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OBJECTIVE: Cancer-related inflammation affects many aspects of malignancy, including proliferation and survival of malignant cells, angiogenesis, and therapeutic response. Some biomarkers representing the degree of systemic inflammation, such as the Glasgow prognostic score, NLR and PLR, have been shown to have prognostic value in many kinds of cancer patients. Aim of this study to investigate to compare neutrophil/leukocyte (NLR) and platelet/lymphocyte (PLR) ratios of the patients with colorectal neoplastic polyps and colorectal cancer (CRC) and tried to determine whether this could be used as a biomarker in follow up of the patients with neoplastic polyps. PATIENTS AND METHODS: A total of 100 colorectal polyps, 113 colorectal cancers and 124 healthy controls were included in the study. Exculusion criteria were endocrinologic or metabolic diseases, acute or chronic diseases, hypertension and atherosclerotic heart diseases, renal diseases. Blood count parameters of the patients were measured. The NLR was calculated as a simple ratio between the absolute neutrophil and the absolute lymphocyte counts. The PLR was defined as the platelet counts to lymphocyte ratio. RESULTS: A statistically significant difference was not detected between Group A and C with regard to NLR and PLR. NLR and PLR were found statistically significantly high in Group B (CRC), Group A (colorectal polyp) and Group C (healthy individuals) (p < 0.001 and p < 0.001). Our study showed that the optimum NLR cut- off point for neoplastic polyps was 2.28 (sensitivity: 68.7%, specificity: 42.3%). When the sensitivity and specificity levels of the PLR were assessed, they were 68.7% and 46.5% for neoplastic polyps, 80% and 68.9% for colorectal cancer. CONCLUSIONS: NLR and PLR may be used for follow up conversion of colonic and rectal neoplastic polyps to invasive tumor. [ABSTRACT FROM AUTHOR]

Distraction osteogenesis technique has been successfully applied in the craniofacial area for long time, and it is being applied increasingly more in cleft lip and palate patients also. Especially in large cleft palate cases, bone grafting or surgical procedures such as distraction osteogenesis can be applied in order to ensure a smooth alveolar arc. In this literature review, alveolar (segmental) distraction osteogenesis applications in patients with cleft lip and palate, indications of the technique, advantages and disadvantages, application methods and types of appliances used for this purpose have been evaluated. As conclusion, especially with the application of alveolar (segmental) distraction osteogenesis, successful outcome can be achieved in cleft lip and palate patients with velopharyngeal insufficiency, maxillary hypoplasia and maxillary crowding, and this technique may be an alternative to conventional osteotomies and extraoral distractions.

A developing country may have two different paths aimed at industrialization policies according to it’s foreign trade perspective. The first one is import substitution industrialization based on protectionism and the second one is the policy of export-oriented industrialization aimed at integration in the international economy. Export-oriented industrialization is a strategy related to the world for connecting local economy to global economy. At the same time, countries that have to shape their allocation of resources according to foreign demand are compulsory to be open for international trade. The reason is that this strategy reaches to success if developed countries open their markets to developing or less developed countries. Whereas, it’s clearly known that developed countries open their market to other develop countries. But in Turkey, when the import substitution industrialization policies that has been applied since 1963 started to be inadequate, export-oriented industrialization policy was adopted with the decision taken within the framework of the Stabilization Program on January 24th 1980 and while the significant increases were performed in Turkey’s export volume as a result of positive developments created by these policies, the composition of export products has changed. The best evidence of this change is incredible progress that is seen in export item of manufacturing industry which is one of the most important industrial sectors in the economic structure.

Background: Metabolic changes resulting from obesity, insulin insensitivity, and imbalances in hormones such as adiponectin, leptin, resistin, apelin and visfatin, which are derived from white adipose tissue-derived hormone, are directly linked to both colon cancer (CC) and inflammatory bowel diseases increasing tissue-derived risk. We conducted this study to evaluate the relationship between the circulating concentrations of adiponectin, leptin, resistin, apelin and visfatin and colon adenoma and CC. Methods: Our study included 90 participants aged >18 years who were divided into three groups: colon cancer, adenoma and control. The serum concentrations of the investigated adipohormones were measured with ELISA in 30 patients with colon adenoma, 30 with CC and 30 controls with no colon pathology. Results: Demographic, anthropometric, metabolic and hormonal parameters were also recorded. The group means were compared by using one-way analysis of variance (ANOVA). Dual comparisons between groups were analyzed with the Tukey test. Pearson correlation coefficient was used to determine the relation between continuous variables. Adiponectin and leptin levels in patients with adenomas (p

A photoinjector, PHIN (PHotoINjector), has been realized at CERN by a joint effort of several institutes within the European Coordinated Accelerator Research in Europe program. The test facility has been installed and commissioned at CERN with the aim to demonstrate the beam parameters needed for the CLIC Test Facility 3 (CTF3). This beam is unique with respect to its long bunch train and high average charge per bunch requirements. The nominal beam for CTF3 consists of 1908 bunches each having a 2.33 nC charge and a bunch frequency of 1.5 GHz. Thus, a total charge of ∼4.4 μC has to be extracted and accelerated. The stability of the intensity and the beam parameters along this exceptionally high average current train is crucial for the correct functioning of the CLIC drive beam scheme. Consequently, extensive time-resolved measurements of the transverse and longitudinal beam parameters have been developed, optimized, and performed. The shot-to-shot intensity stability has been studied in detail for the electron and the laser beams, simultaneously. The PHIN photoinjector has been commissioned between 2008 and 2010 during intermittent operations. This paper reports on the obtained results in order to demonstrate the feasibility and the stability of the required beam parameters.

Summary Giant cell tumor, excluding its prototype in bone, is usually a benign but local aggressive neoplasm originating from tendon sheath or soft tissue. Malignant behavior is uncommon. Visceral organ involvement including urinary bladder is rare. Giant cell tumors in visceral organs usually accompany epithelial tumors and the clinical behavior of giant cell tumor in urinary bladder is similar to its bone counterpart. Here, we report two cases of giant cell tumor located in urinary bladder in comparison with nine reported cases in the English literature. Concurrent noninvasive urothelial carcinoma was also described in all these previous reports and only one patient with follow-up died of disease. One of the two cases we present had no concurrent urothelial tumor at the time of diagnosis but had a history of a low grade noninvasive urothelial carcinoma with three recurrences. The histology of these two cases was similar to the giant cell tumor of bone and composed of oval to spindle mononuclear cells with evenly spaced osteoclast-like giant cells. Immunohistochemically, the giant cells showed staining with osteoclastic markers including CD68, TRAP, and LCA. Immunohistochemical expression of vimentin, CD68, LCA, and smooth muscle actin in mononuclear cells supported a mesenchymal origin with histiocytic lineage. The histologic and immunohistochemical properties in our cases as well as their clinical courses were consistent with a giant cell tumor. Consequently, tumors in urinary bladder showing features of giant cell tumor of bone may also be considered and termed "giant cell tumor".

Objective: The aim of this study was to investigate the predictive importance of the previously validated log(ER)*log(PgR)/Ki-67 predictive model in a larger patient population., Methods: Patients with hormone receptor positive/HER-2 negative and clinical node positive before chemotherapy were included. Log(ER)*log(PgR)/Ki-67 values of the patients were determined, and the ideal cutoff value was calculated using a receiver operating characteristic curve analysis. It was analyzed with a logistic regression model along with other clinical and pathological characteristics., Results: A total of 181 patients were included in the study. The ideal cutoff value for pathological response was 0.12 (area under the curve=0.585, p=0.032). In the univariate analysis, no statistical correlation was observed between luminal subtype (p=0.294), histological type (p=0.238), clinical t-stage (p=0.927), progesterone receptor level (p=0.261), Ki-67 cutoff value (p=0.425), and pathological complete response. There was a positive relationship between numerical increase in age and residual disease. As the grade of the patients increased, the probability of residual disease decreased. Patients with log(ER)*log(PgR)/Ki-67 above 0.12 had an approximately threefold increased risk of residual disease when compared to patients with 0.12 and below (odds ratio: 3.17, 95% confidence interval: 1.48-6.75, p=0.003). When age, grade, and logarithmic formula were assessed together, the logarithmic formula maintained its statistical significance (odds ratio: 2.47, 95% confidence interval: 1.07-5.69, p=0.034)., Conclusion: In hormone receptor-positive breast cancer patients receiving neoadjuvant chemotherapy, the logarithmic model has been shown in a larger patient population to be an inexpensive, easy, and rapidly applicable predictive marker that can be used to predict response.

Sentinel lymph node dissection (SLND) is a reliable method that provides axillary staging in clinical node-negative (cN0) breast cancer patients before neoadjuvant chemotherapy (NACT). However, it is not a standard method on its own due to the high false-negative rates (FNR) reported in initially clinical node-positive patients (cN1-cN3). The contribution of magnetic resonance imaging (MRI) to SLND after chemotherapy is not well understood. In our study, we aimed to investigate the contribution of post-NACT MRI to SLND in breast cancer patients receiving NACT. Between January 2014 and December 2020, patients who had MRI images including the axilla after NACT and had axillary lymph nodes evaluation performed simultaneously with SLND were included in the study. MRI images of all patients were re-evaluated by 2 experienced clinicians. MRI and SLND results were analyzed to detect axillary lymph node metastasis. 117 patients were included in the study. The median age of the patients was 49 years. Before chemotherapy, 108 patients (92.3%) had tumor metastases in their axilla pathologically confirmed by tru-cut biopsy. Axillary downstage was obtained in 48.1% (n=52) of the patients after NACT. Of the 56 patients with axillary node positivity, 3 patients had no metastasis in the SLND evaluation (FNR=5.4%). The sensitivity of post-NACT MRI in detecting node positivity was 69.6%, the specificity was 90.2%, the positive predictive value (PPV) was 86.7% and the negative predictive value (NPV) was 76.4. SLND together with MRI predicted all node-positive patients (FNR=0%). In summary, SLND may not detect a group of patients with residual axillary lymph node metastases after NACT. We have shown that MRI can contribute to identifying these patients. If no metastases are detected by both methods (SLND and MRI), avoidance of axillary dissection may be an acceptable choice.

Objective: We aimed to investigate mammography (MG), ultrasound (US), and magnetic resonance imaging (MRI) findings of papillary breast carcinoma subtypes and to compare the diagnostic features and performance of the imaging method in distinguishing subtypes., Materials and Methods: Forty-two patients presenting with pathological diagnosis of 45 papillary carcinoma lesions, between 2014 and 2019, were included. Cases were assigned to five subgroups according to the latest World Health Organization (WHO) classification. The clinical characteristics (n = 45) and imaging features of each pathological subgroup were retrospectively related to imaging findings from US (n = 45), MG (n = 37), and breast MRI (n = 23), and further compared., Results: The finding of a palpable mass in all subgroups was more common than nipple discharge on clinical breast evaluation, and no significant difference was found between the subgroups. Irregular shape on MG (10/12, 83.3%, p = 0.039) and US (11/12, 91.7%, p = 0.039) was found more frequently in invasive micropapillary carcinoma (IMPC) compared to other subgroups. Circumscribed margins (4/5, 80%, p = 0.002) occurred more frequently in papillary ductal carcinoma in situ (pDCIS) and encapsulated papillary carcinoma (EPC) than in other subgroups (6/8, 75%, p = 0.002). Lower apparent diffusion coefficient (ADC) values were found in solid papillary cancer (SPC) than in other subgroups (ADC = 0.35 x 10 -3 , p = 0.017)., Conclusion: Radiological findings of papillary carcinomas overlap with each other. US and MRI are complementary when revealing specific morphological characteristics., Competing Interests: Conflict of Interest: No conflict of interest was declared by the authors., (©Copyright 2022 by the the Turkish Federation of Breast Diseases Societies / European Journal of Breast Health published by Galenos Publishing House.)

Aim of the Study: Although early diagnosis of breast cancer (BC) is often associated with a good prognosis, there is currently no biomarker with high sensitivity serving this purpose. B7H3, a recently identified member of the B7 family, appears to inhibit antitumor immunity. We investigated the soluble B7H3 (sB7H3) level in BC and its relationship with clinicopathological variables and stromal tumor-infiltrating lymphocytes (sTILs)., Material and Methods: The study, which was designed as a cross-sectional trial between January 2020 and September 2021, included 93 BC patients, 20 patients with benign breast disease (BBD) and 14 healthy volunteers as the control group. Serum sB7H3 levels were measured using the ELISA (enzyme-linked immunosorbent assay) method and sTILs were measured by immunohistochemistry using Tru-cut biopsy materials., Results: sB7H3 levels in BC patients were significantly higher than those in patients with BBD and healthy volunteers. Receiver operating characteristic curve analysis results showed that sB7H3 level may be a potential biomarker for distinguishing patients with BC from those with BBD (AUC: 0.807; sensitivity: 0.786; specificity: 0.706) and from healthy volunteers (AUC: 0.731; sensitivity: 0.700; specificity: 0.692)., Conclusions: To the best of our knowledge, the present study is the first to investigate the relationship between sB7H3 and disease parameters in BC. We found that sB7H3 may be a clinically practical and meaningful biomarker in differentiating BC from BBD. In order to evaluate the relationship of B7H3 with clinical variables in BC, and especially with sTILs, tissue-based studies with higher numbers of patients are needed., Competing Interests: The authors declare no conflict of interest., (Copyright © 2022 Termedia.)

Objectives: Despite being an invasive method, liver biopsy followed by pathological grading remains the gold standard in evaluating liver fibrosis resulting from chronic hepatitis B virus (HBV) infection. The present study aims to evaluate the utility of biochemical parameters and their derived indices in predicting development of fibrosis related to HBV infection., Patients and Methods: Pathology results and biochemical parameters of patients who underwent liver biopsy were retrieved from electronic archive records dated 2010-2019 and evaluated retrospectively. Pathological fibrosis grading was performed as per Ishak scoring, with scores of 1-2 considered as mild fibrosis and 3-6 as advanced fibrosis., Results: The mean age of 302 patients was 37.69 ± 11.33 years. Of the 302 patients, 230 (76.2%) had mild fibrosis and 72 (23.8%) had advanced fibrosis. Age-platelet index, aspartate aminotransferase/platelet ratio index, fibrosis-4 (FIB-4), modified fibrosis-4, platelets count, aspartate aminotransferase to alanine aminotransferase ratio/platelet ratio index, Goteborg University Cirrhosis Index and King's score were markedly and significantly higher in patients with advanced fibrosis than those with mild fibrosis. FIB-4, age-platelet index and King's score had higher (>80%) area under the curve values than other indices in the receiver operating characteristics analysis. Evaluation of sensitivity, specificity and accuracy of these indices with the specified cut-off values revealed 87% sensitivity with FIB-4, 70% specificity with King's score and 72% accuracy with the age-platelet index., Conclusion: In this study, the highest rates of sensitivity, specificity and accuracy in distinguishing and predicting liver fibrosis were observed with the noninvasive indices FIB-4, King's score and the age-platelet index, respectively., (Copyright © 2021 Wolters Kluwer Health, Inc. All rights reserved.)

Objective: The COL6A1 is a gene encoding the alpha 1 polypeptide subunit of collagen 6 (COL6A1), an extracellular matrix protein subunit. Programmed cell death receptor-1 (PD-1) and its ligand, programmed cell death receptor ligand-1 (PD-L1) have been shown to have a prognostic significance in clear cell renal cell carcinomas (RCCs). In this study, we evaluated the expressions of COL6A1 and PD-1 in four different RCC subtypes., Materials and Methods: A total of 161 radical nephrectomy and nephron-sparing surgery cases with RCCs from five different health care centers were included in this study. Clinical data of the cases were taken from electronic records of the institutions. The pathological data were collected by an expert uropathologist and re-evaluated with slides obtained from paraffin blocks of the cases. The correlation of COL6A1 and PD-1 expression with sex, age, tumor type, lymphovascular invasion (LVI), World Health Organization/International Society of Urological Pathology (WHO/ISUP) grade, and tumor stage (pT) was analyzed with the Pearson chi-squared test., Results: Patients with sarcomatoid RCC and clear cell RCC had significantly higher COL6A1 scores and intensities than in other types of RCC (p=0.004 and p=0.002, respectively). WHO/ISUP grade and, COL6A1 and PD-1 staining scores also showed positive correlation (r=0.230, p=0.004 and r=0.277, p=0.001, respectively for COL6A1 and r=0.191, p=0.018 and r=0.166, p=0.041, respectively for PD-1). The staining scores and intensities of COL6A1 and PD-1 were not different between the patients with positive and negative LVI (p>0.05)., Conclusion: In high-grade RCCs, we found the relationship between immunohistochemical staining scores of COL6A1 and PD-1 proteins and clinical, demographic, and histopathological parameters. Our results proved that COL6A1 and PD-1 are really promising proteins as prognostic parameters and for targeted immunotherapy.

Purpose: In this study, we aimed to investigate the breast lesion excision system (BLES) as a tool and a practical alternative technique to surgical biopsy and other percutaneous biopsy methods for suspicious lesions. We also wanted to share our initial experience with BLES and compare it with standard percutaneous biopsy methods., Methods: From July 2015 to December 2016, a total of 50 patients who had high-risk lesions which were diagnosed with core needle biopsy (CNB) or had lesions with radiology pathology discordance, or had high-risk factors, high-grade anxiety, or suspicious follow-up lesions were enrolled in the study. These lesions were classified as Breast Imaging Reporting and Data System (BI-RADS) 3 or 4, which are under 2 cm. Pathologic diagnoses before and after BLES were evaluated comparatively. The diagnostic and therapeutic success and the complications of CNB and BLES were analyzed., Results: After BLES, two cases were diagnosed as atypical lobular hyperplasia and atypical ductal hyperplasia. Since the surgical margin was negative, re-excision was not required. Two cases were diagnosed as malignant, and no residual tissue was detected in the operation region. Total excision rates were reported as 56%. Minor hematoma was observed in only 1 out of 50 cases (2%), and spontaneous remission was observed. Two patients (4%) complained of pain during the procedure. Radiofrequency-related thermal damage to the specimen showed: Grade 0 (<0.5 mm) damage in 88%, Grade 1 (0.5-1.5 mm) in 10%, Grade 2 (>1.5 mm or thermal damage in diffuse areas) in 2%, and Grade 3 (diffuse thermal damage or inability to diagnose) in 0%. We found a significant positive correlation between classification of thermal damage and lesion fat cell content (r = 0.345, P = 0.015)., Conclusion: BLES is a safe technique that can be effectively used with low complication rates in the excision of benign and high-risk breast lesions in selected cases. It may also provide high diagnostic success and even serve as a therapeutic method in high-risk lesions, such as radial scar, papilloma, and atypical lobular hyperplasia with high complete excision rates without fragmentation of lesions.

The aim of this study was to show whether the protective effect of remote ischemic preconditioning (RIPC) on flaps can be transferred among different individuals with the transfusion of blood serum. Blood serum was taken from rats without any procedure (Group x), rats 1 hour (Group y) and 24 hours (Group z) after performing RIPC and the remaining rats were divided into six groups. While the random pattern skin flap was performed only in the back region in Group 1, and it was performed 1 hour (Group 2) and 24 hours (Group 3) after induction RIPC. Flap surgery was performed after the intravenous injection of serum obtained from Group x in Group 4, from Group y in Group 5, and from Group z in Group 6. After 7 days, the ratios of viable areas in the flaps of the remaining rats were calculated. When the viable area ratios in the flaps to the whole flap area were calculated, it was found out that the viable area ratios in Group 2 (61.6%), Group 3 (75.6%) and Group 6 (74.2%) were statistically significantly higher compared to Group 1 (51.5%), Group 4 (52.6%) and Group 5 (58.7%), that viable area ratios in Groups 3 and 6 were statistically significantly higher compared to Group 2, and that there was no difference between Groups 3 and 6. This study showed that RIPC forms a protective effect on the flaps and that this effect could be transferred among individuals with blood serum.

Purpura fulminans associated with antithrombin 3 (AT 3) deficiency is very rare in adults and neonates. It can be categorized into three principal forms - neonatal, idiopathic and acute infectious. Purpura fulminans has been reported to cause cardiac, pulmonary and renal damage in rare cases. We describe an adult case of purpura fulminans developing in association with AT 3 deficiency without infection following a surgical procedure, and acute kidney injury (AKI) developing secondary to rhabdomyolysis and disseminated intravascular coagulation (DIC). To the best of our knowledge there have been no previous cases of purpura fulminans and AKI developing in association with acquired AT 3 deficiency without infection after surgery.

High-grade prostatic intraepithelial neoplasia (HGPIN) is considered to be an important precursor for prostatic adenocarcinoma. The present study aimed to investigate the histological features of the uncommon inverted (hobnail) pattern of HGPIN in transrectal ultrasonographic (TRUS) prostatic needle biopsies from 13 cases. These 13 diagnosed cases of inverted HGPIN were identified out of a total of 2,034 TRUS biopsies (0.63%), obtained from patients suspected to have prostate cancer. The hobnail pattern is comprised of secretory cell nuclei, which are histologically localized at the luminal surface of the prostate gland, rather than the periphery, and exhibit reverse polarity. Histological examinations were performed and the results demonstrated that 5 of the 13 cases exhibited pure inverted histology, while HGPIN was observed to be histologically associated with other patterns in the remaining 8 patients. In addition, an association with adenocarcinoma was identified in 7 of the 13 cases. All 7 carcinomas accompanied by inverted HGPIN were conventional acinar adenocarcinoma cases; of note, for these 7 cases, the Gleason score was 7 for each. One acinar adenocarcinoma case accompanying inverted HGPIN demonstrated hobnail characteristics in large areas of the invasive component. It was observed that nuclei were proliferated in the invasive cribriform glands, which was comparable to that of inverted HGPIN, and were located on the cytoplasmic luminal surface; a similar morphology was also observed in individual glands. In conclusion, the results of the present study suggested that the hobnail HGPIN pattern may be of diagnostic importance due to its high association with adenocarcinoma and the high Gleason scores in the accompanying carcinomas.

Aim: To determine the incidences of copy number aberrations of receptor kinases and their relations in Turkish patients with gastric adenocarcinoma., Materials and Methods: The prevalence of genomic copy number aberrations of epidermal growth factor receptor (EGFR), human epidermal growth factor receptor 2 (HER2)/topoisomerase IIa (TOP2A), centrosome-associated kinase aurora A (AURK A), centrosome-associated kinase aurora B (AURK B), and mesenchymal-epithelial transition factor (MET) genes and polysomies of related chromosomes were analyzed by fluorescent in situ hybridization (FISH) in tumor samples from 35 patients with gastric cancer., Results: There were 28.6%, 65.7%, 20.0%, 17.1%, 60.0%, and 45.7% cases considered FISH-positive for EGFR, MET, HER2, TOP2A, AURK A, and AURK B genes, respectively. Statistically significant associations were determined in detection of amplifications of 1) EGFR gene with chromosome 7 polysomy, 2) MET gene in nonpolysomic chromosome 7 nuclei, 3) HER2/TOP2A genes in nonpolysomic chromosome 17 nuclei, 4) coamplification of HER2/TOP2A in poorly differentiated carcinomas, and 5) AURK A gene in nonpolysomic chromosome 20 nuclei. Most of the aberrations were predominantly seen in poorly differentiated tumors, but a high rate of the amplified MET gene was also detected in moderately differentiated carcinomas., Conclusion: Chromosome 7 polysomy may be responsible for EGFR gene amplifications, and we concluded that MET and AURK A genes amplifications were commonly seen aberrations in gastric adenocarcinomas and may offer information about disease progression and administration of individualized treatment for gastric cancer patients.

Idiopathic granulomatous mastitis (IGM) is a rare, benign, chronic inflammatory condition of the breast, which usually mimics breast carcinoma. The aim of this study was to analyze the clinical features of IGM by identifying a more reliable diagnostic protocol, and evaluating the treatment methods and patient outcomes on follow-up. We performed a retrospective analysis of 46 patients diagnosed with IGM and managed by the same surgical team between 1999 and 2011, at three high-volume hospitals. The median age of the patients was 33 years. The most common symptom was painful breast mass (n = 39), followed by abscess (n = 11). All patients underwent ultrasonography (USG). Mammography (MG) and magnetic resonance imaging (MRI) were also performed in 20 patients (43%) and 17 patients (37%), respectively. The mean size of the lesions was 32.8 ± 8.8 mm and ranged from 15 to 50 mm. Preoperative diagnosis of IGM was established by core needle biopsy (CNB) under USG guidance. Eighteen patients (39%) underwent complete excision of the lesion and 25 (54%) were treated with steroids. Three patients treated with steroids subsequently underwent local excision. The mean follow-up period was 35.4 ± 30.9 months. Eight patients (17%) developed disease recurrence; three of these were successfully treated with steroids, one with surgery, and four with both steroids and surgery. CNB in conjunction with high diagnostic accuracy has a significant role in distinctive diagnosis of IGM and hence, is useful for treatment planning. Treatment can be designated according to the extent and the severity of the disease, and the patient's general health and treatment preferences. Patients with IGM must be closely followed up due to the frequency of disease recurrence., (© 2013 Wiley Periodicals, Inc.)