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Objective: The mainly significant reason in the etiology of lung cancer is smoking, which is important in other environmental pollutants and genetic susceptibility. Lung cancer is separated two major groups as mainly non-small cell and small cell according to the growth rate, spread, timing of metastasis, response to chemotherapy and radiotherapy. Epidermal growth factor receptor (EGFR) constitutes the highest rate with 50-80% in gene mutations which are prognostic value in lung cancer. Many studies have shown that EGFR is overexpressed in lung cancer. In our study, we aimed to investigate the relationship between EGFR gene exon 21 L858R mutations in lung cancer. Material and Methods: Our sample consisted of a healthy group of 190 healthy volunteers with the same age and gender characteristics as the patient group of 178 patients who were diagnosed as lung cancer in the Mersin University Medical Faculty Oncology clinic. The DNAs were obtained according to the standard salt precipitation method. Mutation detection and genotyping analyzes were identified by polymerase chain reaction (PCR) and restriction fragment length polymorphism (RFLP) analyzes. Results: Smoking was one of the other risk factors for lung cancer, 130 (68.33%) in the control group and 156 (87.5%) in the lung cancer group. 27 person of the lung cancer (15%) were female and 151 (85%) were male. In the control group, 92 people (48.33%) were in the wild genotype and 98 persons were in the mutant genotype (51.66%). In the lung cancer group 80 (45%) were wild-type and 98 (55%) were mutant genotypes. According to the histopathological types of lung cancer, EGFR-21 mutation heterozygous or homozygous carriers are proportionally compatible (p = 0.90). Conclusion: According to our findings, the EGFR-21 mutation is not associated with histopathological types of lung cancer.

Our study aimed to determine immunohistochemical expression of ER, PR, C-erbB-2, p53 and BRCA1 genes and their relationship with clinicopathological features and prognostic significance. The present study included 85 patients that were diagnosed with epithelial OC, treated and followed-up between 2002 and 2012 at Mersin University, Faculty of Medicine. Immunohistochemical expression of ER, PR, C-erbB-2, p53 and BRCA1 and their relation-ship with clinicopathological parameters were evaluated. In serous carcinomas, expression of ER was significantly associated with metastasis to the fallopian tube, expression of PR was significantly associated with patient’s age, expression of p53 was significantly associated with the progression-free survival (PFS), cytoplasmic expression of BRCA1 was significantly associated with the overall survival (OS) and PFS. In pathogenesis groups, 55 tumors were type 1, and 30 tumors were type 2. There were significant correlations with ER, PR and p53 expressions between the two groups. In our study, PR and p53 were prognostic factors in serous carcinoma. Extensive studies that contain more cases in each histological group are needed to determine the prognostic value of these five immunohistochemical markers., Çalışmamız ER, PR, C-erbB-2, p53 ve BRCA1 genlerinin immünohistokimyasal ekspresyonunu ve bunların klinikopatolojik özellikler ve prognostik önemi ile ilişkisini belirlemeyi amaçlamaktadır. Çalışmamıza Mersin Üniversitesi Tıp Fakültesi'nde 2002-2012 yılları arasında epitelyal OK tanısı konulan ve takip edilen 85 hasta dahil edildi. ER, PR, C-erbB-2, p53 ve BRCA1'in immünohistokimyasal ekspresyonu ve bunların klinikopatolojik parametrelerle ilişkisi değerlendirildi. Seröz karsinomlarda, ER ekspresyonu fallop tüpüne metastaz ile, PR ekspresyonu hastanın yaşı ile anlamlı şekilde ilişkiliydi, p53 ekspresyonu progresyonsuz sağkalım (PFS) ile anlamlı şekilde ilişkilendirildi, BRCA1'in sitoplazmik ekspresyonu genel sağkalım (OS) ve PFS ile anlamlı şekilde ilişkiliydi. Patogenez gruplarında 55 tümör tip 1 ve 30 tümör tip 2 idi. İki grup arasında ER, PR ve p53 ekspresyonları ile anlamlı korelasyonlar vardı. Çalışmamızda PR ve p53 seröz karsinomda prognostik faktörlerdi. Bu beş immünohistokimyasal belirtecin prognostik değerini belirlemek için her histolojik grupta daha fazla vaka içeren kapsamlı çalışmalara ihtiyaç vardır.

202 Background: The optimal treatment for metastatic colorectal cancer (mCRC) after the second line is still controversial. Regorafenib (Reg) revealed promising results by improving overall survival compared to best supportive care. However, in real-world practice rechallenge chemotherapy (CTr) is often preferred even though supporting evidence is not enough. We aim to compare the efficacy of regorafenib and 5-fluorouracil-based (5-FU) rechallenge treatment in the third line setting of mCRC. Methods: In this retrospective multi-institutional trial, mCRC patients from 21 centers in Turkey progressing after 2 lines of chemotherapy between 2012-2020 were analyzed. Patients who were treated with Reg or rechallenge therapy in the third-line setting were eligible. Rechallenge chemotherapy was identified as the re-use of the 5-FU based regimen which was administered in one of the previous treatment lines. Overall survival (OS), objective response rate (ORR), progression free survival (PFS) and toxicity were analyzed. Chi-square, Kaplan-Meier method and Cox regression analysis were used for analysis. Results: The clinical data of 441 mCRC patients were analyzed. Of these, 284 received regorafenib while 156 received rechallenge chemotherapy. The mean age was 57 and 56% was male. Median OS since the diagnosis was better with CTr than with Reg (48 months (95% CI, 43.4–52.6) vs. 39 months (95% CI, 35.4–42.5), p

Summary Aim The aim of this study is to be informed about demographic features, the reasons for preferring medical oncology, career plans, and the educational problems of the residents training in the subspecialty of medical oncology. Method The responses to questionnaire forms sent by e-mail to subspecialty residents who are continuing their training in different educational institutions of our country were recorded and analyzed. Results Seventynine of 129 residents (61.2%) responded the survey forms. Median age of the participants was 33 years. Thirty six (45.5%) were female, and 43 (54.5%) were male. The responders stated different reasons for their preference of medical oncology but most of them (n:64, 81%) thought that medical oncology has a bright future. Of them, 38 (48.1%) the responders intended to refrain from their medical conscription was their most important concern. Fiftytwo (65.8%) of them were not satisfied much with their present education and academic activities. Sixtynine (87.3%) of the participants indicated that they had been suffering from the symptoms of burnout syndrome. Conclusion Recognition of the subspecialty residents who are the future of medical oncology, and determination of their needs, and problems will contribute to the development of recommendations for their solution. In our country their main problems are medical conscription, inadequate education, and burnout.

Aim To assess the safety and tolerability of adjuvant subcutaneous trastuzumab (Herceptin ® SC, H SC), delivered from an H SC Vial via hand-held syringe (Cohort A) or single-use injection device (Cohort B), with or without chemotherapy, for human epidermal growth factor receptor 2 (HER2)-positive stage I to IIIC early breast cancer (EBC) in the phase III SafeHer study (NCT01566721). Methods Patients received 600 mg fixed-dose H SC every 3 weeks for 18 cycles. The chemotherapy partner was at the investigators' discretion (H SC monotherapy was limited to ≤10% of the population). Data from the first H SC dose until 28 days (plus a 5-day window) after the last dose are presented. Results are descriptive. Results In the overall population, 2282/2573 patients (88.7%) experienced adverse events (AEs). Of the above, 128 (5.0%) patients experienced AEs leading to study drug discontinuation; 596 (23.2%) experienced grade ≥ 3 AEs and 326 (12.7%) experienced serious AEs. Grade ≥ 3 cardiac disorders were reported in 24 patients (0.9%), including congestive heart failure in eight (0.3%). As expected, the AE rates varied according to the timing of chemotherapy in both cohorts, with higher rates in concurrent versus sequential chemotherapy subgroups. In the concurrent chemotherapy subgroup, AEs were more common during the actual period of concurrent chemotherapy compared with the period when patients did not receive concurrent chemotherapy. Conclusion SafeHer confirms the safety and tolerability of the H SC 600 mg fixed dose for 1 year (every 3 weeks for 18 cycles) as adjuvant therapy with concurrent or sequential chemotherapy for HER2-positive EBC. These primary analysis results are consistent with the known safety profile for intravenous H and H SC.

Objective: Breast cancer can lead to alterations in quality of life of the patients. The aim of this study is to evaluate the changes in quality of life of the female patients who had undergone surgical treatment for breast cancer. Materials and Methods: A total of 250 female patients (breast-preserving surgery (BPS), n=27, 11%; modified radical mastectomy (MRM), n=194, 77%, and simple mastectomy (SM), n=29; 11%) aged between 28-55 years (47.4±6.4 yrs) were included in the study. Patient information, demographic characteristics, income, and treatment modalities applied were recorded. Validated Turkish versions of EORTC QLQ-C30, and EORTC–BR23 questionnaires were used for all patients. Results: Breast-preserving surgery has a more favorable impact on general well-being, physical role, cognitive, psychological, and social functions, and symptom scale scores. When the identical parameters were taken into consideration, relatively favorable outcomes of BPS on the patients were observed relative to mastectomized patients. Besides, though not statistically significant, BPS has more patient-friendly effects on sexual function and sexual satisfaction in comparison with mastectomy. Patients with advanced stage disease and elder patients had more unfavorable health related quality of life (HRQoL) scores than younger patients, and those in their early stages of breast cancer. Conclusion: Quality of life of BPS patients is less adversely affected relative to mastectomized patients. In the decision-making process, quality of life should be taken into consideration.

Background: Astrocytic tumors, the most common primary glial tumors of the central nervous system, are classified from low to high grade according to the degree of anaplasia and presence of necrosis. Despite advances in therapeutic management of high grade astrocytic tumors, prognosis remains poor. In the present study, the frequency and prognostic significance of c-erb-B2 in astrocytic tumors was investigated. Materials and Methods : Records of 72 patients with low- and high-grade astrocytic tumors were evaluated. The expression of C-erbB-2 was determined immunohistochemically and intensity was recorded as 0 to 3+. Tumors with weak staining (1+) or no staining (0) were considered Her-2 negative, while tumors with moderate (2+) and strong (3+) staining were considered Her-2 positive. Results : Of the 72 patients, 41 (56.9%) had glioblastoma (GBM), 10 (13.9%) had diffuse astrocytoma, 15 (20.8%) had anaplastic astrocytoma, 6 (8.3%) had pilocytic astrocytoma. C-erbB-2 overexpression was detected in the tumor specimens of 17 patients (23.6%). Six (8.3%) tumors, all GBMs, exhibited strong staining, 2 (2.7%) specimens, both GBMs, exhibited moderate staining, and 9 specimens, 5 of them GBMs (12.5%), exhibited weak staining. No staining was observed in diffuse astrocytoma and pilocytic astrocytoma specimens. Median overall survival of patients with C-erbB-2 negative and C-erbB-2 positive tumors were 30 months (95%CI: 22.5-37.4 months) and 16.9 months (95%CI: 4.3-29.5 months), respectively (p=0.244). Conclusions: Although there was no difference in survival, C-erbB-2 overexpression was observed only in the GBM subtype. Keywords: Glioblastoma - C-erbB-2 - prognostic factor - astrocytic tumor

e15538 Background: The aim of this study was to evaluate the prognostic role of microsatellite instability (MSI) status and PD-L1 expression in surgically resected gastric cancer and the relationship of these parameters with clinicopathological features. Methods: Eighty six gastric cancer patients which had curative surgical resection at Acibadem Atakent and Maslak Hospitals between 2010 and 2017 were analysed. Tumor samples were evaluated with MSI and PD-L1 antibodies by immunohistochemical (IHC) methods. PD-L1 IHC scoring was performed using the combined positive score (CPS). Survival analysis was accomplished using the Kaplan-Meier method. Cox proportional hazard regression model was used to identify independent risk factors that affect patients' overall survival. Results: The rate of PD-L1 expression in tumor cells was 34.9% (n = 30) and the frequency of PD-L1 expression in immune cells with CPS (≥1%) was 57% (n = 49). MSI-H was detected in 11.6%(n = 10), and more observed in PD-L1 positive cases (p = 0.021). MSI-H status was significantly correlated with older age, increased tumor size, presence of PD-L1 expression, and adenocarcinoma subtype. PD-L1 expression was associated with lymph node metastasis, adenocarcinoma subtype, microsatellite instability, presence of preoperative treatment and improved response to preoperative chemotherapy. In our study, the impact of MSI status on survival was not demonstrated, but PD-L1 expression positivity(≥1%) in both tumor cells (15.7 vs 53.4 months, p = 0.008)and in immune cells (20.4 vs NR; p = 0.027) was associated with short overall survival. PD -L1 expression in tumor cells was an independent prognostic factor for overall survival in multivariate analysis (HR: 2.28, p = 0.047). Conclusions: PD-L1 expression was related to a poor prognosis in patients with gastric cancer and can represent a rational approach for PD-1/PD-L pathway-targeted immunotherapy.

Here, we present a 45-year-old woman with endometrial cancer who presented with hyperemesis, vomiting and loss of consciousness. The serum calcium concentration was 18.3 mg/dl and bone scintigraphy revealed no evidence of skeletal involvement by the tumor. Her parathyroid hormone (PTH) level was normal, but the parathyroid hormone-related peptide (PTHrP) level was higher than the normal values. Through our case, we review the treatment of malignant hypercalcemia. Turk Jem 2013; 17: 8-11

The incidence, and thus the economic burden of cancer are increasing rapidly with prolongation of lifespan thanks to newly-developed anticancer drugs. Globally the number of newly diagnosed cases is expected to rise to 21.4 million by the year 2030. In this survey, our purpose was to investigate the level of awareness of oncologists and cancer patients concerning the treatment costs of systemic anticancer therapy.To this end questionnaire forms were sent via e-mails to 123 medical oncologists which were responded by 119 (96.7%) of them.The responders (21%) stated that they had been attentive about the treatment costs or informed (9.5%) their patients about treatment costs. Half of the informed patients were desperately surprised when they heard the treatment costs. Half of the physicians thought that informing the patients had positive effects on patients compliance to the treatment. Most (83.5%) of the physicians prescribed drugs not paid back by reimbursement, and 79.3% of them indicated that overall survival was more important in the selection of expensive drugs. Still 30.2% of them indicated that they hadn't known to perform cost-effectiveness analyses.Creating awareness about costs of different anticancer treatment modalities in the minds of oncologists and their patients will be beneficial regarding rational use of such treatment modalities. Countries with rapidly growing health expenditures, like ours, should possess and implement country-specific criteria of cost-effectiveness in daily practice which hopefull will lead to more proper use of our medical recources.

Background: Cancer biomarkers (CBs) can be used in early detection of several cancers as well as in detection of recurrence and following response to treatment. We aimed to investigate the levels of CBs in proteinuric patients with primary glomerular disease (PGD) and diabetes mellitus, and compare them with healthy controls. Methods: One hundred and two patients with untreated PGD, 62 proteinuric patients with diabetic nephropathy, and 84 healthy controls were enrolled. Levels of cancer antigen 125 (CA 125), cancer antigen 15–3 (CA 15–3), carcinoembriogenic antigen (CEA), α-fetoprotein (AFP), total prostate specific antigen (TPSA), free prostate specific antigen (FPSA) and carbohydrate antigen 19–9 (CA 19–9) were measured. Results: Compared to healthy controls, levels of CA 125, CA 15–3 and CA 19–9 were higher in patients with PGD and diabetic patients (all p0.05). Both urinary protein excretion rate and serum albumin levels were correlated with all CBs (all p Conclusions: CBs levels seem to be changed in different proteinuric patients. This condition should be kept in mind when evaluating CBs levels in proteinuric patients.

Background/Aims: This study aimed to determine the epidemiological characteristics of colorectal cancer in Turkey. Materials and Methods: In this multicenter, prospective, and cross-sectional registry study, data for 968 patients with colorectal cancer from 21 centers in 7 geographic regions were analyzed. Results: Diagnosis was colon cancer in 662 (68.4%) and rectum cancer in 306 (31.6%) patients. In total, 60.9% of patients was male; mean age was 58.9±12.6 years. Among patients, 15.0% was drinking alcohol, 17.5% was smoking, 1.5% had familial history of polyposis, 15.0% had diabetes mellitus, 1.0% had inflammatory bowel disease. Fruit and vegetable consumption was low (25 in all group of patients. Distal rectum (61.3%) and sigmoid colon (36.8%) were the most common locations of cancer, for rectum and colon respectively. In total, 85.6% of patients were operated; 25.8% had emergency surgery. Low anterior resection rate was 64.2% in rectum cancer. In majority (89.8%) of the patients with rectum cancer who received preoperative treatment, conventional chemo-radiotherapy regimen was given. pTNM staging at diagnosis showed that stage III and IV patients were in majority (35.9% and 29.7%, respectively). Conclusion: Colon cancer is more frequent than rectum cancer in Turkey. Colorectal cancer patients are diagnosed at later stages. Most of the cases were operated. Interregional differences for risk factors are worthwhile for evaluation in future trials. © Copyright 2015 by The Turkish Society of Gastroenterology.

PubMedID: 24338610 Background: Optimal duration of adjuvant trastuzumab in early breast cancer is an unresolved issue. In this observational study, we compared the outcome of 9 weeks and 1 year adjuvant trastuzumab in early breast cancer patients in Turkey. Methods: Records of 680 patients with HER2-positive early breast cancer who received adjuvant trastuzumab plus chemotherapy were obtained and patients were followed up to compare the disease-free survival (DFS) outcome of 9 weeks versus 1 year trastuzumab. Results: Nine weeks and 1 year trastuzumab was given to 202 (29.7 %) and 478 (70.3 %) patients, respectively. There was a significantly lower rate of patients with negative lymph nodes in the 9-week trastuzumab group. At median 3 years of follow-up from the date of starting trastuzumab, the DFS rates were 88.6 and 85.6 %, respectively (p = 0.670). When adjusted for all the prognostic factors that were significant on univariate analysis, again there was no significant difference in DFS between the groups (HR 0.675; 95 % CI 0.370–1.231; p = 0.200). Cardiac toxicity defined as a ?15 % decrease in LVEF was significantly higher in the 1-year trastuzumab group (1.88 % versus none for 1-year and 9-week trastuzumab groups, respectively; p = 0.050). Conclusion: The results of this observational study suggest that DFS outcome of 9 weeks of adjuvant trastuzumab may be comparable to 1 year adjuvant trastuzumab: this needs confirmation by randomized trials. © 2013, The Japanese Breast Cancer Society.

Summary Background: Here we present a patient who developed nephrotic syndrome associated with gemcitabine use. Case Report: Gemcitabine therapy was initiated following tumor recurrence in a patient with ovarian cancer, who was previously treated twice with carboplatin and paclitaxel. Radiological findings waned and tumor marker concentrations decreased after gemcitabine treatment. However, edema and ascites development was observed on the fifth treatment cycle. Laboratory results revealed increased blood urea nitrogen and creatinine levels, decreased serum albumin concentrations, and increased 24-hour urinary protein excretion. Renal biopsy findings were compatible with membranous glomerulonephritis. Gemcitabine administration was stopped and the cyclophosphamide and steroid therapy were initiated. The symptoms and findings disappeared after the cessation of gemcitabine and immunosuppressive treatment. Conclusions: Gemcitabine treatment may be associated with proteinuria to the extent of nephrotic syndrome.

Although more palliative care is necessary for terminally ill cancer patients, excess investigational tests, invasive procedures, and treatments are given instead. Between November 2009 and December 2013, six hundred and twenty-four patients with end-stage cancer who were died at inpatient setting evaluated retrospectively. Patients’ characteristics, sites of tumor and metastasis, tests and invasive procedures, treatments performed in the last 2 weeks before death were collected from the hospital files and analyzed. Median age of 624 patients was 58 (range 16–96) years. More than half of the patients (370, 59.3 %) were men. The most frequent cancer sites were gastrointestinal (GI) system (32.2 %), lung (24.0 %), and breast (11.1 %). Frequent metastatic sites were liver (34.8 %), bone (31.5 %), lung (23.3 %), and/or brain (16.9 %). Causes of death were respiratory failure, infections, and/or liver failure in 49.9, 23.9, and 19.4 % of patients, respectively. Radiological tests performed in the last 2 weeks before death were ultrasonography, computed tomography, magnetic resonance imaging, bone scan in 25.6, 16.3, 11.4, and 3.8 % of patients, respectively. Treatments received were intravenous (i.v) serum infusion, blood transfusion, total parenteral nutrition (TPN), human albumin infusion in 55.9, 44.1, 34.9, and 9.5 % of patients, respectively. Invasive procedures such as invasive pain relief, terminal sedation, and chemotherapy performed in 12.6, 4.4, and 10.0 % of patients, respectively. Central venous catheter application, paracentesis, thoracentesis, and GI endoscopy were applied in 41.7, 9.8, 5.6, and 3.4 % of the patients, respectively. Radiological tests, invasive procedures, TPN, and human albumin transfusion were used excessively in terminal stage cancer patients in our medical oncology inpatient clinics. Invasive pain relief and terminal sedation were still underused in our cancer clinics. There is an urgent need in developing national palliative care program to improve the understanding of end-of-life care in our medical oncology clinics.

WOS: 000341713400010, PubMed ID: 24752566, This study aimed to report the practice of managing breast cancer with bone metastasis in Turkey and to determine the adherence to the British Association of Surgical Oncology (BASO) guidelines. This multicenter, cross-sectional epidemiological survey was conducted in 38 centers across Turkey. Data from 1,026 breast cancer patients with bone metastases (mean age 54.0 +/- 11.9 years) were analyzed. Over 30 % of patients had a diagnosis of metastatic breast cancer (stage IV) at the time of primary diagnosis. The imaging modalities used for diagnosing bone metastases were bone scintigraphy (57.8 %), radiography (22.8 %), and bone survey (4.4 %). Tumor markers were detected in 94.9 %, and markers of bone metabolism were measured in 90.4 % of patients. A total of 3.5 % of patients underwent surgery for bone metastasis, 26.4 % underwent palliative chemotherapy (most commonly docetaxel + capecitabine), and 56.5 % endured radiotherapy. Most patients (96 %) also received bisphosphonate. Radiography, bone scintigraphy, and CT were the main imaging tools used for postoperative follow-up of bone metastasis. Our results were > 95 % in line with the BASO guidelines for the management of bone metastasis, except that interventional procedures, such as biopsy, were applied less frequently in our survey. The diagnosis and management practices of breast cancer with bone metastasis in Turkey were generally compatible with international guidelines. However, the awareness and knowledge of physicians on the current guidelines should be increased, and equipment for the appropriate interventional procedures should be provided in every clinic to obtain optimal and standard management of bone metastases., Roche, Turkey, This study was financially supported by Roche, Turkey.

Background: The aim of this study was to assess the epidemiological and clinicopathological characteristics of primary extranodal non-Hodgkin's lymphoma (pENL) patients, focusing on treatment and survival outcome. Materials and Methods: Between October 2003 and March 2012, 802 patients with non-Hodgkin's lymphoma (NHL) were diagnosed and treated in two different cancer centers of Southern Turkey. Results: pENL, constituted 12.4% (100/802) of all NHL studied during this period. Median age of the patients was 56 years (range 17-87 years) and the male: female distribution was 3:2. Eighty-five of 100 patients (85%) were in stage I/II, 9/100 (9%) in stage III, whereas 6/100 (6%) were in stage IV. Head and neck constituted the most common site (51/100, 51%), followed by gastrointestinal tract (GIL) (37/100, 37%), and cerebrum (CL) (5/100, 5%). Diffuse large B cell lymphoma (DLBCL) was the most common histological type, observed in 53% of patients, followed by marginal zone extranodal lymphoma (13%). Most of patients (76%) received a CHOP containing regimen. Complete remission (CR) were achieved in 71% of patients. The median follow-up duration of all patients was reported as 37.6 months (range, 0.8-165 months). This period was reported as 137.5 months (range, 117.5-1578.6 months) in gastrointestinal lymphoma (GIL) patients, 119.0 months (range, 91.8-146.1 months) in head and neck lymphoma (HNL) patients, and 18.4 months (range, 12.6-24.1 months) in cerebral lymphoma (CL) patients. Conclusions: Head and neck, and the gastrointestinal tract were the two most common extranodal sites observed. Histologically DLBC accounted for the majority of cases. Most patients were on earlier stages, had low-low intermediate IPI scores and had a favorable prognosis.

rare condition in which two histologically distinct neoplasms grow concurrently in the same locationdein a 64-year-old male patient, with sharply defined borders. Adenocarcinomas are the most common tumours of the stomach. Other types of tumours can occasionally accompany gastric adenocarcinomas. Foci of adenocarcinoma and neuroendocrine carcinoma were identified in adjacent areas in a 64-year-old male patient who had undergone total gastrectomy due to adenocarcinoma of the gastric cardia. Of the seven metastatic lymph nodes, three were affected by adenocarcinoma and four were affected by neuroendocrine carcinoma. Based on this patient case, we discussed gastric collision tumours in the light of the literature.

A 53-year-old man with triple renal neoplasms in his left kidney presented. He was initially diagnosed intermediate grade non-Hodgkin's lymphoma (NHL) which involved gastrointestinal tract, left kidney, liver and pancreas. He underwent left nefrectomy because of a persistent renal mass after the completion of chemotherapy. The large renal mass revealed a renal cell carcinoma (RCC). Additionally, multiple small nodules of non-Hodgkin's lymphoma and a solitary leiomyoma were observed.

Melanoma can metastasize to almost every organ and tissue. Although bone metastases have been reported frequently, the authors are aware of only a single report of intra-articular synovial metastasis. A case of metastatic melanoma, mimicking degenerative medial meniscal tear of the right knee, is presented. Further examination revealed asymptomatic metastases in the liver, subcutaneous tissue, and left trochanter minor. Arthroscopic examination revealed widespread synovial metastasis and a palliative arthroscopic synovectomy was performed.

Twenty-six patients with metastatic colorectal cancer were given cisplatin (CDDP) and dacarbazine (DTIC). Patients who relapsed while receiving adjuvant 5-fluorouracil (FU) or had 5-FU-resistant metastatic disease were included. Median age was 52 years and the male-to-female ratio was 1. Performance status (ECOG) was 3 in 5 patients and 0–2 in the remainder. CDDP (20 mg/m2/day i.v.) and DTIC were given (250 mg/m2/day i.v.) on days 1–5. The treatment was repeated every 3 weeks until disease progression. Total response rate was 19.2% (95% confidence interval: 4.5–34.3%) with one clinical complete response (3.8%) and 4 partial responses (15.4%). Median response duration was 5 months. Median survival for the whole group and for responders was 6 and 8 months, respectively. In conclusion, CDDP + DTIC combination has modest activity in patients with colorectal cancer resistant to 5-FU treatment.

Increased HER2 expression has a prognostic, and predictive value in many solid cancer types, predominantly in breast cancer. However the effects of HER2 on survival from cancers of pancreas, gall bladder, cholangiocellular, and ampullary region are not known. In this study, the effects of increased HER2 expression on these types of cancer have been analyzed. Immunohistochemical HER2 staining was performed in 31 (44.9 %) female, and 38 (55.1 %) male patients with a mean age of 65 ± 10 years, and various parameters, mostly survival rates of patients with pancreas (n = 30; 43.5 %), gall bladder (n = 17; 24.6 %), cholangiocellular (n = 12; 17.4 %), and ampullary region (n = 10; 14.5 %) carcinomas were evaluated. Strong (3 +) membranous staining for HER2 was observed in 2 patients with gall bladder cancers (11.76 % of all gall bladder cancers). In 2.90 % of all cases strong membranous staining (2+ or 3+) was observed. Weak (1+) membranous staining was noted in one (3.33 %) pancreatic, and one cholangiocellular (8.33 %) cancer patient, and in none of the ampullary region patient membranous staining for HER2 was observed. Since only scarce number of patients demonstrated membranous staining for HER2, survival analysis was not performed on these patients. Based on cytoplasmic HER2 staining scores, the patients were divided into weakly (0–3 pts; n = 17 patients; 24.66 %), moderate (4–5 pts; n = 22; 31.88 %), and strongly (6–7 pts; n = 30; 43.46 %) stained groups. Patients whose specimens demonstrated borderline statistical significant (p = 0.052) low staining for HER2 had higher survival rates when compared with other cases. Increased HER2 expression has no prognostic, and predictive value in cancers of pancreas, biliary tract, and ampulla vateri. If HER2 will be evaluated in these types of cancer, membranous, as well as cytoplasmic staining properties should be taken into account.

Twenty-one consecutive patients with refractory or relapsed non-Hodgkin's lymphomas were treated with a novel combination chemotherapy (MINE-BOP), comprising myelosuppressive (ifosfamide, mitoxantrone, etoposide) and non-myelosuppressive (bleomycin, vincristine and prednisone) drugs. Median age of the patients was 42 years and all had intermediate or high-grade lymphoma. Fifteen patients had refractory disease. All patients had previously been treated with one or two regimens, containing anthracyclines. In all cases the duration between the last chemotherapy and the MINE-BOP regimen was shorter than 12 months. Response rate was 57% with 33% complete remission (CR). Median disease-free and overall survivals were 7 and 10 months respectively. The serum LDH level was the only significant prognostic factor in this study. The toxicity of this regimen was moderate with 24% of febrile neutropenia and 9% of microscopic hematuria. Toxic death due to febrile neutropenia was observed in one patient who had bone marrow involvement. To conclude, the addition of non-myelosuppressive drugs to the chemotherapy regimen and shortening the interval between the application of cytotoxic drugs as used in the present study did not show any improvement of response and survival in this group of patients.

Objectives. Non-Hodgkin Lymphomas (NHLs) are tumours of the lymphoid system which originate from lymph nodes or extranodal lymphatic tissue. Since they represent a heterogeneous group of diseases, it is very important to determine prognostic factors apart from staging and identification of the patients with poor prognosis. The objective of our study is to investigate clinical characteristics, treatments applied, and their outcomes, survival rates, and prognostic factors which may be effective on survival. Methods. Clinical characteristics, treatments applied, and their outcomes, survivals, and prognostic factors which may be effective on the survival in 230 patients who were diagnosed as NHL, and consulted to our center between the years 2002, and 2015 were retrospectively evaluated. Results. Median age of our patients (male, 54.8 %, and female, 45.2 %) was 57 years. The most frequently seen histopathological subtype was diffuse large β cell lymphoma. We have seen that IPI score, β symptom, levels of LDH, albumin, β2 microglobulin, and lymphocyte counts are significant prognostic factors. Stomach was the most frequently involved extranodal organ. Advanced stage, higher IPI score, extranodal organ involvement were found to be correlated with shorter survival times. Conclusion. Everyday developments occur in the diagnosis, classification, and treatment of NHL. Therefore, it is important for medical centres to evaluate their treatment outcomes, and prognostic factors affecting their survival rates.

Gastrointestinal stromal tumors (GIST) are the most common mesenchymal tumors of the gastrointestinal tract, and the majority contain KIT or PDGFRA-activating mutations. However, up to 10% of GISTs are c-kit-negative. Antibodies with increased sensitivity and specificity for the detection of c-kit-negative GIST cases may be of value, especially because some of these cases may also benefit from tyrosine kinase inhibitor therapy. Hematoxylin and Eosin sections of 33 GISTs were re-examined in order to define histopathological criteria used in risk assessment of these tumors. Immunohistochemistry with a panel of antibodies [c-kit, DOG1 (discovered on GIST 1), CD34, smooth muscle actin (SMA), Desmin, S100 and Ki67] was performed on 5 μm-thick paraffin sections of all tumors. Statistical analysis of immunohistochemical studies showed that DOG1 and CD117 were the most sensitive and specific antibodies in the diagnosis of GISTs. Other antibodies were unhelpful in confirming a diagnosis of GIST, but were particularly useful in the differential diagnosis. Reactivity for DOG1 may aid in the diagnosis of GISTs, which fail to express c-kit antigen, and lead to appropriate treatment with imatinib mesylate, an inhibitor of the KIT tyrosine kinase.

Langerhans' cell histiocytosis (LCH) is a condition in which granulomas form in various tissues through the accumulation of abnormal histiocytes (Langerhans' cells), granulocytes and lymphocytes. An important distinction between LCH and primary pulmonary histiocytosis (PPH) is that smoking cessation is known to often lead to spontaneous improvement in PPH patients, while this has not been demonstrated in patients with multisystem LCH. In this case report, we describe the case of a 20-year-old man who presented with cough and palpably enlarged lymph nodes in his neck. An inguinal lymph node biopsy led to the diagnosis of multisystem LCH in the lungs, the cervical, intra-abdominal, and inguinal lymph nodes and the spleen. The patient was a smoker, and had averaged 30 cigarettes per day for 7 years. To address the multisystem involvement, intravenous pulse steroid therapy was administered (30-40 mg/kg daily) in two 3-day treatment periods separated by 3-4 weeks. The patient was also advised to stop smoking, and did so. Serial follow-up examinations confirmed an objective improvement with complete remission. The patient was still healthy at 18 months post-treatment, reflecting a dramatic and positive response to pulse steroid therapy. This encouraging result makes this case an important one to highlight.

e20503 Background: Although more palliative care is necessary for terminally ill cancer patients, excess investigational tests, invasive procedures and treatment is given instead. Methods: Between ...

Objective To document a case of thyroid cancer metastatic from the breast. Methods We present the clinical, laboratory, radiologic, and biopsy findings in our patient and review the related literature. Results A 47-year-old female patient was referred to our clinic because of dyspnea and generalized bone pain. Physical examination revealed a diffusely enlarged nodular goiter, and fine-needle aspiration biopsy demonstrated intrathyroidal anaplastic cells. Total thyroidectomy was done, and the histopathologic diagnosis was anaplastic carcinoma. Unexpected rapid progression of the disease with cervical and intrathoracic lymphadenopathies and osteoblastic metastatic lesions without radioiodine uptake prompted us to attempt to rule out a primary nonthyroidal malignant lesion metastatic to the thyroid gland. The plasma level of CA 15-3 was profoundly increased (388 U/mL). Detailed reassessment of the patient disclosed a small mass in the right mammary gland with histopathologic features similar to those of the thyroidectomy material. Reevaluation of the thyroid specimens resulted in a final diagnosis of primary breast carcinoma in conjunction with metastatic carcinoma of the thyroid. Conclusion Thorough systemic clinical assessment of a patient with a thyroid nodule and careful study of biopsy specimens should be done to ascertain whether the nodule is a primary or a metastatic lesion. (Endocr Pract. 2001;7:379-382)

Although renal transplantation is the preferred the patient developed hyperaemic skin lesions on his treatment for patients with end-stage renal disease chest. Physical examination revealed purple lesions on transplant recipients are at substantially higher risk the oral mucosa and right axillary lymphadenopathy. of developing several types of malignancies due to Pathological evaluation of a mucosal biopsy specimen their immunosuppressive treatment. Non-Hodgkin’s revealed spindle cells with moderate atypia forming lymphoma (NHL) and Kaposi’s sarcoma ( KS) are the slits containing red blood cells. The lymph node and most common tumours found in patients following skin biopsy specimens contained diffuse lymphoid solid organ transplantation, but these usually occur as tumour cells with large nuclei, prominent nucleoli, and separate entities. Solid organ transplantation is associated with a greater than 40-fold increase in the incid- were CD20-positive with frequent mitoses. The lesions ence of NHL, and a 400-fold increase in the incidence of the oral mucosa were diagnosed as KS, and lymph of KS. NHL and KS represent 16% and 4% of all node and skin biopsies indicated the presence of B cell post-transplantation tumours, respectively [1]. NHL. Computed tomography of the chest and abdoWhile the increased incidence of these malignancies men revealed only inguinal lymphadenopathy. There as sequelae to renal transplantation has been well was no infiltration of NHL on examination of the documented, the literature cites only two cases of patient’s bone marrow biopsy. We tested for the pressimultaneous NHL and KS following solid organ ence of human herpesvirus type 8 (HHV8) DNA using transplantation [2,3]. We could find no data concerning the polymerase chain reaction, and the result was the development of lymphoma in recipients who had negative. received organs from the same donor. Here we present We started combination systemic chemotherapy of the cases of two patients who received a kidney from cyclophosphamide, adriamycine and vincristine, disthe same donor; one who developed NHL and KS continued the azathioprine treatment, and reduced the simultaneously, and another who developed cutaneous dose of CsA to 1.5 mg/kg/day. Twenty-six months T cell NHL. after transplantation, the patient had normal graft function and both malignancies had been in comCase reports

Several studies have reported that hepatitis-C virus may have a role in the development of non- Hodgkin's lymphoma. Hepatitis-G virus has hepatitis-C virus like characteristics. The possible association between hepatitis-G virus infection and non-Hodgkin's lymphoma is not clear. The aim of this study was to determine the prevalence of hepatitis-G virus and hepatitis-C virus infection in patients with non-Hodgkin's lymphoma without blood transfusion. Forty-four patients with non-Hodgkin's lymphoma were enrolled in the study. Serum samples derived from the patients were tested for antibodies against hepatitis-C virus by ELISA. Hepatitis-G virus and hepatitis-C virus RNA were detected by reverse transcription-polymerase chain reaction. Only two of 44 patients (5%) with non-Hodgkin's lymphoma were positive for Anti- HCV and hepatitis C virus RNA. One patient had low grade non-Hodgkin's lymphoma with follicular mixed histopathology while the other had intermediate grade with diffuse large cell histopathology. Hepatitis-G virus infection was detected in none of the patients. We concluded that hepatitis-G virus does not seem to be in association with non-Hodgkin's lymphoma.

Clinical, histopathologic, and prognostic features of 114 patients with primary extranodal non-Hodgkin's lymphoma were evaluated. Median age of the patients was 48 (range, 15-76) and the ratio of male/female was 55/59. Thirty-seven patients had stage 1, 55 patients stage II, 6 patients stage III, and 16 patients stage IV. The most common sites of primary extranodal non-Hodgkin's lymphoma were the gastrointestinal (GI) tract and head-neck region. Stomach (66%) and tonsils (33%) were the most frequently involved organ in GI tract and head-neck region, respectively. Eighty percent of patients had intermediate or high-grade lymphomas, 20% had low-grade subtypes. Complete remission was achieved in 83% of all patients with chemotherapy +/- radiotherapy +/- surgery. Overall and disease-free survival at 5 years were 63% and 59%, respectively. In conclusion, clinical and histopathologic characteristics and prognosis of our cases with primary extranodal non-Hodgkin's lymphoma were usually similar to those of the cases in Western countries with some differences in the incidence of some specific primary extranodal non-Hodgkin's lymphomas and in the histopathologic subtypes.

The aim of this study was to evaluate the efficacy of low dose oral clodronate in palliation of pain arising from bone metastases (BM) and to determine the optimal oral clodronate dose which inhibits osteolysis caused by tumor. Fifty patients with bone pain caused by BM were included in this study. All were receiving antitumor chemotherapy or hormonal therapy. The patients were randomized into three groups according to the dose of clodronate. Groups A and B were given 800 mg/d and 1600 mg/d of oral clodronate respectively for 3 months. Group C was the control group. The effect of clodronate in pain palliation was evaluated with pain score, performance status, and changes in analgesic use. The effect on osteolysis was examined with urinary calcium, hydroxyproline (OHP) and serum cross-linked carboxyterminal telopeptide region of type I collagen (ICTP) levels. Group A contained 16 patients, and groups B and C contained 17 patients each. After 3 months use of oral clodronate, significant decrease in the pain score of groups A and B was noted when compared to group C (P = 0.024 and P = 0.007, respectively). The analgesic use of 11 patients in group A (69%) and 8 patients in group B (47%) was decreased, but only the decrease in group A was statistically significant (P = 0.038). Pain score increased in 5 patients in group C (29%), and 3 patients in groups A (19%) and B (18%) each. Urinary calcium, OHP and serum ICTP levels increased in group C and decreased in groups A and B, but only the decrease of urinary calcium levels of group B was significant (P = 0.003). In conclusion, low dose (800 mg/d) oral clodronate seems to be as effective as standard dose (1600 mg/d) in palliation of bone pain secondary to BM.

Background Bisphosphonates, which have been used for the treatment of the metastatic bone disease and malignant hypercalcemia due many cancers. These drugs also inhibit mevalonate pathway that results in the reduction of Ras prenylation, which eventually inhibits tumor growth. Rho/Rho kinase signaling has a fundamental role in cancer cell proliferation, migration and metastasis. In this study, we aimed to investigate the effects of y-27632 (a Rho-kinase inhibitor) and ibandronate (a bisphosphonate) and their combination on cell proliferation in prostate cell lines. Methods The adherent prostate cell line, PC-3, was grown in RPMI-1640 supplemented with 10% fetal bovine serum, 1% L-glutamine, 1% penicillin (10.000U/ml) and streptomycin (10.000 mg/ml) in a humidified atmosphere of 5% CO2 at 37 oC for confluency. The cells were seeded in the wells of E-plates (24,000 cells/well) that allowed a real-time-monitoring of the cell index reflected cell growth and proliferation (xCELLigence, Roche). The cell index was evaluated at the different points of time (post-treatment 12, 24, 36, 48, 60 and 72 h) in the groups of, y-27632, ibandronate, the combination of these drugs and time-course control. Results Both ibandronate alone (10-100 mM) and y-27632 alone (50-100 mM) markedly decreased cell index. But the combination of ibandronate with y-27632 (in differrent concentrations but especially in higher concentrations) resulted in potentiation of cytotoxicity in prostate cell line. Conclusions Rho kinase inhibitors, bisphosphonates and their combinations may be used for the treatment of prostate cancer in the future, according to the possible beneficial results of clinical trials. Disclosure All authors have declared no conflicts of interest.

e15104 Background: Bisphosphonates, which have been used for the treatment of breast and prostate cancers (Epplen et al., 2011) inhibit mevalonate pathway that results in the reduction of Ras prenylation, which eventually inhibits tumor growth (Luckman et al., 1998). Rho/Rho kinase signaling has a fundamental role in cancer cell proliferation, migration and metastasis (Vega et al., 2008) Therefore, in this study, we aimed to investigate effects of Y-27632, which inhibits Rho-kinase, ibandronate, which inhibits farnesyl transferase and their combination on cell proliferation in prostate cell lines, PC-3. Methods: The adherent prostate cell line, PC-3 (ATCC) was grown in RPMI-1640 supplemented with 10 % fetal bovine serum, 1 % L-glutamine, 1 % penicillin (10.000U/ml) and streptomycin (10.000 mg/ml) in a humidified atmosphere of 5 % CO2 at 37oC for confluency. The cells were seeded in the wells of E-plates (24,000 cells/well) that allowed a real-time-monitoring of the cell index reflected cell growth and proliferation (xCELLigence, Roche). The cell index was evaluated at the different points of time (post-treatment 12, 24, 36, 48, 60 and 72 h) in the groups of ibandronate, Y-27632, the combination and time-course control. Results: Ibandronate (10-100 mM), Y-27632 (50-100 mM) markedly decreased cell index. The combination of Y-27632 with ibandronate resulted in potentiation of cytotoxicity in PC-3 cells. Conclusions: Rho kinase inhibitors, biphosphonates and their combination may be beneficial for the treatment of prostate cell cancers.