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Objective:Breast-conserving surgery (BCS) followed by radiotherapy (RT) is the standard treatment for early-stage breast cancer. The use of an additional RT dose (boost) to the tumour bed improves local control but may worsen quality of life (QOL) and cosmetic results. Multifocal/multicentric tumours (MMTs) pose a challenge as they require larger boost volumes. This study investigated the impact of RT volumes on late-term cosmetic outcomes and QOL in patients with unifocal and MMTs who underwent adjuvant RT after BCS.Materials and Methods:Retrospective data of 367 patients who underwent BCS between 2012 and 2014 were reviewed. A cohort of 121 patients with at least six months of completed RT were prospectively included in the study. Cosmetic results were evaluated using a modified scoring system, and QOL was assessed using The European Cancer Treatment and Organization Committee tools.Results:The results showed that the inclusion of regional lymphatics in the RT treatment field significantly affected QOL, particularly in terms of role functioning and social functioning. Higher boost volume ratios were associated with increased pain-related symptoms. However, the presence of MMTs did not significantly affect cosmetic outcomes compared to unifocal tumours.Conclusion:The size of the boost and inclusion of regional lymphatics in RT significantly impact QOL in patients undergoing BCS. Tumour foci number does not affect cosmetic outcomes. These findings emphasize the need for careful consideration of RT volumes to minimize long-term adverse effects on QOL. Future prospective studies should evaluate early side effects and baseline QOL scores to provide a comprehensive assessment.

Objective: Cholecystectomy materials are frequently encountered in routine practice. The aim of this study was to determine the true frequency of gallbladder lesions, the diagnostic consistency, and standardization of reports after macroscopic sampling and microscopic evaluation based on previously defined criteria. Material and Method:14 institutions participated in the study within the Hepato-Pancreato-Biliary Pathology Study Group. Routinely examined cholecystectomies within the last year were included in the study in these institutions. Additional sampling was performed according to the indications and criteria. The number of blocks and samples taken in the first macroscopic examination and the number of blocks and samples taken in the additional sampling were determined and the rate of diagnostic contribution of the additional examination was determined. Results: A total of 5,244 cholecystectomy materials from 14 institutions were included in the study. Additional sampling was found to be necessary in 576 cases (10.98%) from all institutions. In the first macroscopic sampling, the mean of the numbers of samples was approximately 4 and the number of blocks was 2. The mean of the numbers of additional samples and blocks was approximately 8 and 4, respectively. The diagnosis was changed in 144 of the 576 new sampled cases while the remaining 432 stayed unaltered. Conclusion: In this study, it was observed that new sampling after the first microscopic examination of cholecystectomy materials contributed to the diagnosis. It was also shown that the necessity of having standard criteria for macroscopic and microscopic examination plays an important role in making the correct diagnosis.

Pseudoangiomatous stromal hyperplasia (PASH) is a benign lesion of breast composed of prolifereted stromal myofibroblastic cells. It is named due to presence of slit-like spaces without endothelial layer mimicing vascular structures. Most of the lesions detected incidentally in breast tissues resected with other causes. Occasionally it may presented as palpable or radiologically detectable mass. It may confused with malignancy or phylloides tumor in clinically or radiologically if it grows rapidly. Differential diagnosis includes angiosarcomas and other sarcomas on histopathological examination. In this report a PASH lesion presented with differential diagnostic criteria, detected in a 34 year of woman with a breast mass growing markedly in 6 months duration.

Mucocele-like lesion (MLL) of the breast has been firstly described as a benign lesion resembling mucinous carcinoma of the breast. Subsequently, it has also been reported to be associated with ductal hyperplasia or breast carcinoma. The risk of cancer development in the long term is unknown. Therefore, the approach to pure MLL of the breast detected during percutaneous biopsy is controversial. In this report, a mucocele-like breast lesion in a 47-year-old woman was first noticed during a core biopsy and later detected to be associated with ductal carcinoma in-situ focuses in excisional biopsy material is presented. The aim of this paper was to provide an overview of this rare and controversial lesion and its variabilities with regard of the presented case.

Objective:Breast carcinomas positive for the estrogen receptor (ER+) but negative for the progesterone receptor (PR−) have unfavorable prognostic features and are resistant to tamoxifen therapy. The goal of this study was to highlight the significance of PR− breast carcinomas.Methods:Therefore, 146 breast carcinomas comprising 87 ER+/ PR+ and 59 ER+/PR− carcinomas were examined. These two groups were compared in terms of age; tumor type; tumor size; histologic grade; presence of an in situ component; lymphovascular and perineural invasion; and ER, PR, c-Erb B2, Ki-67, and epidermal growth factor receptor (EGFR) status.Results:While the number of metastatic lymph node and related pN2+pN3 tumors were found to be significantly higher in the ER+/PR− group, the differences with respect to the tumor size, metastatic lymph node size, and frequency of lymphovascular invasion were nearly significant.Conclusion:ER+/PR− tumors have an unfavorable prognosis and show a clinical behavior closer to triple negative ones, although classified as luminal tumors. Revealing the mechanisms causing these differences will enhance the success of breast cancer therapy.

Systemic vasculitis such as Wegener’s granulomatosis (WG), giant cell arteritis (GCA), and poliarteritis nodosa (PAN) may produce tumor-like masses in various organs. GCA may affect large vessels and also rarely present with primary visceral involvement in the breast. In these situations, GCA may confuse with malignancy because of characteristics such as tenderness, redness, and mass formation. This article presents a case report on an 87-year-old woman with palpable mass in her breast and was diagnosed as GCA in the biopsied lesion.

Objective:Thyroid transcription factor-1 (TTF-1) immunoexpression is frequently determined in small-cell lung carcinomas, as well as primary lung adenocarcinomas. While dealing with metastatic carcinomas, TTF-1 immunoexpression is a significant indicator of primary lung carcinomas. Recent studies have revealed that TTF- 1 immunoexpression is also defined in non-lung cancers, such as squamous cell carcinomas of different sites and certain neuroendocrine tumors. The verified data obtained from these studies indicate that a straightforward diagnosis of primary lung carcinoma in cases with positive TTF-1 immunoexpression can cause diagnostic contradictions. The aim of our study is to investigate the immunoexpression status of TTF-1 in common non-lung tumors.Methods:A total of 85 cases that were diagnosed in our institute between the years 2011-2012 were included in our study. After a review of the pathological slides prepared from these tumors [colon adenocarcinoma (n: 15), renal cell carcinoma (n: 15), prostate adenocarcinoma (n: 15), invasive papillary urothelial carcinoma (n: 15), invasive ductal carcinoma of breast (n: 15), and neuroendocrine tumors (n: 10)] TTF-1 immunohistochemistry was applied. Semiquantative evaluation based on the distribution and intensity of the staining was performed by two pathologists, respectively.Results:Positive immunostaining was evident in only 1 case of colon adenocarcinoma out of 85 cases.Conclusion:Our study demonstrated that TTF-1 immunoexpression is a very rare finding (1%) in non-lung tumors. This result provides that anti-TTF-1 is a reliable antibody in the interpretation of primary lung carcinomas. In fact, further studies with a large number of cases are needed to confirm the sensitivity and specificity of TTF-1.

Mucous membrane plasmacytosis is a rare reactive process characterized by plasma cell infiltration of mucous membranes for unknown reasons. It may be confused with malignancy because of its exophytic structure and pavement appereances. A laryngeal polypoid lesion was sent to the pathology department, clinically called fibroma, and presented to emphasize the diagnostic and differential diagnostic criteria.

The incidence and prevalence of neuroendocrine neoplasms (NENs) in many organs are increasing. Although such NENs have similar grades, they may exhibit quite different behaviors. In this multicenter study, we aimed to investigate the prevalence and distribution of different morphological NEN variants in the non-pancreatic gastrointestinal (GI) tract and determine whether they can guide prognosis prediction. Two hundred and fifty-six patients diagnosed with NENs originating from the GI tract from 7 different centers were included in the study. In 89 (36.6%) cases, different morphological variants were detected. When the variants were grouped according to their aggressiveness as described in the literature, a statistically significant relationship between aggressiveness and the variables organ and age was found ( p < 0.05). The oncocytic variant was found to metastasize more than the other aggressive types (42.9%). The paraganglioma-like variant was found to have a smaller size, lower proliferation index, and a more benign clinical course. This study demonstrated that well-differentiated GI neuroendocrine tumors (GI-NETs) have considerable morphological diversity. Generally, case reports of rare morphological variants of GI-NETs are available in the literature. We believe that our study contributes to a better understanding of the prevalence, localization, and significance of morphological variations in GI-NETs.

Background: In the updated World Health Organization Classification of Central Nervous System Tumors, the presence of CDKN2A/2B homozygous deletion is now recognized as the indicative of Grade 4 in isocitrate dehydrogenase (IDH) mutant astrocytomas, and it is associated with a poor prognosis in Grade 4 astrocytomas. Conversely, Beclin 1, a crucial protein in autophagy initiation, exhibits a bidirectional effect on tumor progression and suppression. The objective of this study is to evaluate CDKN2A homozygous deletion in IDH mutant astrocytomas of varying grades, to compare it with microvascular proliferation (MVP) and palisading necrosis, and to analyze the relationship between these findings and Beclin 1 expression, subsequently comparing them with prognosis. Subjects and Methods: CDKN2A homozygous deletion and Beclin 1 expression were analyzed in 32 cases with IDH-mutant diffuse astrocytomas of Grades 2, 3, and 4. Results: CDKN2A homozygous deletion was detected in one of 10 patients with Grade 2 and in 8 of 17 patients with Grade 4. Beclin 1 was positively stained in 2 of Grade 2 astrocytomas, 4 of Grade 3 astrocytomas, and 9 of Grade 4 astrocytomas. While Beclin 1 expression was present in 5 of 9 cases with CDKN2A homozygous deletion, no expression was observed in four cases. Conclusion: In this study, the prognostic significance of CDKN2A homozygous deletion alone was found to be lower compared to the deletion in combination with MVP and/or necrosis. At the same time, Beclin 1 expression was determined to exert no prognostic significance alone, while it was found to exert a poor prognostic effect in combination with CDKN2A homozygous deletion.

Amaç: Testiküler germ hücreli tümörler (TGHT), genç yetişkin erkeklerde sık görülen ve bu dönemdeki kanser ilişkili ölümlerin önemli bir sebebi olan solid neoplazmlardır. Histopatolojik sınıflandırma ve evrelemedeki değişiklikler, prognoz ve tedaviyi etkilemektedir. Bu çalışmanın amacı, TGHT tanısı almış olguların analizini yapmak, prognostik parametreleri ve bu parametrelerin insitu germ hücreli neoplazi (İGHN), intratubuler ve intertubuler tümörlerin varlığı ile ilişkilerini gözden geçirmektir.Gereç ve Yöntemler: Bu çalışmada TGHT tanısı almış 77 olgunun Hematoksilen&Eozin boyalı preparatları yeniden değerlendirildi. İGHN, intratubuler ve intertubuler germ hücreli tümör varlığı kaydedildi. Amerikan Birleşik Kanser Komitesi (American Joint Committee on Cancer, AJCC) 8. basımındaki değişiklikler temel alınarak yeniden histopatolojik sınıflama ve evreleme yapıldı.Bulgular: Olguların büyük çoğunluğu (n=42) seminom tanısı aldı, bunu mikst germ hücreli tümör (n=33) ve spermatositik tümör (n=2) izledi. Olguların 30’unda rete testis invazyonu, 6’sında epididim invazyonu, 10’unda hiler yumuşak doku invazyonu, 1’inde tunika vaginalis invazyonu, 4’ünde spermatik kord invazyonu ve 22’sinde ise lenfovasküler invazyon görüldü. İntertubuler seminom 25, intratubuler karsinom 16, İGHN ise 73 olguda saptandı.Sonuç: Histopatolojik tanı, patolojik tümör evresi, serum tümör belirteçleri ve metastaz olup olmaması tedaviyi belirleyen başlıca kriterlerdir. AJCC 8. basıma göre, hiler yumuşak dokuya invazyonun evrelemeye eklenmesi ile pT2 olgularımız arttı. Ayrıca, spermatik kord içerisinde devamlılık göstermeksizin damar trombüsünden yumuşak doku invazyonun pM1 olarak kabul edilmesi de metastatik testis tümörlerinin sayısını artırmıştır.

Objective: As there is continuing disagreement among the observers on the differential diagnosis between the epithelial changes/lesions and neoplasms of the gallbladder, this multicentre study was planned in order to assess the rate of the epithelial gallbladder lesions in Turkey and to propose microscopy and macroscopy protocols. Material and Method: With the participation of 22 institutions around Turkey that were included in the Hepato-Pancreato-Biliary Study Group, 89,324 cholecystectomy specimens sampled from 2003 to 2016 were retrospectively evaluated. The numbers of adenocarcinomas, dysplasias, intracholecystic neoplasms/adenomas, intestinal metaplasias and reactive atypia were identified with the review of pathology reports and the regional and countrywide incidence rates were presented in percentages. Results: Epithelial changes/lesions were reported in 6% of cholecystectomy materials. Of these epithelial lesions, 7% were reported as adenocarcinoma, 0.9% as high-grade dysplasia, 4% as low-grade dysplasia, 7.8% as reactive/regenerative atypia, 1.7% as neoplastic polyp, and 15.6% as intestinal metaplasia. The remaining lesions (63%) primarily included non-neoplastic polypoids/hyperplastic lesions and antral/pyloric metaplasia. There were also differences between pathology laboratories. Conclusion: The major causes of the difference in reporting these epithelial changes/lesions and neoplasms include the differences related to the institute's oncological surgery frequency, sampling protocols, geographical dissimilarities, and differences in the diagnoses/interpretations of the pathologists. It seems that the diagnosis may change if new sections are taken from the specimen when any epithelial abnormality is seen during microscopic examination of the cholecystectomy materials.

Metastatic tumors of thyroid are rare and constitute 1.2% of all thyroid malignancies. Metastasis to thyroid gland from head and neck region occurs usually via direct spread. Hematogenous metastases are mostly seen in kidney, breast, and lung tumors and malignant melanomas. Thyroid gland metastasis is usually seen in widespread diseases. Solitary metastasis in this gland is extremely rare. A 68-year-old male patient was admitted to the general surgery clinic with swelling in the neck. The patient had undergone right lobectomy in another hospital due to lung cancer two years ago. Ultrasonography revealed the presence of nodules in both lobes with maximum diameter of 4.5 cm in the right lobe and 2 cm in the left lobe. Bilateral total thyroidectomy was performed. Nodules with diameter of 4.5 and 3.5 cm were observed in the right lobe. In the histopathologic examination of a small nodule, adenocarcinoma infiltration which was 2 cm in diameter was observed. Tumoral infiltration was not observed in nodule capsule and thyroid capsule. Immunohistochemically, tumor was positive for carcinoembryonic antigen (CEA), weakly positive for thyroid transcription factor-1 (TTF-1), and negative for thyroglobulin, chromogranin A, and calcitonin. Slides of lobectomy material were reexamined and it was observed that the two tumors had the same properties. The case was reported as “pulmonary adenocarcinoma metastasis in thyroid.” No other metastasis was observed in the whole body scan of the patient. In conclusion, in the presence of nodule in thyroid gland, possibility of metastasis should be considered if a history of malignancy exists.

Objective:Cavitation and coagulation necrosis due to high temperature caused by application of the high intensity focused ultrasound (HIFU) to a focal area occurs. This feature makes HIFU possible to use in the destruction of cancerous tissue. In this study, it was aimed to determine the effect of HIFU on Balb/c mice with Ehrlich ascites tumor model to reach effective usage of HIFU with its clinical and experimental applications in various types of cancer.Methods:Ehrlich ascites tumor cells were obtained from the intraperitoneal region of a donor mouse. Fresh ehrlich ascites tumor cells were injected into 24 mice that were randomly distributed after tumor formation as a control (Group 1), sham treatment (Group 2) and HIFU treatment (Group 3). HIFU application was performed under ultrasound image until conversion of the hypoechoic tumor tissues to hyperechoic appearances. Tumor size and volumes were measured.Results:Tumor sizes and volumes in all groups showed an increase after the treatment. Pathologically all tumors were solid carcinoma with an expansive growth pattern. Necrosis percentages in Group 1, Group 2 and Group 3 were 70±9.6, 70±9.4 and 75.6±4.17, respectively. With regard to Volume 2, there were significant differences between Group 2 and both Group 1 and 3 (p=0.004 and p=0.0001, respectively).Discussion:High intensity focused ultrasound is an effective method in Ehrlich ascites tumor model via prevention of tumor growth and production of necrosis. To achieve a reduction in tumor volume, increasing the duration of HIFU treatment and/or repeatedly application of the treatment is thought to be effective.

Primary gastric adenosquamous carcinomas are extremely rare tumors. A gradual transition between the malignant glandular and squamous components of the tumor is seen on performing a histopathological evaluation. These tumors are known to have poorer clinical outcomes than conventional adenocarcinomas. We aimed to present two cases of primary adenosquamous carcinomas that were diagnosed at the later stage in our institute.

Hyperplastic polyps constitute 75% of all gastric polyps. Most of them are innocent lesions and are smaller than 1 cm. They develop as a consequence of an exaggerated mucosal response to tissue injury and inflammation on the basis of chronic gastritis. A 69-year-old male was admitted to the Gastroenterology Clinic with complaints of abdominal pain and vomiting. Gastroscopy showed a polyp that was 2 cm in its greatest dimension. A histopathologic examination of this lesion revealed adenocarcinoma infiltration in the mucosa. Subtotal gastrectomy was performed. Macroscopically, a polyp with a stalk was seen in the antrum; microscopically, it was consisted with a hyperplastic polyp. In the polyp, a few foci of infiltrative glands embedded in the mucinous matrix were noticed in the lamina propria, and the patient was diagnosed as intramucosal mucinous adenocarcinoma arising from a gastric hyperplastic polyp. Because of the risk of carcinoma development, which is rare, all hyperplastic polyps should be completely excised, and a histopathologic examination should be carefully performed.

Objective To investigate the role of positron emission tomography (PET) and magnetic resonance imaging (MRI) in evaluating the feasibility of skin-sparing mastectomy in patients with locally-advanced breast cancer (LABC) who will undergo neoadjuvant chemotherapy (NAC) by evaluating the sensitivity and specificity of PET and MRI compared with skin biopsy results before and after NAC treatment. Methods Patients with LABC who were treated with NAC between November 2013 and November 2015 were included in this study. Demographic, clinical, radiological and histopathological features of the patients were recorded. Results A total of 30 patients were included in the study with a mean age of 52.6 years (range, 35–70 years). Sensitivity and specificity for detecting skin involvement in LABC was 100%/10% (62%/85%) with MRI and 60%/80% (12%/92%) with PET before (after) NAC, respectively. When radiological skin involvement was assessed in relation to the final histopathological results, the preNAC PET results and histopathological skin involvement were not significantly different; and there was no difference between postNAC MRI and histopathological skin involvement. Conclusions As preNAC PET and postNAC MRI more accurately determined skin involvement, it might be possible to use these two radiological evaluation methods together to assess patient suitability for skin-sparing mastectomy in selected patients.

Objective:Renal cell carcinoma (RCC) is the 14th most common tumor in the world. In 2010, the protocol for the examination of kidney specimens with invasive carcinoma of renal tubular origin was updated. The aim of our study was to review 1-year RCC patients of our hospital according to the new protocol, classification, and staging systems with respect to their morphological and immunohistochemical features.Methods:The medical records of 54 RCC patients between July 2012 and July 2013 were retrospectively reviewed. They were classified according to the WHO 2004 classification system and newly defined subtypes. The following variables were determined in each case: age, sex, histological subtype, stage, and Fuhrman nuclear grade.Results:In our study, 30 (55.6%) men and 24 (44.4%) women were diagnosed with RCC out of 54 patients. The median age was 56 years. In total, 21 patients had (55.2%) right- and 17 had (44.74%) left-sided tumors. Thirty-eight (70.3%) clear cell, 6 (11.1%) papillary, 7 (12.96%) chromophobe, 1 (1.85%) multilocular, 1 (1.85%) unclassified, and 1 (1.85%) tubulocystic RCC were seen. According to primary tumor, 33 (61.1%) pT1, 10 (18.51%) pT2, 9 (16.66%) pT3, and 2 (3.70%) pT4 patients were reported. Chromophobe RCCs were excluded from the Fuhrman grading (G) system; of the remaining 2 (4.17%) were G1, 30 (62.5%) were G2, 13 (27.08%) were G3, and 3 (6.25%) were G4 tumors.Conclusion:Although RCC constitutes the majority of renal tumors, different subtypes are also encountered. In our study, clear cell RCCs were the most common type of tumors consistent with the literature. The remarkable point was that chromophobe RCCs were more frequent in our study. Because of infrequency, more examples are required to distinguish newly defined subtypes.

Objective: To detect the relationship between molecular subtypes of breast cancer with expressions of androgen receptor, cytokeratin 5/6 (CK5/6)and Ki-67.Materials and Methods: Expressions of androgen receptor, CK5/6 and Ki67 were determined by immunohistochemistry in paraffin-embedded sections obtained from 86 invasive breast cancer cases of stages I/IIa/IIb in 4 molecular subtypes. Patients treated for recurrent disease and locally advanced disease were excluded.Results: Forty one luminal A cases, ie. positive estrogen receptor(ER) and/or progesteron receptor (PR) with negative epidermal growth factor receptor (HER2), 14 luminal B, ie. positive ER and/or PR and positive HER2, 14 HER2-enriched (HER2+), ie. negative ER and PR with positive HER2, and 17 triple negative (negative ER and PR and HER2) invasive breast cancers were included. Mean follow-up was 17.46±11.70 mo. Androgen receptornegativity and CK5/6-positivity were significantly more common in HER2+ and triple negative groups. Ki-67 and histological grade were higher in HER2+ group, significantly. Two deaths were triple negative (P=0.04). Androgen receptor-negativity, CK5/6 and Ki-67 status did not affect survival or systemic metastases, significantly. All groups had local recurrences. Local recurrence was significantly associated with androgen receptor-negativity in luminal A and high Ki-67 value in HER2+ groups. Systemic metastases were significantly more common in triple negative and HER2+ groups.Conclusion: Molecular subtypes of breast cancer are prognostic and predictive. Androgen receptor is expressed more commonly in luminal subtypes with better prognosis and androgen receptor negativity is associated with development of local recurrence in luminal A cancers.

Myofibroblastoma of the breast (MFB) is a very rare benign stromal tumor. In recent years, increase in mammographic screenings has resulted in increased diagnosis of MFB. Most cases are old males and postmenopausal women. MFB may be confused as malignant, clinically, morphologically, or by imaging. Immunohistochemistry is essential for final diagnosis in these cases. We report a case of a pathologically diagnosed MFB in an 80-year-old male patient who had coexisting prostate cancer and describe its imaging characteristics, especially magnetic resonance imaging (MRI). In this paper, histopathological and MRI findings of the MFB were discussed.

Hepatoid adenocarcinoma (HAC) is a very rare type of extrahepatic adenocarcinoma which has a clinicopathologic and morphologic similarity to hepatocellular carcinoma (HCC). Although it is not common, it can be seen in organs other than the liver. The correct diagnosis can be a challenge because of its clinically similarity to HCC and the diagnosis is usually achieved by pathological examination following the surgery. We present a 48-year-old woman who was following with the diagnosis of stage 5 hepatic hydatic cyst. In her routine blood examinations, her alpha feta protein level was found higher than normal and her abdominal computed tomography and magnetic resonance findings did not reveal any pathological findings rather than hepatic hydatic cysts. There was a high activity of FDG on PET CT in the hepatic region so we performed a right lateral hepatectomy to the patient and final pathology was adrenal hepatoid adenocarcinoma. In this paper we aimed to present a rare case of hepatoid carcinoma of the adrenal gland.

Basal cell carcinoma is the most commonly seen nonmelanoma skin cancer which is rarely encountered in the childhood period. An 11-year old child was admitted to our clinic due to an erythematous and a slightly pigmented lesion with a 3×4 cm diameter on his posterior scalp. Macroscopically, the lesion was excised with a 10 mm safety margin. Pathologic examination revealed a basal cell carcinoma. No symptoms or signs of a syndrome were observed both in the patient and his family.