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Bu çalışmanın amacı 20 yıllık dönemde Dokuz Eylül Üniversitesi Tıp Fakültesi Patoloji anabilim Dalı'nda saptadığımız 159 tiroid kanserinin retrospektif olarak incelenmesidir. Olguların sasso (132 olgutiti tiroid papiller karsinomu {TPK}. vaee [15 olgui'ü tiroid tolliküier karsinomu (TFK). "tacın (?clgulı'ü tiroid modüller karsinomu [TMR]. %32 {5 olgul'si de timid Hürthie hücreli karsinomitümörü tTl—lHI—(iTl dür. Saptadığımız timid kanseri olgularının histopatolojik bulgulari yeni bilgiler ışığında değerlendirilmiştir. Anahtar Sözcükler: Timid kanseri. mikrokarsinom. timid papiller tümörü. mikst timid karsincmları. iroid karsinomları az görülen kanserler olmasına karşın. her yıl birkaç binden az insanı etkiler ve kanser ölümlerinin “fal'den azını oluşturur. Etioloji'de çevresel etkenler. kalıtımdan daha önemlidir. Guatrın endemik olduğu bölgelerde sıklığı yüksektir {1-3}. Ayrıca

İnvaziv iobüler karsinom memede en sık görülen ikinci histopatoljik türü oluşturur ve sıklıkla gastrointestinal ve kadın genital kanalına metastaz var:-ar. Bu çatışmada anormal vajinal kanama ve abdominal yakınma nedeniyle ovarva karsinomu ön tanısı ile totai abdominal histerektomi ve bilateral saipingooferektomi operasyonu uygulanan premenapozal ve postmenaoozal dönemdeki üç hastanın klinik ve patolojik özellikleri sunulmuştur. Her bir olguda iki taraflı ovarvurn. tubal ve servikal stromal hücrelerde taşlı vüzük görünümünde hücreler saptanmıştır. Tüm olgularda metastatik malignitenin yüksek olasılıkla memenin invaziv Iobüler karsinomu ile uyumlu olduğu saptanmıştır. Son dönemde yayınlanan bir çok çalışmada bu neoplazinin saldırgan davrandığı ve kötü bir doğal gidişi olduğu gösterilmiştir

The aim of this study was to compare two different physiotherapy methods in the treatment of lymphedema after breast surgery.This study was performed on 53 patients who had developed unilateral lymphedema after the breast cancer treatment. Twenty-seven patients served as the experimental group and were treated with complex decongestive physiotherapy (CDP) applications including lymph drainage, multi layer compression bandage, elevation, remedial exercises and skin care. Twenty-six patients in the control group were treated with standard physiotherapy (SP) applications including bandage, elevation, head-neck and shoulder exercises and skin care. Both groups were recommended a home program consisting of compression bandage exercises, skin care and walking. Patients were taken to a therapy program once a day; 3 days a week for 4 weeks. The range of motion, circumferential measurement, and volumetric measurement were assessed before and after treatment.The overall improving in the CDP group was shown to be greater than the SP group but when the evaluation results of both groups were compared before and after treatment, a significant statistical difference in edema according to circumferential and volumetric measurements results was found in favor of the CDP group (p0.05).In the patients with upper extremity lymphedema, the shoulder mobility can be increased and edema can be decreased by the use of complex physiotherapy programs.

Purpose: The aim of this study was to evaluate the efficacy of complex decongestive physiotherapy (CDP) in patients with upper extremity lymphedema. Materials and methods: One hundred-two women with lymphedema after having breast surgery and adjuvant radiotherapy were included in this study. The subjects were divided into three groups as mild lymphedema (N=31), moderate lymphedema (N=34), and severe lymphedema (N=37). They were treated with CDP applications of daily manual lymph drainage, compression bandage, remedial exercises and skin care, for five days per week, four weeks. They also received a prophylactic physiotherapy and education for self-management techniques. Lymphedema was assessed through circumference and volumetric measurements before and after the treatment. Results: Volume of lymphedema was found to be decreased significantly in each group after CDP (p

Sentinel lymph node biopsy (SLN) has rapidly become standart of care in early stage breast cancer. However, the optimal injection sides remained unclear for successful lypmhatic mapping. Here, we attempted to investigate the efficacies and success rates of different injection routes on the localization of SLNs. Between November 1998 and January 2007 in an University Hospital, SLN biopsy was performed in 281 consecutive patients and data was analysed retrospectively in terms of injection techniques. Sentinel lymph nodes succesfully identified in 92 % of patients. Univariate analysis revealed that, no significance was found between intratumoral, peritumoral or pericavitary injections in the aspect of successful SLN identification (p=0,55). Also, similar results were observed between intradermal and paranchymal radionuclide injections (p=0,474). Whereas, isosulphan blue was found to be superior than methylene blue dye (p=0,004). However, remarkable skin necrosis due to intradermal isosulphan blue dye injection was observed in some patients. In conclusion, whether the radionuclide combined with blue dye or not, each injection route has successful but similar SLN identification rates.

LYVE-1 is a -recently identified- selective lymphatic endothelial surface receptor which plays mainly role on transportation of hyaluronan from extracellular matrix to the regional lymph nodes. In a few cancer studies, relationships between LYVE-1/Hyaluronan and lymphatic invasion and metastasis has been shown. However, predictive values of peritumoral or intratumoral LYVE-1 positivity for the assesment of regional lymphatic invasion is unknown. In the present study, we aimed to investigate whether the peri/intratumoral LYVE-1 immunoreactivity related to sentinel lymph node status in 25 breast-cancer-patients. Sentinel lymph node (SLN) biopsy was performed by using combined technique with vital blue dye and hand-held gamma probe dedection in patients with early breast cancer. Lymphoscintigraphy was performed in all patients. Metastases to sentinel lymph nodes was evaluated both Hematoxylene/Eosine (HE) and immunohistochemical (IHC) staining. Serial sections which contain both invasive tumor and peri-tumoral area from the original block were cut (4 um) and stained with HE and LYVE-1. "LYVE1 antibody-lymphatic vessel marker" was used for IHC analysis. The sensitivity and specifity of the method were established as 67% and 71% respectively. The LYVE-1 positivity was mostly peritumoral (85 %) Negative and positive predictive values of LYVE-1 immunostaining were 77% and 60% respectively. On conlusion, as a novel lymphangiogenesis marker LYVE-1, has limited predictive values for the evaluation of sentinel lymph node metastasis in patients with early breast cancer.

LYVE-1 lenfatik endotele özgü, yeni keşfedilmiş bir hücre yüzeyi reseptörüdür. Hyaluronan'ın extrasellüler matrixten lenf düğümüne aktarılma işlevinde rol alır. Sınırlı sayıda çalışma lenfatik invazyon ve metastazda LYVE-1/Hyaluronan ilişkisinin rol oynadığını göstermiştir. Malign meme tümörlerinde peritümöral ve intratümöral LYVE-1 pozitifliğinin, bölgesel lenfatik metastaz varlığını ne derecede öngörebileceği iyi bilinmeyen bir konudur. Bu çalışmada meme kanserli olup, bekçi lenf düğümü biyopsisi yapılan 25 olguda immunohistokimyasal (İHK) olarak LYVE-1 boyanmasının bölgesel lenf düğümü yayılım varlığını ne derecede gösterdiği incelendi. Bekçi lenf düğümü biyopsisi T1 ve T2 invaziv meme kanseri olgularında gamma dedeksiyon ve vital boyanma yöntemlerinin birlikte kullanımı ile belirlendi. Tüm olgularda lenfosintigrafi elde olundu. Bekçi lenf düğümlerindeki yayılım, Hematoksilen-Eosin (HE) ve standart İHK boyaması ile belirlendi. Analiz için, tümör ve çevresini içeren HE boyalı kesitler seçildi. Bunların parafin bloklarından polilizinli lamlara 4 mikronluk kesitler alındı. LYVE-1, "LYVE1 antibody - Lymphatic Vessel Marker" ı kullanılarak Immunohistokimyasal yöntemle incelendi. Yöntemin özgüllüğü % 71, duyarlığı %67, pozitif öngörüsü % 60, negatif öngörüsü % 77 olarak belirlendi. İmmunreaktivitenin % 85 i peritümöral, % 15 i intratümöral bölgede belirlendi. Sonuç olarak, lenfanjiogenetik bir belirteç olan LYVE-1'in , meme kanserli olgularda bölgesel lenfatik metastazın belirlenmesinde sınırlı bir etkinliğe sahip olduğu düşünüldü.

Purpose To evaluate the prognostic value of extracapsular extension (ECE) of axillary lymph node metastases in 221 patients with axillary lymph node-positive, T1-T2 breast cancer treated at Dokuz Eylul University Hospital, Department of Radiation Oncology. Patients and methods The clinical records of patients with axillary node-positive, pathological stage II—III breast cancer examined at Dokuz Eylul University Hospital, Department of Radiation Oncology, between 1991–1999 were reviewed. All patients underwent modified radical mastectomy (MRM) or wide excision with axillary node dissection. Axillary surgery consisted of level l-ll dissection. The number of lymph nodes dissected from the axilla was equal to or more than 10 in 92% of the patients. All 221 patients had pathological T1–T2 tumors. The number of involved lymph nodes was four or more in 112 51% patients and less than four in the remaining 109 (49%). In 127 (57.5%) patients, extracapsular extension was detected in axillary lymph nodes. Tangential radiotherapy fields were used to treat the breast or chest wall. Lymphatic irradiation was performed in 215 (97%) patients with fields covering both the supraclavicular and axillary regions. Median radiotherapy dose for lymph nodes was 5000 cGy in 25 fractions. The following factors were evaluated: age, menopausal status, histological tumor type, pathological stage, number of involved axillary lymph nodes, and extracapsular extension. The chisquare test was used to compare proportions of categorical covariates between groups of patients with and without ECE. Survival analyses were estimated with the Kaplan-Meier method. The Cox regression model was used for the analysis of prognostic factors. Results The median follow-up for the survivors was 55 months (range, 19–23). The median age was 52 years (range, 28–75). In patients with extracapsular extension the percentages of pathological stage III (22% vs 4.3%, P Conclusion The rate of extracapsular extension was found to be directly proportional to the number of axillary lymph nodes involved and the stage of disease. Extracapsular extension had significant prognostic value in both univariate and multivariate analysis for DFS and DMFS but not OS. The reason for ECE not affecting OS might be related to the much more dominant prognostic effect of the involvement of four or more axillary nodes on OS. Studies with more patients are needed to demonstrate that ECE is a likely independent prognostic factor for OS.

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Juvenile hypertrophy of the breast (JHB) is an uncommon, benign disorder and typically occurs in peri-pubertal females. The etiology of JHB is uncertain. It may represent an end-organ hypersensitivity of the breast to normal levels of sex steroids. Clinically, it is characterized by rapid enlargement of breasts, either unilateral or bilateral. The definitive diagnosis is made by histopathologic examination. Treatment recommendations include surgery and hormonal therapy, although hormonal manipulation is still controversial in pediatric patients. Here we report a 13-year-old girl with unilateral JHB who did not require surgery or medical treatment.

AMAÇProksimal pankreatikoduodenektomi (PPD) sonrası postoperatif pankreatik fistüller (POPF) sık görülen komplikasyonlardan dır. PPD sonrasında POPF %0-17 oranında görülmektedir. Genellikle anastomoz kaçağı sonrası oluşan pankreatik fistüller PPD sonrası mortalite ve morbiditenin en önemli sebebidir. International Study Group on Pancreatic Fistula (ISGPF) tarafından POPF; postop 3. gün veya sonrasında elde edilen dren sıvısındaki amilaz değerinin serum amilaz değerinden 3 kat daha fazla olması olarak tanımlamış ve Grup A, Grup B ve Grup C olarak üç gruba ayrılmıştır. Grup B-C POPF gelişen hastalar klinik olarak anlamlı olarak gruplandırılmıştır.Bu çalışma da PPD sonrası görülen en önemli komplikasyonu olan POPF gelişimine neden olan risk faktörlerinin belirlenmesi amaçlandı.GEREÇ-YÖNTEMBu çalışmada, Dokuz Eylül Üniversitesi Tıp Fakültesi Genel Cerrahi Anabilim Dalı tarafından 08.03.1995?03.08.2011 tarihleri arasında PPD yapılan 204 hastanın verileri retrospektif olarak incelendi.Ameliyat öncesi dönemde; yaş, cinsiyet, geliş yakınması, ASA skoru, hemogram ve biyokimya değerlerine, ameliyat öncesi tanı ve tedavi amaçlı herhangi bir girişim yapılıp yapılmadığına (ERCP, PTK ,internal ve eksternal drenaj kateteri) bakıldı.Ameliyat sırasında; ameliyat süresine, ameliyatta kullanılan eritrosit süspansiyonuna, kanama miktarına, Wirsung kanal çapına, pankreas kıvamına, ek organ rezeksiyonu, portal ven rezeksiyonu yapılıp yapılmadığına bakıldı.Ameliyat sonrası dönemde; pankreatik fistül gelişip gelişmediğine ve çıkarılan piyesin patoloji sonuçlarına, ameliyat öncesi ve sonrası klinik notları, operasyon notları, laboratuar sonuçları, radyoloji raporları ve patoloji raporlarını içeren tıbbi kayıtlar incelenerek elde edilecektir.Elde edilen veriler SPSS 15 0 programı kullanılarak analiz edildi.SONUÇBu çalışmada, yapılan tek değişkenli analizde, tüm gruplarda, POPF gelişmesinde etkili ana pankreatik kanal çapının (Wirsung) 3 mm altında olması (p=0,004) ve pankreas kıvamının yumuşak olması (p