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SUMMARY OBJECTIVE: This study aimed to examine the prognostic effect of the tumor-stroma ratio, which has been shown to have prognostic value in various cancers, in patients with gallbladder cancer who have undergone curative resection. METHODS: The records of gallbladder cancer patients who underwent surgical treatment in our clinic between December 2005 and March 2021 were analyzed retrospectively. The hematoxylin and eosin-stained sections representing the tumors were evaluated under light microscopy to determine tumor-stroma ratio, and based on the results

Purpose: Accurate restaging of the axilla after neoadjuvant chemotherapy (NAC) is an important issue to ensure deescalating axillary surgery in patients with initial metastatic nodes. We aimed to present our results of targeted axillary biopsy (TAB) combined with sentinel lymph node biopsy (SLNB) for axillary restaging after NAC. Methods: In 64 breast cancer patients who underwent NAC, biopsy-proven positive nodes were marked with clips before NAC, and ultrasound-guided wire localization of clip-marked nodes was performed after NAC. Patients underwent TAB and SLNB for post-NAC axilla restaging. Results: Identification rates of post-NAC TAB and SLNB were 98.4% and 87.5%, respectively (P = 0.033). Histopathology revealed a nodal pathologic complete response (pCR) rate of 47% in which axillary lymph node dissection (ALND) was avoided. TAB alone and SLNB alone detected residual disease in 29 (85.3%) and 20 (58.8%) patients (P = 0.029), respectively. Whereas rates of up to 97% had been achieved with a combination of TAB and SLNB. The pCR rates after NAC were 64.3% for human epidermal growth factor receptor 2 positive and triple-negative tumors and 13.6% in luminal tumors (P = 0.0002). Conclusion: Pathologic analysis following TAB combined with SLNB revealed the pCR rates to NAC in a considerable number of patients that provided de-escalation of axillary surgery. A combination of SLNB and TAB was found to be an accurate procedure in establishing residual nodal disease. This combined procedure in patients with initially positive nodes was a reliable method for post-NAC axillary restaging. WOS:000658410700001 2-s2.0-85107531288 PubMed: 34136426

Background The triple test, i.e., cytology combined with clinical and radiological findings, is the goal for accurate assessment of palpable breast lesions. Because of the limitations of fine-needle aspiration cytology (FNAC), its utility has somewhat decreased nationwide. We have been using a combination of physical examination, radiological modalities, and FNAC for the diagnosis of palpable/nonpalpable breast mass lesions for the last 23 years. Our institutional experience of the last 10 years is presented here, using FNAC of breast lesions along with an analysis of the diagnostic accuracy. Methods 4956 breast aspirates in 4860 cases were collected from the computer database of Haydarpasa Numune Education and Research Hospital in Istanbul, Turkey. Most of the FNACs were performed under ultrasound guidance and FNAC procedures were performed by radiologists and pathologists who used 22 gauge needles. Cytological diagnoses were classified as “unsatisfactory”, “benign”, “malignant”, “atypical/probably benign”, “atypical/probably malignant”, and “atypical/NOS” (not otherwise specified) and were compared to the histopathological diagnoses obtained from core needle biopsy, lumpectomy or mastectomy to give an assessment of the diagnostic performance of FNAC in 733 aspirates. Results The sensitivity, specificity, accuracy, positive and negative predictive value, false positive, and false negative rates of FNAC were 98.02, 90.58, 95.97, 96.48, 94.54, 2.6, and 1.4%, respectively. Conclusions This study once again shows that FNAC is a reliable method for the initial evaluation and diagnosis of breast masses. In case of any suspicious conditions, FNAC, and core biopsy are considered complementary to one another. Diagn. Cytopathol. 2015;43:978–986. © 2015 Wiley Periodicals, Inc.

Malignant melanoma, breast cancer and lung cancer are the most causative malignancies of leptomeningeal carsinomatosis (LC). A LC case that was previously diagnosed as tuberculosis meningitis, is presented here to emphasize the importance of maintaining a broad differential diagnosis in patients applied to the hospital with meningeal irritation symptoms. A 35-year-old woman was suffering from a severe headache and photophobia. Physical examination revealed nuchal rigidity but Kernig’s and Brudzinski signs were negative. Cerebrospinal fluid (CSF) findings were 171 cells/mm3 (lymphocytic predominance), elevated protein levels, decreased glucose. Atypical cells were detected in CSF cytology. The result of breast biopsy was in accordance with breast lobular carcinoma nuclear grade III. LC, usually developes in patients who have a known primary malignancy. As it occured in our case; in up to 10%-20% of cases, however, symptoms caused by LC may emerge before the diagnosis of the primary tumor. It should remember that meningitis may not be always infectious originated. J Microbiol Infect Dis 2015;5(3): 133-136Key words: leptomeningeal carcinomatosis, meningitis, cerebrospinal fluid cytology, Meme kanseri, akciğer kanseri ve malign melanom leptomeningeal karsinomatosize (LK) neden olan en sık malignitelerdir. Meningeal iritasyon bulguları olan hastalarda geniş ayırıcı tanı yapılmasının önemini vurgulamak için, tüberküloz menenjit ön tanısı almış bir LK olgusu sunulmuştur. Ciddi başağrısı ve fotofobi yakınması olan otuz beş yaşında kadın hastanın fizik muayenesinde ense sertliği vardı fakat Kernig-Brudzinsky belirtisi negatifti. Serebrospinal sıvı (BOS) analizinde, 171 hücre/mm3(lenfosit baskın) artmış protein seviyesi, azalmış glukoz saptandı. BOS sitolojisinde atipik hücreler görüldü. Meme biyopsisinin sonucu nükleer grade 3 meme lobüler karsinomu ile uyumluydu. LK, genellikle bilinen primer malignitesi olan hastalarda rastlanır. Bizim vakamızda olduğu gibi, vakaların % 10-20’sinde primer tümörün tanısı konulmadan önce LK’e sekonder gelişen semptomlar ortaya çıkabilir. Menenjitin her zaman enfeksiyöz orjinli olmayabileceği unutulmamalıdır

Background: Heat shock protein (60 kd HSP) has been implicated in the etiology of Behcet's disease, but its expression at sites of inflammation is unknown. Objective: Our aim was to investigate local HSP 60 expression and to quantify T-cell receptor (TCR) γδ-positive cells, which are known to respond to HSP peptides. Methods: Patients with active Behcet's disease (n = 21) and controls (n = 18) were included. Flow cytometric analysis was performed on peripheral blood to investigate TCR γδ-positive cell counts. Biopsies were performed on active skin lesions, and immunohistochemical analysis was performed by a streptavidin-biotin method using the monoclonal ML-30 antibody; HSP staining intensity and distribution were evaluated in a blinded fashion. Immunhistochemical studies were performed to quantify TCR γδ-positive cells at lesional sites. Results: Mucocutaneous lesions of patients with Behcet's disease had statistically significantly increased expression of HSP 60/65. Peripheral blood TCR γδ-positive cell counts were similar in both groups. However, lesional skin of patients with Behcet's disease had significantly increased γδ-positive T-cell counts. Conclusion: Up-regulation of HSP expression was found at lesional skin sites in Behcet's disease. The increased number of TCR γδ-positive cells, which are known to respond to HSP peptides, may support the function of HSPs in the etiology of Behcet's disease. However, these findings may also be an epiphenomenon that needs to be further investigated. (J Am Acad Dermatol 2001;45:904-9.)

To achieve a negative surgical margin, resection of superior mesenteric/portal vein is necessary in pancreatic cancer. This study is designed to demonstrate the demographic and clinical differences of the patients requiring major vein resection and the incidence of histopathological vein invasion.A retrospective analysis of patients that underwent pancreaticoduodenectomy for adenocarcinoma of the pancreas between January 2000 and September 2011 was performed. Macroscopic adhesion to vein was considered as an invasion and a resection was performed.Twenty three of 100 patients that underwent pancreaticoduodenectomy for adenocarcinoma of the pancreas had vein resection. Although the operation time (p=0.001), blood loss (p0.001) and perioperative blood transfusion (p0.001) were higher in the vein resection group, there were no differences in perioperative and hospital mortality, complication rate and hospitalization time. The tumor was larger (p=0.001) and lymphovascular invasion (p=0.030), perineural invasion (p=0.011), median metastatic lymph nodes (p=0.007), rate of R1 resection (p=0.007) were higher in vein resection group. Only 9 patients out of 23 patients had histopathological vein wall invasion. Overall survival was also not significantly different (p=0.14).Overall survival in vein resected group was also not significantly different than patients with standard pancreaticoduodenectomy and not all macroscopic vein adhesion means histopathological vein wall invasion.

Textiloma is a term used for retained cottonoid or surgical sponge in the operation field. Although they occur mostly after thoracic or abdominal operation, they can also be encountered after surgery of extremities or the spine. There are few reports of spinal cases in which MR and CT imaging findings of textilomas have been described. In this report, two additional cases with MR, CT and pathological features of paraspinal textilomas are described. CT image demonstrated a paraspinal mass simulating a malignant tumour. While T1-weighted MR images showed the masses with low signal intensity, T2-weighted MR images showed heterogeneous masses with low and high signal intensities.

Schwannomatosis is a rare tumour syndrome characterized by more than one schwannoma without any sign of neurofibromatosis (NF). A 22-year-old male patient was admitted with weakness in his extremities. Neurological examination revealed a tetraparesis syndrome below the C6 level. Magnetic resonance (MR) imaging showed a demarcated mass with strong enhancement at the C4-7 levels. The patient improved rapidly after removal of the tumour. The histological diagnosis was schwannoma. Two years later, the same patient was admitted with the complaint of severe low back and leg pains. The neurological examination was normal except bilateral positive straight leg raising test and dysesthesia at the L3,4 and 5 dermatomes. MR showed a wellcircumscribed lesion at L4-5. Laminectomy and tumour excision relieved his complaints. The histological diagnosis was schwannoma. A detailed clinical examination and MR scanning of the central nervous syndrome excluded NF2. In conclusion, although schwannomatosis is a benign condition, symptomatic tumours should be resected surgically.