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Amaç: Çalışmamızda lokal ileri evre rektum kanseri tanısı alanhastalarda, neoadjuvan tedavi öncesi serum Karsionoembriyonik Antijen (CEA)düzeyleri ile neoadjuvan tedaviye yanıt ölçütleri arasındaki birlikteliğideğerlendirmeyi amaçladık.Gereçler ve Yöntem: 1993-2009 yılları arasında lokal ileri rektum kanseri tanısıalıp takipleri Dokuz Eylül Üniversitesi Tıp Fakültesi’nde yapılan 138 hastaincelendi. Tüm hastalara toplam 45-50 Gy dozunda (20-25 günde) preoperatifradyoterapi uygulandı ve eş zamanlı 5-Fluorouracil (225mg/m2/gün, haftanın 5günü) kemoterapisi verildi. Neoadjuvan tedavi sonrası 6-8 hafta içerisindehastalar total mezorektal eksizyon tekniği ile opere edildi. Neoadjuvan tedaviöncesi hastalardan çalışılan serum CEA düzeyleri, neoadjuvan tedaviye yanıtölçütleri ile birlikte değerlendirildi.Bulgular: Ortalama izlem süresi 42 ay olan hastaların ortalama yaşının58 ± 13 ve 89 (%64,5)’unun erkek olduğu belirlendi. Preoperatif evrelerinebakıldığında, 24’ü evre II (%17,4), 114’ü evre III (%82,6) olarak bulundu. 83(%60,1) hastaya sfinkter Koruyucu Cerrahi (SKC) yapılırken diğer hastalara AbdominoperinealRezeksiyon (APR) uygulandı. Postoperatif 8 (%5,8) hastada patolojik tam yanıtsaptandı. Hastaların 86’sında (%62,3) neoadjuvan tedavi sonrası evre gerilemesisaptandı. Ortalama CEA değeri 11,1 ± 23,6 ng/ml (dağılım; 0,32-202ng/ml) idi.74 hastanın (%53,6) CEA düzeyi ≤5 ng/ml olarak kaydedildi. İzlemde 19 hastadalokorejyonel nüks saptandı. Neoadjuvan tedavi öncesi CEA düzeyi 3,5 ng/mLaltında olan hastalarda lokorejyonel nüks sıklığı istatistiksel olarak anlamlışekilde daha düşüktü. Neoadjuvan tedaviye yanıtlılarda genel sağ kalım 127±13ay (p

Amaç: Çalışmamızda lokal ileri evre rektum kanseri tanısı alan hastalarda, neoadjuvantedavi öncesi serum Karsionoembriyonik Antijen (CEA) düzeyleri ile neoadjuvantedaviye yanıt ölçütleri arasındaki birlikteliği değerlendirmeyi amaçladık.Gereçler ve Yöntem: 1993-2009 yılları arasında lokal ileri rektum kanseri tanısı alıptakipleri Dokuz Eylül Üniversitesi Tıp Fakültesi’nde yapılan 138 hasta incelendi. Tümhastalara toplam 45-50 Gy dozunda (20-25 günde) preoperatif radyoterapi uygulandıve eş zamanlı 5-Fluorouracil (225mg/m2/gün, haftanın 5 günü) kemoterapisi verildi.Neoadjuvan tedavi sonrası 6-8 hafta içerisinde hastalar total mezorektal eksizyontekniği ile opere edildi. Neoadjuvan tedavi öncesi hastalardan çalışılan serum CEAdüzeyleri, neoadjuvan tedaviye yanıt ölçütleri ile birlikte değerlendirildi.Bulgular: Ortalama izlem süresi 42 ay olan hastaların ortalama yaşının 58 ± 13 ve 89(%64,5)’unun erkek olduğu belirlendi. Preoperatif evrelerine bakıldığında, 24’ü evre II(%17,4), 114’ü evre III (%82,6) olarak bulundu. 83 (%60,1) hastaya sfinkter KoruyucuCerrahi (SKC) yapılırken diğer hastalara Abdominoperineal Rezeksiyon (APR)uygulandı. Postoperatif 8 (%5,8) hastada patolojik tam yanıt saptandı. Hastaların86’sında (%62,3) neoadjuvan tedavi sonrası evre gerilemesi saptandı. Ortalama CEAdeğeri 11,1 ± 23,6 ng/ml (dağılım; 0,32-202ng/ml) idi. 74 hastanın (%53,6) CEA düzeyi≤5 ng/ml olarak kaydedildi. İzlemde 19 hastada lokorejyonel nüks saptandı.Neoadjuvan tedavi öncesi CEA düzeyi 3,5 ng/mL altında olan hastalarda lokorejyonelnüks sıklığı istatistiksel olarak anlamlı şekilde daha düşüktü. Neoadjuvan tedaviyeyanıtlılarda genel sağ kalım 127±13 ay (p

Introduction. We discuss a rare gastrointestinal stromal tumor (GIST) case detected at the 10th postpartum week and we want to pay attention to the challenges and improvements in the diagnosis, surgery, chemotherapy, and follow-up of this rare tumor accompanied with the review of the current literature. Case Presentation. A 32-year-old multiparous woman presented with abdominal swelling 10 weeks after her second vaginal birth. Abdominal examination revealed a mass starting from the pelvic level and extending to the right upper quadrant. Radiological examinations showed a solid, multiloculated, and hypervascular mass starting from the pelvis and extending to the transverse colon. En bloc mass with a 20 cm jejunal segment resection and a left pelvic side wall peritonectomy with omentectomy was performed. The pathologic examination revealed a high-risk GIST which originated from the jejunum and disseminated to the peritoneum. The patient has been given imatinib 400 mg/day since then. She did not reveal any progression during the 15-month follow-up postoperatively. Conclusion. GIST tumors are rare and there is not sufficient information in the literature regarding its management. In this patient having high risk GIST and GIST sarcomatosis we successfully treated the patient by surgery and adjuvant imatinib chemotherapy.

In this paper, we present our initial natural orifice transluminal endoscopic surgery (NOTES) experience through video of a transvaginal appendectomy. Our experience demonstrated that pure NOTES appendectomy by transvaginal access is a safe and well tolerated procedure which can be performed also in emergency conditions.

© Pioneer Bioscience Publishing Company.Background: Colorectal cancer has a heterogeneous nature that is influenced by the tumour site. Many improvements have been made in identifying and characterizing the genetic alterations between colon and rectal cancers. However, there is not enough information about KRAS mutational differences between rectosigmoid and colon cancers arising elsewhere in the large bowel. The aim of this study was to determine the differences in the frequency of KRAS genetic alterations between rectosigmoid cancers and colon cancers. Methods: Eighty-four patients diagnosed with colorectal cancer were included in this study. Genomic DNA was extracted from formalin-fixed paraffin-embedded tumour tissue sections. KRAS mutation analysis which was designed to detect the seven most common KRAS gene mutations (Gly12Ala, Gly12Asp, Gly12Arg, Gly12Cys, Gly12Ser, Gly12Val and Gly13Asp) was performed. Chi-square test was used to test the association between mutation status and other variables. Results: This study represents the first KRAS mutational results from Turkish rectosigmoid cancer patients. The KRAS mutation frequency of rectosigmoid tumours is higher (34.3%, 12/35) than that of colon-localized tumours (30.6%, 15/49). However, there is no significant correlation between the KRAS mutation status and tumour location (rectosigmoid and colon). Conclusions: KRAS mutation analysis has a predictive and prognostic value in identifying tumours that may be resistant to treatment. Our study shows that differences in the biological behaviour of rectosigmoid and colon cancers should be considered. This finding highlights the importance of personalized cancer management, which could be assisted by cancer genotyping tools.

The prognostic value of KRAS and BRAF mutation in colorectal cancer (CRC) is very consistent. Several studies have demonstrated an association between these gene mutations and resistance to anti-EGFR based therapies. Wild type KRAS and BRAF is required for a response to CRC therapy. The aim of this study is to identify the frequency of KRAS and BRAF gene mutations in a series of Turkish CRC patients and to evaluate the relationship between the mutations and demographic features in the Turkish population. KRAS and BRAF mutations were analyzed in 220 colorectal tumor tissues. The mutation assays were performed with genomic DNA using automated microarray-based genotyping technology (Autogenomics Inc., Infinity Biofilm Chip Microarray, KRAS-BRAF Assay). Statistical analyses of the data were performed using SPSS (SPSS/Windows version 19.0, SPSS Inc., Chicago, IL, USA). In total, 33.2% of patients possessed a mutant KRAS genotype, and 6.7% of patients harbored BRAF mutations. The most common KRAS mutations were Gly12Asp and Gly12Val. All of the BRAF mutations were V600E. Patients with KRAS mutations did not harbor BRAF mutation. Female patients displayed an increased KRAS mutation frequency compared with male patients (P value = 0.027). KRAS and BRAF gene alterations may determine the therapeutic response to anti-EGFR treatments. The utility of these markers was clarified by correlating genotyping studies with demographics and clinical findings. Cancer mutation profiles are influenced by cultural life style, environment and race/ethnicity. Genotype analysis could be used to select patients eligible for treatment. Patients should be classified according to genotypic subgroups for the selection of therapeutic agents.

Introduction. Carcinoid tumors are low-grade tumors originating from endoderm and mostly involving the gastrointestinal system. However; they may be seen in any site within the gastrointestinal system. Case Presentation. A 69-year-old female patient. The results of blood tests were observed to be consistent with obstructive jaundice. A mass appearance was not encountered on tomographic examination. Papilla that was tumor-like macroscopically was seen in the second part of the duodenum in diagnostic endoscopy. Pylorus—preserving pancreaticoduodenectomy surgical procedure was applied. On pathological examination of the mass, a tumoral mass was detected in ampulla vateri localization, 1.5 × 1 × 0.8 cm in size, which, in immunohistochemical staining, was evaluated as a neuroendocrine tumor. Also, Metastasis was observed. Conclusion. The rarest type of carcinoid tumor is ampullary located carcinoid tumor, and tumor size is not a reliable indicator for tumor aggressivity in ampullary carcinoid tumors.