for retinal and choroidal tumors: cytopathological results, surgical complications, and patient outcomes.

Jpn J Ophthalmol 2021 Mar 9;65(2):250-260. Epub 2021 Jan 9.

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

Purpose: To evaluate the cytopathological results, surgical complications, and patient outcomes after transretinal biopsy (TRB) for diagnosis of retinal/choroidal tumors METHODS: Records of 40 cases who underwent TRB via 23-gauge (23 G) pars plana vitrectomy between March 2011 and March 2020 were reviewed.

Study Design: Retrospective.

Results: Twenty-six (65.0%) cases were women and 14 (35.0%) were men. The mean age at diagnosis was 57.2 (range: 18-83) years. The mean tumor base diameter was 12.0×9.8 mm and the mean tumor thickness was 4.9 mm. According to cytopathological examination, 29 (72.5%) cases had choroidal melanoma, 2 (5.0%) had non-small cell lung cancer metastasis, 1 (2.5%) had adenoma of retinal pigment epithelium, 1 (2.5%) had small cell lung cancer metastasis, 1 (2.5%) had invasive breast cancer metastasis, 1 (2.5%) had retinal astrocytic hamartoma, and 1 (2.5%) had pseudoneoplastic gliosis. Cytopathological examination of 4 (10.0%) cases revealed findings consistent with macular and extramacular degeneration. Postoperative complications were mild vitreous hemorrhage in 16 (40.0%) cases, gradually worsening cataract in 4 (11.8%), retinal detachment in 1 (2.5%), hyphema in 1 (2.5%), glaucoma in 1 (2.5%), and macular hole in 1 (2.5%). During the mean 11.1 (range: 1-55) months follow-up, 1 (3.4%) patient with choroidal melanoma developed liver metastasis. All patients were alive at the end of follow-up.

Conclusions: TRB using 23 G pars plana vitrectomy can be used to make the cytopathologic diagnosis of retinal/choroidal tumors whenever the clinical diagnosis is not certain or in cases with known diagnosis to obtain information on cell type/cytogenetics. In our series, the most common diagnosis after cytopathologic examination was choroidal melanoma.
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http://dx.doi.org/10.1007/s10384-020-00795-4DOI Listing
March 2021

The influence of thyroid nodule size on the diagnostic efficacy and accuracy of ultrasound guided fine-needle aspiration cytology.

Diagn Cytopathol 2019 Jul 12;47(7):682-687. Epub 2019 Mar 12.

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

Background: Diagnostic accuracy of fine-needle aspiration cytology (FNAC) in large and subcentimeter nodules is still debated. We aimed to evaluate the impact of nodule size on efficacy of the ultrasound-guided FNAC.

Methods: B-mode grayscale ultrasound (US), US-guided FNAC according to Bethesda system and histopathological data of 514 nodules from 371 patients, who underwent thyroidectomy were examined retrospectively. Nodules were grouped by maximal diameter; group A nodules were smaller than 10 mm (n = 59), group B nodules were between 10 and 29 mm (n = 218), and group C nodules were 30 mm or greater (n = 130).

Results: Sensitivity, specificity, and accuracy of FNAC was 92.0%, 100%, and 95.1% in group A, 80.7%, 99.1%, and %92.9 in group B, 70.0%, 98.9%, and 95.8% in group C nodules, respectively. The prevalence of papillary thyroid cancer (PTC) and incidental PTC were 44.2% (n = 164) and 6.4% (n = 24), respectively. Malignancy rate was more frequent in group A when compared to groups B and C (P < 0.01). Nodule size was positively associated with follicular cancer risk (P = 0.009). The thyroid stimulating hormone level was positively associated with malignancy (P = 0.02) and optimal cut-off value was 0.96 mIU/L. False-negative rate was 8.0%, 19.3%, and 30.0% in groups A, B, and C nodules, respectively.

Conclusions: Although the malignancy rate was low in nodules ≥30 mm, diagnostic surgery for large nodules should be considered because of decreased reliability of FNAC, ineffectiveness of clinical and sonographic criteria. False-negative rate was relatively low and malignancy rate was high in subcentimeter nodules, supporting the accuracy of FNAC.
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http://dx.doi.org/10.1002/dc.24170DOI Listing
July 2019

Diagnostic Value of S100p, IMP3, Maspin, and pVHL in the Differantial Diagnosis of Pancreatic Ductal Adenocarcinoma and Normal/chronic Pancreatitis in Fine Needle Aspiration Biopsy.

J Cytol 2018 Oct-Dec;35(4):247-251

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

Introduction: Differentiation between pancreatic ductal adenocarcinoma (PDAC) from benign mimickers is a well-known problem in cytological materials. Recent studies incorporated biological markers into this question and some studies showed that expression of S100P, IMP3, and maspin as well as nonexpression of von Hippel-Lindau gene product (pVHL) were significantly correlated with PDAC. In this study, we aimed to investigate diagnostic value of maspin, IMP3, S100P, and pVHL immunostaining in fine needle aspiration biopsies (FNABs) of pancreatic lesions.

Materials And Method: In all, 33 cases of FNAB cell blocks of PDAC and 34 cases of surgical non-neoplastic pancreas specimens which were retrieved from the archives slides from 2007 to 2011 were included in this study. All the cases were stained with maspin, IMP3, S100P, and pVHL. Expression patterns of markers were scored and compared with benign mimickers. Test performance of each antibody and possible antibody combinations were also evaluated.

Results: The study was composed of 33 PDAC and 34 control cases (8 chronic pancreatitis, 3 mucinous cystic neoplasm, and 23 nontumoral pancreatic tissue of PDAC). Diagnostic sensitivity for malignancy in S100P, IMP3, and maspin was 84.8%, 81.8%, and 87.5%, respectively. Specificity of these three markers was 100%. Sensitivity and specificity of pVHL for detecting nontumoral pancreatic tissue were 100% and 81.8%, respectively. When maspin, IMP3, and S100P expression were used together as triple test, sensitivity was 62.5% and specificity 100%. However, when any two of each three markers were evaluated (triple test/dual response), sensitivity reached 93.8% and specificity 100%.

Conclusion: We observed that dual response in triple test (positive staining with two of these three markers) of maspin, IMP3, and S100P immunocytochemistry is very sensitive and specific in differential diagnosis of PDA and non-neoplastic pancreatic lesions. pVHL may have an additional role, when triple assessment is not satisfactory.
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http://dx.doi.org/10.4103/JOC.JOC_18_17DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6210825PMC
December 2018

Are thyroid nodules with spongiform morphology always benign?

Cytopathology 2019 01 29;30(1):46-50. Epub 2018 Oct 29.

Department of Endocrinology and Metabolic Diseases, Ankara University Faculty of Medicine, Ankara, Turkey.

Objective: Fine needle aspiration (FNA) biopsy for evaluation of spongiform nodules ≥20 mm or observation without FNA was recommended by American Thyroid Association. However, this was a weak recommendation supported by moderate quality evidence. We aimed to assess malignancy risk in spongiform nodules.

Methods: From January 2015 to June 2016, an experienced endocrinologist performed B-mode greyscale ultrasonography and observed 96 spongiform nodules among 3748 ultrasound procedures. Power Doppler ultrasonography and ultrasound-guided FNA were performed to 96 spongiform nodules. Both colour elastography and strain ratio measurements of dominantly solid areas were performed.

Results: All spongiform nodules had benign cytology. Fifty-two (54.2%) nodules were ≥20 mm and 44 (45.8%) were smaller than 20 mm in maximum diameter. Presence of ultrasonography features related to malignancy was rare; 2% (n = 2) microcalcification, 9.4% (n = 9) taller than wide shape and 2% (n = 2) marked central blood flow were noted. None of the nodules had two or more suspicious features. Ultrasound elastography findings revealed that dominantly solid components of nodules were usually soft as 66.7% had an elasticity score 1 according to colour scale and mean strain ratio was 1.39 ± 0.99.

Conclusions: Follow-up with ultrasonography seems to be an efficacious method even for spongiform nodules larger than 2 cm. Determination of soft appearance according to colour map on ultrasound elastography and low strain ratio values of dominantly solid areas may be useful to avoid unnecessary biopsies.
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http://dx.doi.org/10.1111/cyt.12635DOI Listing
January 2019

Allogeneic stem cell transplantation for relapsed primary central nervous system lymphoma: Is it feasible?

Hematol Oncol Stem Cell Ther 2019 Dec 16;12(4):220-225. Epub 2018 Mar 16.

Ankara University School of Medicine, Department of Hematology, Cebeci, Ankara, Turkey.

Primary central nervous system lymphoma (PCNSL), has an aggressive course and in untreated patients median survival is limited to three months. For relapsed PCNSL, the treatment options are few and results are usually unsatisfactory. Allogeneic Hematopoietic Stem Cell Transplantation (allo-HCT) has been widely used for treatment of relapsed/refractory NHL patients. However there are limited data whether graft versus lymphoma effect can work in PCNSL patients. Here, we present a relapsed refractory PCNSL case treated by allo-HCT.
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http://dx.doi.org/10.1016/j.hemonc.2018.02.001DOI Listing
December 2019

An Unusual Cause of Oligoarthritis and Erythema Nodosum: Idiopathic Granulomatous Mastitis.

Arch Rheumatol 2017 Mar 13;32(1):71-75. Epub 2017 Jan 13.

Department of Dermatology and Venereology, Medical Faculty of Ankara University, Ankara, Turkey.

Idiopathic granulomatous mastitis (IGM) is an unusual benign inflammatory disease of breast. Breast cancer mimics IGM both radiologically and clinically. However, IGM is a benign disease and awareness of such an entity prevents unnecessary surgical procedures. Although its etiology is unknown, it may be an autoimmune disease. There are few patients reported in the literature presenting with reactive arthritis and/or erythema nodosum accompanying IGM of breast. Granulomatous mastitis should be considered as a possible underlying cause of arthritis and erythema nodosum. In this article, we report this interesting association of IGM as an underlying cause of arthritis and generalized erythema nodosum in a 32-year-old female patient. Comprehensive examination for granulomatous mastitis showed no apparent underlying cause. Indomethacin was beneficial in treatment of arthritis and erythema nodosum. Resistant IGM was responsive to colchicine treatment. Clinical management and therapeutic approach have been discussed in detail.
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http://dx.doi.org/10.5606/ArchRheumatol.2017.5952DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6190935PMC
March 2017

Diagnostic accuracy and safety of CT-guided fine needle aspiration biopsy of pulmonary lesions with non-coaxial technique: a single center experience with 442 biopsies.

Diagn Interv Radiol 2017 Mar-Apr;23(2):137-143

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

Purpose: We aimed to evaluate the diagnostic accuracy and safety of computed tomography (CT)-guided biopsy of pulmonary lesions with fine needle aspiration (FNA) using non-coaxial technique.

Methods: We analyzed 442 patients who underwent CT-guided lung biopsy with FNA and non-coaxial technique to determine the diagnostic outcomes, complication rates, and independent risk factors for diagnostic failure and pneumothorax.

Results: Diagnostic accuracy, sensitivity, and specificity were 97.6%, 97.3%, and 100%, respectively. Age and >35 mm lesion size were significant risk factors for diagnostic failure. The rates of pneumothorax and chest tube placement were 19% and 2.9%, respectively. Middle and lower lobe location, lesion to pleura distance >7.5 mm, and >45° needle trajectory angle were significant risk factors for pneumothorax.

Conclusion: CT-guided FNA of pulmonary lesions with non-coaxial technique is a safe and reliable method with a relatively low pneumothorax rate and an acceptably high diagnostic accuracy.
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http://dx.doi.org/10.5152/dir.2016.16173DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5338580PMC
September 2017

A case of acanthosis nigricans as a paraneoplastic syndrome with squamous cell lung cancer.

Onco Targets Ther 2016 3;9:4815-20. Epub 2016 Aug 3.

Medical Oncology Department, Hacettepe University Cancer Institute.

A 55-year-old man presented with oral mucosal ulcers, blackening of both hands, and hyperpigmentation on axillary, anal, and inguinal regions for the last 3 months, which were all progressive. The patient was referred to the oncology department with the diagnosis of acanthosis nigricans for investigation of an underlying malignancy. He was a smoker. A computed tomography scan of thorax revealed enlarged mediastinal lymphadenopathies and a lesion on the left upper lobe. Fine-needle aspiration biopsy of the mediastinal lesion was consistent with squamous cell carcinoma, and biopsies of the skin and oral mucosal lesion also further confirmed the diagnosis of acanthosis nigricans. After docetaxel and cisplatin chemotherapy, a significant improvement in his skin and mucosal lesions was observed with almost complete resolution of the pulmonary lesion and the mediastinal lymph nodes.
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http://dx.doi.org/10.2147/OTT.S95020DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4976921PMC
August 2016

Intranodal Palisaded Myofibroblastoma: Radiological and Cytological Overview.

Pol J Radiol 2016 22;81:342-6. Epub 2016 Jul 22.

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

Background: Intranodal palisaded myofibroblastoma is a benign and very rare mesenchymal neoplasm of the lymph nodes originating from differentiated smooth muscle cells and myofibroblasts.

Case Report: We report a case of intranodal palisaded myofibroblastoma in an 84-year-old woman with Parkinson's disease that presented as a left inguinal mass. The diagnosis was made using ultrasound-guided fine needle aspiration biopsy and consequent cytopathological examination that included immunohistochemical analysis. Herein, we discuss the presentation of a rare intranodal palisaded myofibroblastoma with emphasis on its ultrasonographic and cytopathologic features.

Conclusions: Intranodal palisaded myofibroblastoma should be considered in the differential diagnosis of inguinal lymphadenopathy and the diagnosis is possible with cytopathologic exam and immunohistochemical analysis using ultrasound-guided FNA biopsy, guiding the clinician to nodal excision rather than aggressive measures.
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http://dx.doi.org/10.12659/PJR.895743DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4959455PMC
August 2016

Aspergillus Thyroiditis after Allogeneic Hematopoietic Stem Cell Transplantation.

Case Rep Hematol 2015 12;2015:537187. Epub 2015 Nov 12.

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

Aspergillus thyroiditis is a rare disorder detected in immunocompromised patients during disseminated infections. Early management is essential to prevent high mortality. A 61-year-old allogeneic stem cell male recipient presented with painful thyroid nodular enlargement. He had low TSH and low free T4 levels. The thyroid ultrasound showed a hypoechoic nodule; biopsy indicated suppurative Aspergillus thyroiditis. He was successfully treated by amphotericin B.
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http://dx.doi.org/10.1155/2015/537187DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4660011PMC
December 2015

Mediastinal schwannoma with atypical localization diagnosed by endobronchial ultrasound.

Clin Respir J 2017 Nov 13;11(6):739-742. Epub 2016 Jan 13.

Department of Chest Disease, Ankara University School of Medicine, Ankara, Turkey.

Introduction: Schwannoma is a peripheral nerve sheath tumor usually originating from the posterior mediastinum. Because schwannomas can exhibit high fluorodeoxyglucose uptake on positron emission tomography, they cannot be distinguished from malignant tumors.

Objectives: We present this case to stress the importance of endobronchial ultrasonography in the diagnosis of intrapulmonary masses with rare occurrence and different localization.

Methods: A patient was referred to our clinic for further workup of a soft tissue mass in the anterior mediastinum and diagnosed with a benign schwannoma by endobronchial ultrasonography.

Results: The diagnosis is thus largely based on pathological examination. Until today schwannomas have been diagnosed by pathology examination of lesions excised surgically for suspected malignancy.

Conclusion: This article was reported since intrapulmonary schwannoma is a very rare tumor and this was the first case of an anterior mediastinal schwannoma diagnosed by endobronchial ultrasonography.
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http://dx.doi.org/10.1111/crj.12410DOI Listing
November 2017

Secondary Neoplasms in Children with Hodgkin's Lymphoma Receiving C-MOPP and Radiotherapy: Presentation of Four Cases.

Turk J Haematol 2016 Mar 6;33(1):66-70. Epub 2015 Aug 6.

Kemer Sk. No: 21/78 Büyükesat, Ankara, Turkey. E-mail:

Patients who survive Hodgkin lymphoma (HL) are at increased risk of secondary neoplasms (SNs). A wide variety of SNs have been reported, including leukemias, non-Hodgkin's lymphomas, and solid tumors, specifically breast and thyroid cancers. Herein we report subsequent neoplasms in four patients with HL receiving chemoradiotherapy. It is interesting that three SNs, fibrosarcoma, thyroid carcinoma, and retrobulbar meningioma, were observed in the radiation area in one of our patients. A hypopharyngeal epithelioid malignant peripheral nerve sheath tumor as an unusual secondary malignant neoplasm developed in another patient, while a benign thyroid nodule and invasive ductal breast carcinoma were observed at different times in the female patient. Follicular adenoma of the thyroid gland developed in one of our patients.
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http://dx.doi.org/10.4274/tjh.2015.0027DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4805347PMC
March 2016

Intrathyroidal Ectopic Thymus in Children: Retrospective Analysis of Grayscale and Doppler Sonographic Features.

J Ultrasound Med 2015 Sep 12;34(9):1651-6. Epub 2015 Aug 12.

Departments of Pediatric Radiology (A.E.Y., S.F.), Pathology, Division of Clinical Cytology (K.C.), Pediatric Endocrinology (Z.S., P.B., M.B.), and Pediatric Surgery (E.A.Y.), Faculty of Medicine, Ankara University, Ankara, Turkey.

Objectives: The purpose of this study was to define grayscale and color Doppler sonographic features of an ectopic intrathyroidal thymus and to differentiate it from other thyroid nodule etiologies.

Methods: We retrospectively reviewed imaging findings from 30 children who had a diagnosis of an ectopic intrathyroidal thymus from November 2005 to January 2013. Nodular thyroid lesions that were enclosed by the thyroid parenchyma and showed a typical echo pattern consistent with the thymus were accepted as the enclosed form of an intrathyroidal ectopic thymus. Eleven of these 30 children had an intrathyroidal ectopic thymus enclosed by the thyroid parenchyma, and they were enrolled in the study. The recorded sonograms were reviewed according to side, location, size, shape, echo pattern, internal content, and vascularization.

Results: The enclosed forms of ectopic intrathyroidal thymuses were unilateral in all children and located in the mid portion (n = 10) or lower portion (n = 1). All lesions were well demarcated, and the most common shape was fusiform (n = 8). Nine lesions showed a typical hypoechoic echo pattern with internal linear and punctate echoes resembling a mediastinal thymus. On color Doppler imaging, 6 lesions showed hypovascularity compared to the thyroid parenchyma, and 5 lesions showed internal vascularity.

Conclusions: Unique sonographic features of the enclosed form of an ectopic intrathyroidal thymus, including a hypoechoic echo pattern with multiple linear and punctate echoes, a fusiform shape, a well-demarcated contour, and a mid- or low-lying location with hypovascularity or internal vascularity, can help radiologists differentiate it from other thyroid nodule etiologies.
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http://dx.doi.org/10.7863/ultra.15.14.10041DOI Listing
September 2015

Idiopathic Pulmonary Hemosiderosis With Allergic Asthma Diagnosis in a Pediatric Patient.

J Pediatr Hematol Oncol 2015 Oct;37(7):e435-7

Departments of *Pediatrics †Pediatric Hematology ‡Pathology, Ankara University School of Medicine, Dikimevi, Ankara, Turkey.

Idiopathic pulmonary hemosiderosis (IPH) is a rare disorder with unknown pathogenesis that usually presents in the first decade of life. As a result of diffuse alveolar hemorrhage, respiratory symptoms such as cough attacks, hemoptysis, dyspnea, and recurrent and refractory iron-deficiency anemia (IDA) are observed. We present an 8-year-old girl who was followed up with recurrent IDA and allergic asthma and later diagnosed with IPH. IPH was confirmed by the presence of hemosiderin-laden macrophages in bronchoalveolar lavage obtained by bronchoscopy and exclusion of the secondary causes of pulmonary hemosiderosis. Glucocorticoids and iron supplementation were started. Clinical and laboratory improvement was observed with therapy. Our case illustrates that refractory/recurrent IDA with any pulmonary symptoms may be the only presenting feature of IPH.
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http://dx.doi.org/10.1097/MPH.0000000000000412DOI Listing
October 2015

Electromagnetic navigation-guided TBNA vs conventional TBNA in the diagnosis of mediastinal lymphadenopathy.

Clin Respir J 2015 Apr 20;9(2):214-20. Epub 2014 Mar 20.

Department of Chest Diseases, Ankara University School of Medicine, Ankara, Turkey.

Objectives: Conventional transbronchial needle aspiration (C-TBNA) is a safe method for the diagnosis of hilar and mediastinal lymphadenopathy (MLN). However, diagnostic yield of this technique varies considerably. Electromagnetic navigation bronchoscopy (ENB) is a new technology to increase the diagnostic yield of flexible bronchoscopy for the peripheral lung lesions and MLN. The aim of this prospective study was to compare the diagnostic and sampling success of ENB-guided TBNA (ENB-TBNA) in comparison with C-TBNA while dealing with MLN.

Methods: Consecutive patients with MLN were randomized into two groups - C-TBNA and ENB-TBNA - using a computer-based number shuffling system to avoid recruitment bias. Procedures were performed in usual fashion, published previously.

Results: Ninety-four cases (M/F: 45/49) with a total of 145 stations of MLN were enrolled in the study. In 44 patients, 81 stations were sampled by ENB-TBNA, and in 50 patients 64 stations by C-TBNA. The mean size of MLN in study subjects was 17.56 ± 6.25 mm. The sampling success was significantly higher in ENB-TBNA group (82.7%) compared with C-TBNA group (51.6%) (P < 0.005). Defined by histopathological result, the diagnostic yield in ENB-TBNA was 72.8%, and 42.2% with C-TBNA (P < 0.005). For subcarinal localization, sampling or diagnostic success was higher in ENB-TBNA than that of C-TBNA (P < 0.05). Based on the size of the MLN ≤15 mm or >15 mm, the sampling success of ENB-TBNA was also significantly higher than C-TBNA in both subgroups (P < 0.005 and P < 0.005, respectively). No serious complication was observed.

Conclusion: In this study comparing ENB-TBNA and C-TBNA, the sampling and diagnostic success of ENB-TBNA was found to be superior while dealing with MLN, in all categories studied.
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http://dx.doi.org/10.1111/crj.12126DOI Listing
April 2015

The evaluation of thyroid carcinoma in childhood and concomitance of autoimmune thyroid disorders.

J Pediatr Endocrinol Metab 2014 Sep;27(9-10):901-8

Autoimmune thyroiditis has been suggested as a precancerous condition in some adult studies, but there is still controversy. The importance of autoimmune thyroiditis in childhood thyroid cancer is not yet completely clear. We aimed to evaluate in this study the characteristics of childhood thyroid cancer in patients particularly in terms of coexisting factors including autoimmune thyroid disorders (ATD). Twenty patients diagnosed with primary thyroid cancer were evaluated retrospectively in a Pediatric Endocrinology clinic for 10 years. Patients were followed up for 57.22±11 months. Concomitant conditions (thyroidal and/or extra thyroidal) were determined. Most of the patients (80%) had a coexisting factor. ATDs are the most frequently encountered among them (40%). The ages at the time of diagnosis were older; and the tumor sizes were smaller in patients with concomitant ATDs than without autoimmune thyroid disorders. The follow-up characteristics were similar in both groups. In conclusion, ATDs are frequently encountered in association with thyroid cancer during childhood and adolescence. A thyroid autoimmunity may facilitate the development of a malignant thyroid tumor; on the other hand, increased attention to the thyroid gland may facilitate frequent diagnosis of thyroid cancer. A close follow-up of ATD patients should also include the evaluation of the development of thyroid malignancy.
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http://dx.doi.org/10.1515/jpem-2013-0273DOI Listing
September 2014

Acute suppurative thyroiditis following fine-needle aspiration biopsy in an immunocompetent patient.

J Clin Ultrasound 2014 May 26;42(4):215-8. Epub 2013 Jul 26.

Department of Endorinology and Metabolism, Ankara University School of Medicine, Sihhiye, 06100, Ankara, Turkey.

The thyroid gland is remarkably resistant to infectious agents owing to several protective mechanisms. Acute suppurative thyroiditis after fine-needle aspiration (FNA) in an immunocompetent patient is very rare. We report the case of a 50-year-old immunocompetent male patient who presented with painful cervical swelling, fever, and chills after an FNA of the thyroid. His physical and laboratory examination suggested an acute suppurative thyroiditis. Repeat FNA results were consistent with thyroid abscess. Physicians should be aware of the probability of acute bacterial thyroiditis after FNA.
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http://dx.doi.org/10.1002/jcu.22077DOI Listing
May 2014

Intraabdominal follicular dendritic cell sarcoma: a report of three cases and review of the literature.

Tumori 2013 Mar-Apr;99(2):e65-9

Department of Medical Oncology, Ankara University Faculty of Medicine, Ankara, Turkey.

Follicular dendritic cell sarcoma (FDCS) is a rare neoplasm that originates from follicular dendritic cells in lymphoid follicles. FDCS has been increasingly reported in recent years. However, data on FDCS are mostly based on single case reports or case series and its natural history and standard treatment are not clear. To increase the understanding of this rare disease, we report our experience of three cases of FDCS with an analysis of the morphological and immunophenotypic characteristics, clinical course, treatment options and response to treatment. In addition, we reviewed the literature on FDCS.
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http://dx.doi.org/10.1700/1283.14210DOI Listing
August 2013

Evaluation of vascular endothelial growth factor A and endostatin levels in induced sputum and relationship to bronchial hyperreactivity in patients with seasonal allergic rhinitis.

Am J Rhinol Allergy 2013 May-Jun;27(3):181-6

Division of Immunology and Allergic Diseases, Department of Chest Diseases, Ankara University, School of Medicine, Ankara, Turkey.

Background: Studies about the pathogenesis of bronchial hyperreactivity (BHR) in patients with allergic rhinitis (AR) and its relationship with lower airway remodeling are extremely limited. In this study, bronchial vascular remodeling and its relationship with BHR were evaluated by measurement of vascular endothelial growth factor A (VEGF-A) and endostatin in patients with seasonal AR (SAR).

Methods: The study group consisted of 30 patients with SAR (positive skin test to grass pollens) and 14 healthy controls. Induced sputum and bronchial provocation test (BPT) to methacholine (M) were performed in season. VEGF-A and endostatin levels were measured by ELISA in induced sputum supernatant.

Results: The percentages of eosinophils in induced sputum were significantly increased in BHR+ patients (n = 10) with SAR compared with BHR(-) patients (n = 20) with SAR (p < 0.001). There was no correlation between eosinophils and provocative concentration of M required to produce a 20% decrease in forced expiratory volume in 1 second. The levels of VEGF-A were significantly higher in SAR patients with BHR than in SAR patients without BHR and healthy controls (respectively, p = 0.014 and p = 0.04). The levels of endostatin were significantly lower in SAR patients with BHR than in SAR patients without BHR and healthy controls (respectively, p = 0.020 and p = 0.014). The ratio of VEGF-A/endostatin was significantly higher in SAR patients with BHR than in SAR patients without BHR and healthy controls (respectively, p = 0.009 and p = 0.019).

Conclusion: In this first study comparing the VEGF-A and endostatin levels of patients with SAR in sputum supernatant, the presence of BHR was shown to be associated with the vascular component of remodeling "angiogenesis."
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http://dx.doi.org/10.2500/ajra.2013.27.3867DOI Listing
December 2013

Rapid on-site evaluation and low registration error enhance the success of electromagnetic navigation bronchoscopy.

Ann Thorac Med 2013 Jan;8(1):28-32

Department of Chest Diseases, Ankara University School of Medicine, Ankara, Turkey.

Background: Electromagnetic navigation bronchoscopy (EMN) is a novel technology which allows localizing peripheral lung lesions and mediastinal lymph nodes for sampling and thus increasing diagnostic yield of Flexible Bronchoscopy.

Objectives: A prospective study was conducted to investigate the diagnostic yield of EMN with lower average fiducial target registration error (AFTRE) and rapid on-site evaluation (ROSE).

Methods: Consecutive patients with peripheral lung lesion (PL) or enlarged mediastinal lymph node (MLN) which could not be diagnosed by conventional techniques and/or if the patients were not suitable for such interventions were included. The navigation procedure was continued once registration error was reached below/equal to the absolute value of 5 mm. ROSE was performed by an expert cytopathologist.

Results: A total of 76 patients; 22 having only PLs, 41 having only MLNs, and 13 having both PLs and MLNs together were enrolled. Thirty-two of 35 PLs (91.4%) and 85 of 102 MLNs (83.3%) were successfully sampled. Overall diagnostic yield was 89.5%. PLs and MLNs were further grouped according to their size (PLs: <20 mm vs ≥20 mm, MLNs: <15 mm vs ≥15 mm). The sampling yield was independent of size for both PL and MLN (P = 1.00, P = 0.38). In diagnostic EMN cases, mean AFTRE was 4.33 ± 0.71 mm, whereas it was 5.16 ± 0.05 mm (P = 0.008) in nondiagnostics. The total duration of procedure was 36.17 ± 9.13 min. Pneumothorax was observed in three patients (3.9%).

Conclusion: EMN with low AFTRE in combination with ROSE is a reliable method with high sampling and/or diagnostic rate in PLs and MLNs.
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http://dx.doi.org/10.4103/1817-1737.105716DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3573554PMC
January 2013

The role of cytopathology in diagnosing HPV induced oropharyngeal lesions.

Diagn Cytopathol 2012 Sep 22;40(9):839-43. Epub 2011 Jun 22.

Department of Pathology, Moti Lal Nehru Medical College, 16/2 Lowther Road, Allahabad, India.

HPV detection in fine needle aspirates from suspected head and neck metastasis may be useful in clinching the diagnosis of HPV related oral squamous cell carcinoma. Ascertaining the HPV status of a particular tumor on cytological specimens could be useful for prognostication as HPV-related tumors appear to have a better prognosis and clinical outcome. The various techniques of detection are reviewed.
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http://dx.doi.org/10.1002/dc.21756DOI Listing
September 2012

Epithelioid angiosarcoma.

Acta Cytol 2010 Jan-Feb;54(1):109-12

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http://dx.doi.org/10.1159/000324982DOI Listing
April 2010

Congenital absence of portal vein associated with nodular regenerative hyperplasia of the liver and pulmonary hypertension.

Clin Imaging 2009 Jul-Aug;33(4):322-5

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

We present a 15-year-old girl with congenital absence of the portal vein, pulmonary arterial hypertension and multiple liver lesions proven to be nodular regenerative hyperplasia with biopsy. Ultrasonography, computed tomography, and magnetic resonance imaging findings of the liver lesions and Type I portosystemic shunt are presented.
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http://dx.doi.org/10.1016/j.clinimag.2008.12.011DOI Listing
September 2009

Fine needle aspiration biopsy features with histologic correlation in mediastinal hepatoid yolk sac tumor presenting with sternum metastasis: a case report.

Acta Cytol 2007 Jul-Aug;51(4):610-5

Division of Clinical Cytology, Department of Pathology, Faculty of Medicine, Ankara University, Turkey.

Background: The hepatoid variant of yolk sac tumor (H-YST) is an exceedingly rare and highly malignant neoplasm. We present and discuss our experience with cytologic and histopathologic features of a mediastinal H-YST presenting with sternum metastasis, which to the best of our knowledge has not been previously reported.

Case: A 38-year-old man presented with a large mass on the sternum. Computed tomography of the thorax showed a large anterior mediastinal mass with sternum metastsis and multiple lung metastases. Laboratory examination revealed elevated serum alpha-fetoprotein (60,000 IU/mL). No tumor was found in the other organ systems. A percutaneous fine needle aspiration biopsy and subsequent open surgical biopsy were performed on the sternum metastasis. Cytologically, the tumor was composed of monotonous, large, round to polygonal hepatoid cells forming solid sheets and trabeculae entrapped with endothelial cells resembling hepatocellular carcinoma. Histopathologic sections of tumor showed tumor cells with eosinophilic to clear cytoplasm arranged in a solid, trabecular growth pattern, with some acinar formations. Immunohistochemical study supported the hepatoid origin.

Conclusion: Fine needle aspiration cytology, together with the characteristic clinical presentations and specific tumor markers, is crucial to the initial diagnosis of H-YST.
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http://dx.doi.org/10.1159/000325809DOI Listing
September 2007

Lupus mastitis is not a surgical disease.

Breast J 2007 Mar-Apr;13(2):187-8

Department of Surgery, Section of Surgical Oncology, Ankara University School of Medicine, Ankara, Turkey.

A 23-year-old woman with a 2-year history of discoid lupus (SLE) presented with a right lateral upper quadrant breast mass. Physical examination revealed a 5 cm irregular, hard lesion suggestive of a breast malignancy. Ultrasound-guided fine needle aspiration biopsy of the mass confirmed the diagnosis as lupus mastitis. Differential diagnosis of a breast mass in a patient with SLE must include the possibility of lupus mastitis. Surgical resection is usually not necessary, and medical treatment can be implemented successfully.
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http://dx.doi.org/10.1111/j.1524-4741.2007.00402.xDOI Listing
April 2007

Alpha fetoprotein producing gastric hepatoid adenocarcinoma.

J Pak Med Assoc 2006 Jun;56(6):292-4

Department of Medical Oncology, Ankara University School of Medicine.

Gastric carcinoma generally as presents adenocarcinoma and rarely shows a hepatoid pattern, it may or not produce alpha-fetoprotein. The interpretation of the lesion may be difficult in a patient with a hepatic mass and raised alpha-fetoprotein level. A 51 year old man with hepatoid adenocarcinoma in stomach, producing alpha-fetoprotein is presented.
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June 2006