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Objective: The present study reviews the records of patients with solid pseudopapillary pancreas neoplasm (SPT)., Methods: A total of 13 patients diagnosed with SPT were included in the study. The criteria for SPT in the pathology specimens were the presence of cells with an oval round orthochromatic nucleus, with a thin chromatin structure and no nucleolus distinction, lined around a fibrovascular papilla in cystic areas., Results: The study included 11 female and two male patients, with a mean age of 33.07 (range: 16-73) years. All operated patients underwent open surgery, with five undergoing a subtotal pancreatectomy and splenectomy; one a distal pancreatectomy and splenectomy; four a spleen-preserving distal pancreatectomy; and one a pancreaticoduodenectomy. None of the operated patients developed recurrence during the long-term follow-up. The mean follow-up time of operable patients was 69.18 (range: 22-97) months, and none had metastasis at follow-up. The mean follow-up time for the malignant SPT patients was 2.75 (1.5-4) months., Conclusion: SPTs are rare pancreatic tumors encountered more frequently today due to advances in imaging methods and have a low potential of recurrence and a good prognosis., Competing Interests: No conflict of interest was declared by the authors.

Objective: This study aimed to examine the factors linked to the development of clinically significant pancreatic fistulas following distal pancreatectomy (DP) and to assess the efficacy of suture ligation of the main pancreatic duct., Patients and Methods: A single-center retrospective study was performed on the medical records of 82 patients who underwent DP in our institution between January 2011 and December 2019., Results: There were 28 males (34.1%) and 54 females (65.9%). The patients' age ranged from 18 to 86 years (median: 55.5 years). Indications for DP included primary pancreatic disease (n=63, 76.8%) and non-pancreatic disease (n=19, 23.2%). Postoperative mortality and morbidity rates were 3.7% and 48%, respectively. Pancreatic parenchymal closure was accomplished by a hand-sewn technique or mechanical stapling in 89 and 13 patients, respectively. Identification of the pancreatic duct and suture ligation was performed in 46 patients (56.1%). Pancreatic fistula was developed in 20 patients (24.4%); 12 fistulas were classified as Grade B, and 8 as Grade C. Biochemical leaks (Grade A) were identified in 8 patients (9.8%). Multivariate analysis indicated that failure to ligate the main pancreatic duct was the only variable associated with an increased risk for pancreatic leak (p=0.031; odds ratio=0.233; 95% confidence interval, 0.062-0.879)., Conclusions: Pancreatic leak remains a common complication after DP. The incidence of leaks is reduced significantly when the main pancreatic duct is identified and directly ligated during DP.

Purpose: This study aimed to determine the C-reactive protein (CRP) ratio for the survival of patients with Fournier gangrene (FG)., Methods: Fifty-two patients with FG between January 2011 and September 2018 were retrospectively analyzed. Data on clinical presentation, Fournier Gangrene Severity Index (FGSI), CRP ratio, management, and outcome were analyzed. The CRP ratio was calculated as preoperative CRP/postoperative CRP value that measured 48 hours after surgical intervention. Possible alternative cutoff points for the FGSI and CRP were determined by receiver operating characteristic (ROC) analyses. The risk factors related to the prognosis were evaluated by univariate and multivariable logistic regression analyses., Results: The mean CRP ratios were 6.7±6.6 in the survivor group and 1.2±0.8 in the nonsurvivor group (P=0.001). FGSI was significantly higher in the non-survivor group compared to survivor group (8.5±2.5 vs. 3.5±2.2, P=0.001). There was a negative correlation between FGSI and CRP ratio (r=-0.51). ROC analysis determined the cutoff value as 1.78 for CRP (sensitivity, 86%; specificity, 82%; area under the ROC curve, 0.90) to predict death. The incidence of death for patients with CRP ratio of ≤1.78 increased 26.7 fold for those with CRP ratio of >1.78 (95% confidence interval [CI], 4.8-146.5; P=0.001). In the multivariable logistic regression model, CRP ratio (odds ratio [OR], 10.3; 95% CI, 1.5-72.2; P=0.019) and FGSI (OR, 17.8; 95% CI, 2.6-121.1; P=0.003) were independent risk factors for death., Conclusion: The CRP ratio is a simple method to use to predict mortality in FG.

Objective: This study aimed to reveal the incidence, clinicopathological, and oncological outcomes of appendiceal neoplasms., Methods: This is a retrospective cohort study from a single institution. Patients with a pathological diagnosis of malignancy who underwent appendectomy between January 2011 and 2021 were included in the study, and groups were formed according to pathological type. Clinical, pathological, and oncological results were compared in these groups., Results: The incidence of neoplasia was 2.38% (n=34) in a cohort of 1,423 appendectomy cases. Of the cases, 56% (n=19) were female. The median age in the entire cohort was 55.5 (range: 13-106) years. In the cohort, the rate of neuroendocrine tumor mucinous cystadenoma adenocarcinoma, and low-grade appendiceal mucinous neoplasm, according to the American Joint Committee on Cancer classification of appendiceal neoplasms, was 32.3% (n=11), 26.4% (n=9), 26.4% (n=9), and 14.7% (n=5), respectively. Neuroendocrine tumor patients (median age: 35 years) were younger than the other groups (p=0.021). Secondary complementary surgery was performed in 66.7% (n=6) of adenocarcinoma patients and 27.3% (n=3) of neuroendocrine tumor patients. Right hemicolectomy was performed in all neuroendocrine tumor patients requiring secondary surgery, while right hemicolectomy was performed in three adenocarcinoma patients and cytoreductive surgery and hyperthermic intraperitoneal chemotherapy in three adenocarcinoma patients. After a median follow-up of 44.4 months (95% confidence interval: 18.6-70.1), the mean survival rate was 55% in appendiceal adenocarcinoma patients compared to 100% in neuroendocrine tumor patients., Conclusion: Appendiceal neoplasms are rare but remain an important cause of mortality. Appendiceal adenocarcinomas are associated with poorer oncological outcomes compared to other neoplasms.

Chylous fistulas (CF) are rare surgical complications and there is no standard treatment. This study presents the treatment modalities performed on patients who developed CF over a 10-year period. During the observation period, CF developed in 29 patients, 16 of whom were women. The mean age was 55.76± 13.48. Lymphatic duct injury was mostly seen in the abdomen (58.6%) and the most common reason was nephrectomy (20.7%). Extended lymphatic dissection due to malignancy was performed in 82.7% of all cases. Chylous leakage started postoperatively on 3.78±3.94 days (range: 1-19 days). Fasting, total parenteral nutrition (TPN), and somatostatin treatment were applied to all patients, and 75.8% of the fistulas were resolved completely with medical treatment. Surgical ligation of the lymphatic canal was performed in 7 patients. One was not successful and underwent percutaneous embolization of the thoracic lymphatic leakage cavity. All fistulas were resolved in 18.18±10.4 days. The resolution time and hospital stay were significantly higher in thoracic fistulas (p=0.017; p=0.003, respectively). In addition, malignant cases had longer resolution time (32.40±28.72 vs 16.27±11.25, p=0.036) and hospital stay (35.0±29.74 vs 16.25±14.05p= 0.002 respectively) than non-malignant. There was no chylothorax, chylous ascites, or recurrence at 20.55±22.88 months follow-up. Treatment of CF with fasting, TPN, and somatostatin analogs are effective. Other interventions such as surgical ligation with or without fibrin glue and interventional radiology treatments may be considered when conservative treatments fail., Competing Interests: The authors of this article and the planning committee members and staff have no relevant financial relationships with commercial interests to disclose., (Copyright by International Society of Lymphology.)

Background: Periductal mastitis (PM) is a rare disease characterized by chronic inflammation of the terminal mammary ducts. Complete removal of terminal lactiferous ducts with Hadfield procedure is a previously defined technique in treatment but carries various complications risks. This study aims to evaluate the effectiveness of modified techniques in the treatment of PM., Methods: Twenty women who underwent surgery due to PM between January 2012 and December 2019 were retrospectively analyzed. Types of PM were determined. All patients were operated on with three different incisions [Hadfield's operation with periareolar incision (n:11), periareolar combined radial incision (n:7), and round block incision (n:2)]., Results: The mean age was 37.5 ± 6.5 years (range: 24-49). Sixty percent of patients had type 3 PM. In Hadfield's procedure, NAC retraction (n:2), seroma (n:1), and hematoma (n:1) were seen. In the periareolar incision combined radial incision group only one patient had complications (seroma) and none in the round block method. Follow-up was 12 ± 1.5 months and disease relapse occurred in two patients in the Hadfield group. Patients who underwent round block were more satisfied with the appearance of the nipple., Conclusions: In the treatment of PM, the main principle of surgical treatment is the excision of the affected canal with a clear margin. Apart from the classical Hadfield procedure, the round block method and periareolar combined radial incision techniques can be performed in the treatment of PM., (© 2022. The Author(s).)

Background: In this study,we aim to present the clinical features of patients with rectus sheath hematoma(RSH), as well as the condition's therapeutic management and results. Methods: The study included patients who were diagnosed with and received treatment for spontaneous RSH between the years 2010 and 2020. The demographic and clinical features of the patients, as well as follow-up parameters, were analyzed retrospectively. Results: Our study included 53 patients. The number of female patients was twice as many as the number of male patients. The median age was 65.7 +-14.68 years, and 63.3% of the patients were over the age of 65. The most frequently used anticoagulant was warfarin (30.1%), and it was most often used for heart diseases (54.7%). The international normalized ratio value at the time of admission to the hospital was 1.93+1.18, and the hemoglobin value was 11.2 gr/dl. The average hematoma diameter was 74 mm, and the most common stage was typeI (75.6%). Of the patients, 90.6% were followed up conservatively. The average duration of hospital stay was 15.1 days, and mortality occurred in eight patients during their hospital stay. Conclusion: Spontaneous RSH should be consideredfor elderly female patients who have used anticoagulants. Most patients are followed up medically, but mortality is still high., (Celsius.)

Purpose: The aim of the present study is to describe the cavity-reducing internal capitonnage technique that we used for the surgical therapy of liver hydatid cyst, and contribute to the literature by presenting the short- and long-term outcomes of the patients who were operated on with this technique., Methods: A drainage and internal capitonnage technique was performed on 12 cases due to liver hydatid cyst in our clinic between January 2016 and December 2019., Results: The mean age of cases was 36.25 ± 12.5 years, with 7 females and 5 males. All cases had pain in the right upper quadrant, and a sense of fullness in 5 cases. None of the cases had ruptured cysts, jaundice, or other clinical manifestations. The preoperative laboratory findings were normal in 8 cases. Intraoperative biliary-cyst communication was demonstrated in 8 cases (66.7%). Cases were followed up for a mean duration of 38.1 months (range, 24-88 months)., Conclusion: The drainage/internal capitonnage with/without selective bile duct repair is a technique that can be performed with very low morbidity and mortality rates in experienced hands, especially for centrally located hydatid cysts., Competing Interests: Conflict of Interest: No potential conflict of interest relevant to this article was reported., (Copyright © 2021, the Korean Surgical Society.)

Purpose: The aim of this study was to review patients with xanthogranulomatous cholecystitis (XGC)., Methods: A total of 79 patients diagnosed with XGC were included in the study. The criteria for XGC in the pathology specimens were the presence of histiocytes, cholesterol deposits, lipids, and focal or widespread wall enlargement., Results: Patients were diagnosed with XGC, of which 52 (65.8%) were male and 27 (34.2%) were female, creating a male-to-female ratio of 2:1. The mean age was 65.8 ± 14.3 years (range, 36-97 years). The most common presenting symptom was abdominal pain (63.3%), and the least common presenting symptom was jaundice (8.9%). Of the total, 25 patients were found to have pathological conditions with the potential to obstruct the bile duct or to slow bile flow. A frozen section examination was performed on 20 patients due to suspicion of a tumor by intraoperative macroscopic examination. However, no malignancy was detected in the cases who underwent a frozen section examination. An increase in wall thickness of the gallbladder was observed in 81.6% (n = 31) of the patients on computed tomography scans and in 81.8% (n = 18) of the patients on magnetic resonance imaging scans in which possible tumor lesions were reported, but no tumor was detected., Conclusion: It is difficult to diagnose XGC either preoperatively or intraoperatively, and further imaging methods are needed in the preoperative period other than ultrasonography. However, a definitive diagnosis depends exclusively on pathologic examination., Competing Interests: Conflict of Interest: No potential conflict of interest relevant to this article was reported., (Copyright © 2020, the Korean Surgical Society.)

Hepatocellular carcinoma metastases to the breast have been reported only rarely. A 63-year-old male patient with metastatic hepatocellular carcinoma presented with a lump in his left breast. On physical examination, there was a hard, well-circumscribed, and partially mobile mass of 2 cm in diameter in the lower middle quadrant of the left breast. Breast ultrasound revealed a hypoechoic solid lesion of 1.8 cm × 1.9 cm in diameter in the lower middle quadrant of the left breast. F-18 FDG PET/CT imaging revealed bilateral subcutaneous nodular lesions of anterior chest wall that were adjacent but not invasive to the glandular tissues of the breasts, with high SUVmax values. Tru-cut biopsy result of the mass in the left breast region was reported as hepatocellular carcinoma metastasis. Positive immunohistochemical staining for Hep Par 1 and glypican-3 were detected. While the patient was on sorafenib therapy, he died 6 months later. Hepatocellular carcinoma is a common malignancy for which chronic hepatitis B infection has been defined as the most common etiologic factor. The most frequent metastatic sites are the lung, bone, lymphatics, and brain, respectively, and metastases to the breast have been reported extremely rarely. Breast metastasis from non-mammary malignant neoplasm is rare, accounting for approximately 2% of breast tumors. Metastasis to the breast from an extramam mary neoplasm usually indicates disseminated metastatic disease and a poor prognosis. It should be borne in mind that a mass lesion detected in the breast region by physical examination and imaging methods may be a hepatocellular carcinoma metastasis in male or female patients with hepatocellular carcinoma. KEY WORDS: Breast, Hepatocellular carcinoma, Metastasis.

Purpose: Since the treatment strategy for benign and malignant pancreatic lesions differ, we aimed to evaluate the clinical value of PET/CT in the diagnosis and management of pancreatic lesions., Methods: Ninety patients who had a histologically confirmed pancreatic lesion were studied. Receiver operating characteristic (ROC) curve analysis was used to investigate the ability of PET/CT to differentiate malignant lesions from benign tumors., Results: The malignant and benign groups comprised 64 and 26 patients, respectively. Despite the similarity in the size of primary tumors (P = 0.588), the mean maximum standardized uptake values (SUVmax) obtained from PET/CT imaging were significantly higher in malignant lesions (9.36 ± 5.9) than those of benign tumors (1.04 ± 2.6, P < 0.001). ROC analysis showed that the optimal SUVmax cutoff value for differentiating malignant lesions (to an accuracy of 91%; 95% confidence interval, 83%-98%) from benign tumors was 3.9 (sensitivity, 92.2%; specificity, 84.6%)., Conclusion: PET/CT evaluation of pancreatic lesions confers advantages including fine assessment of malignant potential with high sensitivity and accuracy using a threshold SUVmax value of 3.9., Competing Interests: Conflict of Interest: No potential conflict of interest relevant to this article was reported., (Copyright © 2020, the Korean Surgical Society.)

Pancreatic fistula formation is a known complication of pancreatic surgery, pancreatitis, and pancreatic injury. We here report a case of a 65-year-old man who was diagnosed with gallstone-induced acute pancreatitis with walledoff pancreatic necrosis. The patient initially underwent medical treatment and percutaneous drainage at 4 weeks. After a four-week period, a formal laparotomy with necrosectomy, and the catheter drainage of the cavity were performed. Having postoperatively developed a pancreatic fistula, the patient was managed conservatively. After 6 weeks of medical treatment, patient underwent an endoscopic retrograde pancreatography and was diagnosed with disconnected duct syndrome. The conservative management was continued for 3 more months. Pancreatic duct stenting was attempted but was not successful in cannulating the disconnected duct, and he was finally planned for a Roux-en-Y fistulojejnuostomy. The fistulojejunostomy was performed on an average of 6 months after placement of peri-pancreatic drain. The patient recovered uneventfully and is doing well at a 12-month follow-up. Refractory external pancreatic fistula is defined as an external pancreatic fistula not resolving with these measures for longer than 6 weeks. Most fistulas developing after acute pancreatitis are related directly to the need for necrosectomy to treat infected necrosis. Patients are initially approached conservatively. When patients fail to respond to either percutaneous drainage, endoscopic interventions, or novel techniques, operative intervention is the most viable approach to treat the fistula. Fistulojejunostomy is a safe and effective treatment for intractable pancreatic fistula having the benefit of avoiding a difficult major pancreatic resectional surgery, along with low postoperative morbidity and mortality. KEY WORDS: Acute pancreatitis, Pancreatic necrosis, Pancreatic fistula, Fistulojejunostomy.

Background: Psoriasis is a chronic inflammatory skin disease with an incidence of 1-3%. Psoriasis usually occurs in the scalp, knee, elbow, sacral region and joints. The nipple-areola complex involvement is rarely encountered in the literature., Case Report: 31-year-old female patient, who presented at the dermatology outpatient clinic with a lesion characterized by bright, pearlescent-white squamous lesions on an erythematous plaque, limited to the nipple-areola complex for the past three years, and who was diagnosed with "Psoriasis" following incisional biopsy., Conclusions: The benign or malignant distinction should be made for lesions observed in the nipple-areola complex. It should not be forgotten that psoriasis may also be present in the differential diagnosis of dermatitis-like benign lesions that do not respond to long-term and various drug treatment, although they are rare., Key Words: Complex Benign lesions, Breast, Nipple areola, Psoriasis.

Background: Scarce data are available comparing outcomes of hepatic resection vs orthotopic liver transplantation (OLT) for localized hepatocellular carcinoma (HCC) patients both meeting and exceeding the Milan criteria. This study compared the clinical and oncological outcomes of patients undergoing hepatic resection vs transplantation localized HCC., Method: Between January 2005 and February 2017, clinical and oncological outcomes of patients who underwent liver resection (n = 38) vs OLT (n = 28) for localized HCC were compared using a prospectively maintained database., Results: A total of 66 patients (with a median age of 62) who met the study criteria were analyzed. Comparable postoperative complications (13.2% vs 28.6%, P = .45) and perioperative mortality rates (7.9% vs 10.7%, P = .2) were noted for the resection vs OLT groups. While Child-Pugh Class A patients were more prevalent in the resection group (78.9% vs 7.1%, P = .0001), the rate of patients who met the Milan criteria was higher in the OLT group (89.3% vs 34.25, P = .0001). Recurrence rates were 36.8% in the resection group and 3.6% in the OLT group at the end of the median follow-up period (32 vs 39 months, respectively). The HCC-related mortality rate was significantly higher in the resection group (39.5% vs 10.7%, P = .034). However, a subgroup analysis of patients who met the Milan criteria revealed similar rates of recurrence and HCC-related mortality (15.4% vs 8%, P = .63). Based on logistic regression analysis, number of tumors (P = .034, odds ratio: 2.1) and "resection"-type surgery (P = .008, odds ratio: 20.2) were independently associated with recurrence., Conclusion: Compared to liver transplantation, hepatic resection for localized hepatocellular carcinoma is associated with a higher rate of recurrence and disease-related mortality., (Copyright © 2019 Elsevier Inc. All rights reserved.)