Makale Arama

Objective: The aim of this study is to evaluate the perioperative and postoperative follow-up results of patients operated for a parotid mass.

Materials and Methods: A total of 66 patients who were operated between 2000 and 2011, were evaluated retrospectively.

Results: The mean age of the patients was 48,6. On the basis of post-operative histopathologic assessement, 61 of the cases were found to be primary benign, 3 of the cases  primary malignant and 2 of the cases secondary malignant. Pleomorphic adenoma was the most common in primary benign tumors group with 29 cases, Warthin tumors were in the second place with 14 cases. Adenoid cystic carcinoma, adenocarcinoma and expleomorphic adenoma were observed as primary malignant tumors. Both of the seconder malignant tumors were metastasis of squamous cell carcinoma. Sensitivity and specifity of the preoperative fine needle aspiration biopsy in the benign-malignant differentiation were found as 60 % and 96 %, respectively. Superfacial parotidectomy, total parotidectomy and radical parotidectomy were used as surgical procedures. In addition to this procedure, neck dissection was performed in several cases. The most frequent complication was temporary facial nerve paresis.

Conclusion: Fine needle aspiration biopsy is an effective diagnostic procedure for the benign-malignant differentiation of the parotid tumors. Superfacial parotidectomy is an adequate and efficient surgical procedure for the benign parotid tumors and complication risk is considerably low when applied carefully. For malignant tumors, superfacial, total or radical parotidectomy should be performed and when necessary, neck dissection and postoperative radiotherapy should be added to the treatment.

Aim: Gallbladder cancer is an uncommon, but aggressive tumor. Its prognosis is poor and the most cases are incidentally detected in histopathological examinations of cholecystectomies due to benign diseases. With the era of laparoscopic cholecystectomy, the number of cases detected in early stage is increasing. In this study, we aimed to evaluate the rate of cancer encountered and the distribution of non-cancer diagnoses in cholecystectomy materials sent to our department, together with the literature findings.

Materials and Methods: The results of the cholecystectomy materials sent to the pathology laboratory and examined routinely in 2016-2017 were retrospectively evaluated by forming diagnostic groups. Clinical preliminary diagnoses, demographic informations (age, sex), and pathology reports of the patients were reviewed.

Results: We included a total of 1000 cholecystectomy materials into the study. Two of the 7 patients who presented with malignancy were incidentally diagnosed and underwent laparoscopic cholecystectomy with the preliminary diagnosis of cholelithiasis, with the primary focus was gallbladder in one patient, and the other was compatible with colonic adenocarcinoma infiltration. Preoperative and / or perioperative malignancy was detected in the remaining 5 patients. A large proportion (> 90%) of the other cases had chronic or chronic active cholecystitis and low rate of acute cholecystitis included gastric heterotopia found in 2 (0.2%), tubular adenoma in 1 (0.1%), tubulovillous adenoma in 1 (0.1%), adenomyoma / adenomyomatosis in 4 (0.4%), polyp in 6 (0,6%) and dysplasia (Biliary intraepithelial neoplasia, BilIN) in 5 (0.5%) patients.

Objective: The aim was to review the hormonal status, treatment and histopathological diagnosis of patients admitted to our endocrinology outpatient clinic with the diagnosis of adrenal incidentaloma.

Material and Methods:Between 2015-2018, 217 patients with adrenal incidentaloma who were admitted to the endocrinology outpatient clinic were included in the study. 1 mg overnight dexamethasone suppression test (DST), 24 hour urine free cortisol, 24-hour urine methanephrine and normetanephrine levels were evaluated in all patients.Patients who also have hypertension or hypokalemiawere screened for the plasma aldosterone/renin activity ratio. CT or MRI imaging properties of adrenal incidentalomas were screened.

Results: In the evaluation of cases; 180 (83%) of the masses were evaluated as non-functional and 37 (17%) as functional. Of the 37 patients evaluated as having functional adrenal mass; 10 (4.6%) pheochromocytoma, 5 (2.3%) Cushing's syndrome, 9 (4.1%) subclinical Cushing’s syndrome and 13 (6%) primary hyperaldesteronism were detected. In 180 patients who were evaluated as having non-functional adrenal mass; metastatic disease in 7 (3 non-small cell lung cancer, 1 breast cancer, 1 prostate carcinoma and 2 unknown primary cancer), myelolipoma in 4, ganglioneuroma in 1, hydatid cyst in 1, adrenocortical carcinoma in 2 patients were detected.

Conclusion: According to the results of this study, it is not uncommon for adrenal incidentalomas to be functional. It may be malignant in some cases. For this reason, adrenal incidentaloma is a condition that should be examined both in terms of
functionality and malignancy potential.

Objective: Most of the renal neoplasms are the epithelial and malign ones. The renal cell carcinoma (RCC), which is the most frequently seen malign renal tumor, consists of 2-4% of all the malign tumors seen among adult individuals and 80-90% of all the malign renal tumors. RCCs peak at sixties and seventies and its prevalence among males is two folds of its prevalence among females. RCCs have bad prognosis. The recurrence is seen in 40% of the cases, and the metastasis despite the early diagnosis was detected in 50% of cases. In present study, it was aimed to distribution of renal tumors in our hospital, discuss the prognostic factors such as the, pathological stage, nuclear grade and tumor diameter accompanied by literature information.

Patients and Method: By retrospectively scanning the records of Pathology Department of Medical Faculty, Fırat University, for the period between 1988 and 2009, 140 renal tumor cases were determined and the previous diagnoses, histological degrees, pathological stages of these cases were evaluated and the final diagnoses were taken as base in the present study. In pathologically staging (pT) of RCCs, TNM classification was used, whereas Fuhrman nuclear grading (FNG) was used in nuclear grading procedure. The patients were divided into different groups based on their genders and ages. The statistical analyses were performed in SPSS-12.0 software by using Chi-Square and Correlation tests.

Results: When compared to the literature in terms of the mean age, the present study involves relatively young population (mean age 57), and the majority was male (male/ female:1.1). The distributions of renal tumours, malign and benign subtypes, and RCC subtypes show similarities with the general literature. When examining the RCCs statistically, no significant relationship was found between diagnosis and age, and between nuclear grade and tumor diameter (p>0.05). In the present study, the RCCs with largest diameter were papillary type (9,78cm) ones, whereas the RCCs with lowest diameter values were classic type. A statistically significant relationship was observed between the benign, borderline and malign tumor diagnoses and diameters (p= 0.023). It was determined that approximately one-four of RCC cases were in highly pathological stage (21,6%, pT3a-3b). A direct proportional and statistically significant relationship was found between nuclear grade and diameter (p=0,002).

Conclusion: RCCs have poor prognosis and their frequency is increasing. Pathological stage, nuclear grade and diameter are the leading factors affecting the prognosis. As in our study, in retrospective studies involving old ages and not enough sampling, tumor diameter may be used as an alternative prognostic factor for pathological staging in tumors with a stage above pT2.

Objective: The present study aimed to investigate the predictive value of (F/T)/PSAD and Free PSA/PSAD in PCa detection in Turkish males.

Material-Methods: A retrospective analysis of patients’ files, from January 2007 to December 2017, with prostate-specific antigen (PSA) values between 4-10 ng/dl was conducted. According to the prostate biopsy outcomes, data were collected from patients and divided into prostate cancer (PCa) and/or benign prostatic hyperplasia (BPH) groups. Among the groups, prostate volume (PV), Free PSA (FPSA), Total PSA (TPSA), free-to-total PSA ratio (F/T), PSA Density (PSAD), (F/T)/PSAD, and FPSA/PSAD values were evaluated and compared. The utilization of these values in PCa detection was examined. We compared our results statistically with the ROC curve and calculated the sensitivity, specificity, PPV, and NPV values.

Results: The present study participants were 131 PCa and 196 BPH patients, 327 in total. Sensitivity and specificity values of (F/T)/PSAD and FPSA/PSAD were better than PSAD, PSA, F/T. According to the optimal cut-off value, the sensitivity of (F/T)/PSAD and FPSA/PSAD was similar. Likewise, NPV of F/T, (F/T)/PSAD, and FPSA/PSAD were also similar. The logistic regression model using a combination of age, PV, FPSA/PSAD, and (F/T)/PSAD displayed a higher AUC than each of these values per se.

Conclusion: FPSA/PSAD and (F/T)/PSAD, the relatively new parameters, have similar predictive accuracy in PCa detection. They have higher sensitivity and specificity than F/T PSA and PSAD alone. However, more research is needed to evaluate the efficiency of predictive value of these parameters.

\r\n Colloid cysts are rare benign tumors of the third ventricle and have a wide range of clinical representations from incidentomas to acute death.  The growth of these cysts is an uncommon event and may cause obstructive hydrocephalus that lead to sudden deterioration in the patient's condition and may cause life-threatening complications. The large colloid cyst of third ventricle caused sudden death of children due to clogging, diagnosed in vivo is a very rare case in literature. We are representing here a case which patient admitted to emergency room for sudden loss of consciousness. Even he had urgent ventriculostomy due to acute hydrocephalus development, brain death has occured because of 3rd ventricle colloid cyst.

Objective: Conjunctiva is a region where various neoplastic or non-neoplastic lesions may develop.  In this study, we aimed to perform a histopathological analysis of conjunctival lesions and to determine their prevalence.

Material & Methods: Conjunctival biopsies of 401 patients who presented to the pathology laboratory between 2009 and 2019 were retrospectively examined. The cases were histopathologically divided into two groups as non-neoplastic and neoplastic lesions. Neoplastic lesions were further divided into subgroups as benign, premalignant, and malignant lesions. The prevalence of lesions and distribution of age and gender among the groups were analyzed.

Results: In our series of 401 patients, the mean age was 49.89±21.75 years. Of all patients, 209 (52.1%) were male and 192 (47.9%) were female. Non-neoplastic lesions were found in 296 (73.8%) and neoplastic lesions in 105 (26.2%) patients. The mean age was found as 50.79±19.34 years in patients with non-neoplastic lesions, and 47.34±27.39 years in patients with neoplastic lesions. Of neoplastic lesions, 64 (60.2%) were benign, 17 (16.2%) premalignant, and 24 (22.6%) malignant. The most commonly found non-neoplastic lesion was pterygium (n:220; 54.78%) while the most common benign lesions were nevus and other pigmented lesions (n:38; 9.5%), and the most common malignant lesion was squamous cell carcinoma (n:14; 3.5%). The prevalence of neoplastic lesions significantly increased over 45 years old (p<0.05).

Conclusion: In the current study, conjunctival lesions diagnosed in our laboratory over 10 years were reviewed and histopathologically analyzed. Recognition of conjunctival lesions and being aware of the rates of non-neoplastic and neoplastic lesions are crucial for treatment planning and protection of visual functions.

ANTEGRAD URETERAL STENTING; INDICATIONS - METHODS - COMPLICATIONS AND RADIOLOGICAL APPROACH TO  COMPLICATIONS

Abstract:

Objectives

The aim of this study is to evaluate the indications, success rate, complications, technical success enhancing method, methods of antegrad ureteral stenting and the radiological management of complications due to retrograde and antegrade ureteral stenting in the treatment of ureteral obstructions and ureteral leaks caused by malignant and benign etiologies.

Materials and Methods

In this retrospective study, fluoroscopy and US-guided antegrade ureteral stenting procedures between January 2016 and December 2018 were examined. The study included 110 antegrade ureteral stenting and percutaneous nephrostomy in a total of 78 patients with 25 female patients (32.05 %), a mean age of 65.87 (20-90) and 53 male patients (67.94%) with a mean age of 68.73 (30-90).  Demographic data, antegrade ureteral stenting indications, procedure results and complications were evaluated for each patient.

Results

Antegrade ureteral stenting is a good alternative for patients with retrograde ureteral stent placement and already with percutaneous nephrostomy catheters. It has a high technical success rate and low complication risk. The use of the equipment used in other radiological procedures in antegrade ureteral stenting increases the technical success. Malposition,  perforation, hemorrhage, urinoma, abscess complications such as retrograde or antegrade ureteral stenting can be managed by radiological methods.

Key Words: Double J Ureteral stent, Ureteral obstruction, Percutaneous, Antegrade, Hydronephrosis,

Aim: In this study, it was aimed to investigate the kidney function, hypertension development and
proteinuria in individuals with only one kidney .
Patients and Methods: The study included 96 patients who had previously undergone nephrectomy with
the causes of nephrolithiasis and chronic pyelonephritis-induced nonfunctional kidney, RCC (Renal Cell
carcinoma), trauma, and donor nephrectomy among 17800 patients who applied to the Siirt State Hospital
Nephrology and Urology outpatient clinics between January 2016 and December 2019. The data of the
patients were obtained from patient files database retrospectiv ely.
Results: A total of 96 patients, 45 female and 51 male, were included in the study. 23 (24%) of the
patients had donor nephrectomy (DN), and 73 (76%) had nephrectomy (DE) due to nephrolithiasis, chronic
pyelonephritis, trauma, and renal cell cancer (RCC). The patients were divided into two groups as those
who underwent DN and DE due to other etiologies. Between DN and DE group, there was no statistically
significant difference in terms of mean age, distribution of gender, presence of HT before nephrectomy,
DM, presence of hematuria and new onset proteinuria (P> 0.05). Compared to the DN group, the frequency
of new onset in CKD and HT development was significantly higher DE group.
Conclusion: Nephrectomy is a risk factor for the development of CKD, proteinuria and hypertension.
Therefore, preventive measures should be taken in a timely manner to reduce the prevalence of
nephrectomies due to benign diseases.

Aim: Autologous bone harvesting is the gold standard for grafting in a variety of orthopaedic procedures.
The aims of this study were to introduce an alternative technique of K-wire guided, multidirectional
percutaneous bone graft harvesting with Jamshidi from the anterior iliac crest, and to put forward the early
comparative clinical results of this technique.
Patients and Methods: 38 patients, who underwent a variety of hand surgeries in which bone grafting was
required between January and November 2013, were included in this retrospective, comparative study.
The included diagnoses of the patients were; non-unions of hand and wrist bone fractures, and benign
bone tumors. The prospectively collected data of patients were retrospectively evaluated in two groups.
Iliac crest autograft harvesting were performed with a standardized open technique, and with a novel
percutaneous technique -which will be described in the subsequent section- in group I, and II, respectively.
The mean age of the patients was 29.6 +/- 6.4, and 28.6 +/- 8.2 in group I, and II, respectively. The patients’
postoperative pain related with the perception of the pain and surgical scar, were evaluated according to the
graded Visual Analogue Scale; at postoperative 6th months. Statistically , Mann-Whitney U test was used.
Results: There were no major postoperative complications in the percutaneous group. Regarding pain,
mid-term at postoperative 6th months, VAS scores were found to be lower in group II than in group I,
significantly (p< 0.05).
Conclusion: The novel K-wire guided bone graft harvesting with Jamshidi from the iliac crest is a safe and
patient-friendly method in terms of postoperative pain reduction. This technique is useful in small joint and
bone surgeries, requiring bone grafting. The results of this study should be further supported with higher
level of evidence studies.

\r\n Brown tumors are benign, but locally aggressive tumors that may emerge as a rare complication of prolonged hyperparathyroidism. They may be clinically and radiologically confused with bone metastases. Browns tumors show increased metabolic activity on F-18 FDG-PET/CT just as metastatic bone lesions. In this study, we present a patient who underwent PET/CT to seek a primary focus with the presumed diagnosis of  multiple bone metastasis, and Brown tumor was suspected because no primary focus was detected on imaging and increased FDG enhancement was seen in parathyroid locations, and the diagnosis was confirmed with further investigations. Herein, we aimed to underline that Brown tumors should be kept in mind in the differential diagnosis in patients who are clinically and radiologically considered to have bone metastasis. 

Aim: Mesenchymal tumors of the gastrointestinal tract other than gastrointestinal stromal tumors are rare and most of them are benign. The aim of this study to reveal the clinical and pathological features of non-gastrointestinal stromal tumor mesenchymal tumors of the gastrointestinal tract.

Materials and Methods: All gastrointestinal endoscopic and surgical resection materials, between 2008-2018, were retrospectively reviewed. Cases diagnosed with mesenchymal tumor other than gastrointestinal stromal tumors were included.

Results: Twenty four lipomas, 14 inflammatory fibroid polyps, six leiomyomas, four lymphangiomas, four hemangiomas, four schwannomas, two neuromas, two malignant melanomas, one leiomyosarcoma, one granular cell tumor and one Kaposi sarcoma were detected. The median ages of the cases were 61 years (29-87), the median tumor size was 1.5 cm (0.2-14). Thirty seven (58.7%) cases were female and 26 (41.3%) were male. They caused nonspecific symptoms. No recurrence or metastasis was detected after excision in benign tumors regardless of the pathological diagnosis.

Conclusion: Non-gastrointestinal stromal tumor mesenchymal tumors of the gastrointestinal tract are mostly small and benign tumors that can be seen at any age and are frequently seen in women. The most common ones are lipomas and inflammatory fibroid polyps. Most gastric tumors cause dyspeptic complaints and intestinal tumors cause abdominal pain, nausea or vomiting, as well as some of the intestinal tumors lead to serious, even fatal clinical situations such as acute and chronic bleeding, obstruction, perforation, volvulus or intussusception. For benign tumors’ treatment, excision is sufficient, they do not exhibit recurrence or metastasis.