Makale Arama

İn this article, CT features of 21 cases with be-nign and 21 cases with malignant pleural diseases were described. Features that are helpful in distinc-tion malignant from bening pleural disease were, mediastinal pleural invasion, nodular and more than 1 cm tickening in pleura. The specıficities of these findings were 77%, 93%, 100% and sen,.sitivities 50%, 50%, 33%, respectively. High contrast en-hancement that does not show significant differenpe was detected in all malignant lesions and benign in-fectious pleural diseases. Consequently, it has been emphasized that CT is a useful radiologic method in detertnining of pleural lesions and, their extentions and, in the differential diagnosis of benign and malignant conditions.

Primary spinal intramedullary glioblastoma is a very rarely seen clinical entity. By this case report main characteristic features and treatment strategies of this rarely seen neoplasm reported and discussed in the light of relevant literature. Fifty years old man admitted to our clinic with numbness and weakness of limbs for a year escpecially worsened last 2 months. Magnetic resonance imaging (MRI) showed expansion of the spinal cord from C3 to C6 by a lesion. The patient operated and tumoral lesion subtotally removed. The pathological results were consistent with glioblastoma multiforme. Main features of this neoplasm discussed with related literature in this report. Despite of the neoplasm’s low incidence it’s rapid progresive clinical course constrain us to make a correct diagnosis immediately to help the individuals.

Benign cysts of Mullerian type present as pelvic mass in perimenopausal and postmenopausal women mimicking ovarian malignancy. Herein, a case of benign uterine mullerien cyst detected in a woman with postmenopausal uterine bleeding resistant to medical treatment and operated with a preoperative diagnosis of right ovarian simple cyst is presented. Differential diagnosis is also discussed. Sixty two years old postmenopausal woman presented with complaint of abdominal pain and vaginal bleeding. A cystic mass of 4x3 cms thougth to be originated from right ovary was determined on pelvic ultrasound. The patient with postmenopausal uterine bleeding resistant to medical treatment of 6 months given before went to surgery with a preoperative diagnosis of right ovarian simple cyst. After pathologic examination, the cyst was diagnosed as benign uterine mullerien cyst.

Pulmonary embolism(PE) is a serious disease which is one of the most important reason of cardiovascular mortality. In spite of the fact that electrocardography(ECG) has a limited effect on the diagnosis and determination of the prognosis of PE, it is an essential method for clinically differentiating PE from other diseases that might be confused with PE, such as myocardial infarction(MI) .The aim of this case report presentation is to discuss whether this stuation might be a marker on determination of the prognosis.and the fact that PE could mimic the ECG findings of ST elevation myocardial infarction even though it is rare. Fifty six years old patient with acute renal failure and disorder of liver dysfunction, who had been treating in intensive care unit of internal medicine department, complained about chest pain and shortness of breath occuring on second day of his admission to the hospital. The patient was taken from cardiology department with anteroseptal MI prediagnosis after evaulation of the ECG demonstrating about 4 mm ST elevation in V1-V4 precordial derivations. Coronary angiography was performed to the patient being thought to whom primary percutaneous coronary intervention might be neccessary and there was not any lesion determined in epicardial coronary arteries. The parameters obtained from transthoracic echocardiographic evaulation of the patient was corcordant with the diagnosis of PE. It was understood from the imaging reports performed previously that trombus in vena cava inferior had been detected. The patient had cardiac arrest and died while he was being prepared for the pulmonary embolectomy operation after diagnosing of PE. The aspect which made our case report more attractive is that there were only various case reports published about PE in literature, which indicateST elevationmimicing anterior myocardial infartion. It is thought that this situation might be observed in PE and might guide for determination of the prognosis as well when this case report is evaulated together with the other ones.

In this study, we investigated ultrasonographic findings of pleural effusion in 35 patients with ple-urisy as an aid to differential diagnosis. 25 of the patients were male amd 10 female. The mean age was 41 (range 18 tO 66). All the cases except one with transudate had pleural thickening. The mean thickness of pleura was 5 mm (range 3-11 mm) in cases with tuberculous effusion, 11 mm (range 6-19 mm) in cases with malignant effusion and 7mm (range 4-17 mm) in cases with pneumonic effusions. In cases with tuberculous effusion pleural thickening was diffuse and regular in 12 of 13 cases (%92). It was also determined mobile echogenic fibrils on the surface of pleura in 10 (%77) of the tuberculous ef-fusions. This study suggests that ultrasonography may he useful in the differential diagnosis of tu-berculous pleural effitsions.

Moebius syndrome is a rare, non-progressive congenital syndrome presenting with complete or partial facial paralysis. It is usually associated with orofacial malformations, musculoskeletal defects, brainstem dysplasia, and other cranial nerve palsies. Mean incidence is 2-20/million, although there is considerable regional variation. The most common presentation is with bilateral lateral rectus palsies and facial diplegia. Frequently, the 5th, 10th, 11th and 12th cranial nerves are involved and may cause cough, difficulty in chewing and swallowing, and respiratory insufficiency. Complete or partial facial nerve palsy is necessary for a diagnosis of Moebius syndrome. A 4-month-old girl was brought to our clinic with complaints of inability to close her right eye completely and internal deviation in that eye, beginning from birth. She had micrognathia and an inability to completely close the right eye. Both eyes were turned inwards during primary gaze. She had limited lateral gaze, a pes equinovarus deformity in her feet, and flap ears. Cranial magnetic resonance imaging was performed because of the dysmorphic features and revealed micrognathia and volume loss at the tongue. Bilateral facial nerves could not be visualised by a 3D FIESTA scan, suggesting bilateral facial nerve agenesis. This case is presented to highlight Moebius syndrome in the differential diagnosis of cases presenting with congenital facial weakness.

Aim: It was aimed to discuss a rare case which was diagnossed as pilomatrix carcinoma. Case Report:We report the case of a 50-year- old man with a pilomatrix carcinoma in his left forearm. In his history the patient announced taht the lesion had developed one year ago, and its size had expanded rapidly after the first six- month period. Diagnosis of malignant pilomatricoma is essentially histopathological .The tumor was composed of pleomorphic basaloid cells with prominent nucleoli and frequent atypical mitoses accompanied by central areas with keratotic materials, shadow cells, and foci of necrosis. Vascular or perineural infiltration was not observed. The patient remained disease-free at the 22 months follow- up. Conclusion: Pilomatrix carcinoma is a neoplasm of low-grade malignancy that should be distinguished from the conventional pilomatrixoma and its variants. Clinicians and pathologists should be aware of the occurrence of pilomatrix carcinoma because of its potential for distant metastases. We reviewed the literature and comment on the histopathologic differences from other cutaneous tumors.

Pericardial cysts and diverticula compose %7 of all mediastinal masses. Pericardial cysts and diverticula are generally present at right cardiophrenic sinus also within left cardiophrenic sinus, superıor mediastinum, aortic arch level and left hilum. Pericardial cysts and diverticula are lesions which resemble themselves in shape, localiaztion and symptoms. Radiography, CT and MRI has demonstrative importance in their diagnosis. We want to present similarities and differences of symptoms, diagnosis and treatment of pericardial cysts and diverticula which are important in differential diagnosis of mediastinal cystic lesions within these 3 cases.

Testicular adrenal rest tumor (TART) is a benign testicular tumor that was seen in male patients with a history of congenital adrenal hyperplasia. It is often localized as bilateral. It can cause infertility. Differential diagnosis includes, Leydig and Sertoli cell tumors, seminomas and other germ cell tumors. Ultrasonography and magnetic resonance imaging are radiological imaging methods used in the diagnosis of TART. In this article, clinical features, radiological findings and differential diagnosis of TART is presented.

Aim: To report an immature teratoma case that was differentiated from mature teratoma. Case report: A 29 year old woman consulted to Gynecology and Obsterics clinic vvith pelvic pain. İn the histoıy of the patient, it was un- derstood that she had left sided ooferectomy due to left ovarial cyst. At that time the ovarial pathologyhad been reported as normal. İn the pelvic examination of the patient a pelvic mass that can not be differentiated from ute- rus was detected. İn the pelvic ultrasonography of the patient, at the right ovarial area a smooth bordered hete- rogenous mass that had calcified areas vvith in the body, and that was measured as to be 11x11 cm and found to have solid and cystic components was detected.İn the laboratory finding AFP: 10,5 (0-7), CEA: 6,4 (0-4,1), CA 125: 32,9 (0-21), CA19.9: 322 (0-18,4), CA 15.3 :24,5 (7,5-53 ), HCG < 1 was found. The patient had been operated, the right ovarial mass extirpation and right ooferectomy had been done. The diagnosis vvith the histopathological examination of the mass was defined as immature teratoma grade-l. Conclusion: İt is needed to get several biop- sies of the pathological spesimen in order not to skip. The immature components of the teratomas and neural com­ ponents should be shown vvith immunohistochemical methods.

We aimed to present a rare case with giant ovarian tumor which causes intraabdominal mass in a 14-year-old girl. On examination, there were abdominal distension and a palpable solid mass in abdomen. On abdominal ultrasonography (US) and computed tomography (CT) examination, a giant mass, which covers all intraabdominal cavity, was identified in the abdomen. Laparatomy was carried out in elective conditions after all tests had been performed. The mass originated from left ovary was excised totally via left salpingoooferectomy, following both ovaries and both tuba uterinas. The operative diagnosis of dysgerminoma was confirmed with histopathologic examination. Chemotherapy was scheduled by Hematology-Oncology Department. Dysgerminoma should be considered in the differential diagnosis of the girls who are admitted with the intraabdominal giant masses.

The purpose of the study is to discuss an atrial myxoma case, rarely thought for the differential diagnosis of dizziness, with the help of literature. A 65 year old woman patient was admitted to neurology clinic with complaint of dizziness that started four months ago. No neurological cause was defined as the result of the examinations and the patient was referred to cardiology clinic. After a detailed physical examinaiton, a huge myxoma that lead to obstruction on the left entrance and exit ways in left atrium was defined. The patient was recommended to have a surgical operation, yet she refused to do so. Dizziness is a frequently encountered clinical complaint. Since it may cause rare but serious clinical results, atrial myxoma should definetely be taken into consideration in differential diagnosis.

Cerebrospinal fluid lactate dehydrogenase (LDH) enzyme levet was investigated in this research for the differential diagnosis of bacterial and aseptic meningitis. LDH enzyme levels in CSF were determined in a group of 58 pediatric cases which were constituted of 30 normal imdividuals, 14 patients with bacterial meningitis and 14 patients with aseptic meningitis. The values of CSF LDII levels in normal group, bacterial meningitis group and aseptic meningitis group were obtained as 25,02 ±9 ,47 IUIL, 119,26 ±41,34 IUIL, ± 0 ÷ ,61 IUIL, respectively. In the levels of LDH enzyme ,in CSF of bacterial meningitis cases, a significant difference was found in comparison to the other groups which were normal individuals and aseptic meningitis cases (p<0,001).Based on these findings, it is concluded that the determinations of LD11 levels of CSF are helpful in differentiating bacterial from aseptic meningitis.

\r\n External ophthalmomyiasis is infestation of ocular surface with fly larvae. In our report, we described a 47-year-old man who presented with complaints of foreign body sensation, itching and redness in the right eye. Slit-lamp biomicroscopy revealed tiny larvae crawling on the conjunctival surface. A total of four larvae were removed under topical anesthesia and sent to laboratory where they were identified as first stage larvae of oestrus ovis. Topical antibiotic-steroid combination drop was prescribed. The patient had no complaints in the follow-up examinations. External ophthalmomyiasis should be remembered in the differential diagnosis of red eye as myiasis may also occur in healthy people living in city centers.

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Organizing pneumonia (OP) is characterized histopathology cally by tufts of fibroblasts and immature collagen filling of respiratory bronchioles and alveoli. Symptoms are usually nonspecific and include cough and dyspnea. Radiograph cally, OP frequently manifests as patchy bilateral infiltrates that can be relapsing and migratory. Cryptogenic organizing pneumonia (COP) may be defined as having non-specific symptoms which can ultimately be described as a subset of the OP that cannot be attributed to any reason. Forty-nine-year-old female patient admitted with the complaints of 2 year exertional dyspnea and 20 day dry cough. The patient was diagnosed of pneumonia and prescribed with antibiotics; however, no improvement was observed in her complaints and lung graphics. The physical examination of the patient, routine laboratory analyses, collagen tissue markers and bronchoscopy were normal. In chest X-Ray, there were 4 nodular density approximately 1 cm in size, in the upper zone. In thorax CT, there were irregular contours multiple nodules, and the biggest one was approximately 35x7 mm in the upper lobes and in the superior of the left lower lobe of lungs. Acid fast bacteria was negative at bronchoalveolar lavage. The patient was diagnosed COP as clinically and radiologically. Then, systemic cortico steroid therapy was started. A complete clinical recovery was observed in the sixth month of the treatment and at the control thorax CT displayed that nodular lesions were disappeared completely. In the cases that were not respond to antibiotic therapy and patients having radiologically mobile and temporary infiltrations may be taken into consideration in the differential diagnosis.

Lymphocytic adenohypophysitis is a rare disease associated with late pregnancy and early postpartum. Autoimmune mechanism is blamed as cause. İt is frequent in females, and may be misdiagnosed as pituitary adenoma. 29 years-old -female with 2 children presented with headache follovving cryptic tonsillitis. Recently she had problems vvith her Vision. Clinical and radiological work up including magnetic rezonance imaging revealed a mass in the sellar and suprasellar region. She undervvent surgical decompression follovving functional hormona! studies. Histopathologic evaluation of the specimen was reported as lymphocytic hypophysitis. Differential diagnosis of lymphocytic hypophysitis from that of adenoma is important in planning surgery. Relation to the pregnancy, a severe hypopituitarism, edematous anterior and posterior pituitary lobe are in favour of lymphocytic hypophysitis. But certain diagnosis is made via histopathologic diagnosis. İt is thought to be autoimmune in origin especially in pregnant or recently delivered vvomen. But in nonpregnant persons it may start or be aggravated after an infection as it is in our patient.

Ovarian cysts rarely reach enormous dimensions. The giant ones could be get mixed with mesenteric cysts, lymphangioma, local ascites or peritoneal inclusion cysts. We presented a case in which the preoperative evaluations revealed a lymphangioma eventhough the final hystopathological diagnosis was an endometriotic cyst (a type of benign ovarian cyst). Cystic lesions related to gonadal structures should be kept in mind when you’re dealing with giant cystic structures which are encountered rarely as a result of physical and laboratory examination at acute abdomen. The fertility situation and wish of patient should be considered when the treatment algoritm with an interdisciplinary approach are drawn .

Sialolipom is a rare benign tumor, defined as the variant of intraoral lipoma. Tumour is completely surrounded by thin fibrous capsule and consisted of mature adipocytes and normal salivary gland tissue. In here, we present a 55 years old female patient with submandibular gland located sialolipoma.

Lipomas are benign mesenchymal neoplasm commonly occurring throughout the whole body and comprise mature fat tissue. However, intestinal mesentery originated lipomas are rarely seen. A 42-yearold female patient presented with right sided abdominal distension. Exploratory laparotomy was performed and fat tissue was excised. Lipomas might or might not present with any symptoms. Complete surgical excision is the only treatment with a very good prognosis.

Abdominal actinomycosis is a rare infectious disease caused by an anaerobic bacterium actinomyces israeli. Pelvic actinomycosis is generally associated with the use of intrauterin devices (IUD). This chronic suppurative infection can mimic pelvic malignancy. The diagnosis of the disease is frequently miss preoperatively. The surgeons must be aware of this rare complication in order to avoid an extensive surgical procedure. Case: We present the case of a 31 year old premenoposal woman with an abdominal pain and a history of IUD us efor 6 years. On physical examination the patient had tenderness on right lower abdomen and a palpable cystic mass 8x10 cm in size on pelvic bimanual examination. A preoperative transvaginal USG showed a 9x9 cm cystic mass originated from right ovary. The patient was taken to the emergency operating suite with the diagnosis of torsion of the right cystic ovary by gynaecologist. During the exploratory laparotomy we observed an extensive diffusely infiltrating process involving right adnexa, sigmoid colon sacrum and right pelvic Wall. A loop of jejunum was adherent to this infiltrating process and a mass 5x6 cm in size was palpated in sigmoid colon. These findings were highly suggestive of a colonic carcinoma and the patient was consulted with a general surgeon intraoperatively. Right salpingo -ooferectomy + sigmoid resection + segmental jejunal resection was performed. Pathologic findings showed chronic inflammatory tissue with evidence of actinomycosis. Conclusion: The case described here underlines that surgeons must be aware of this unusual infectious disease in the differential diagnosis of pelvic mass.

The aim of the study was carried out to investigate the diagnostic value of the AgNOR to distinguishing betvveen preneoplastic and neoplastic lesions of the endometrium. Retrospective analysis included tissue material obtained from 50 patients with simple and complex hyperplasia with and without atypia and well differantiated endometrial adenocarcinoma. Sections were stained with AgNOR technique. The results obtained indicate that AgNOR counts have statistical significant in differantiating betvveen well differantiated endometrial adenocarcinoma and, simple hyperplasia and complex hyperplasia with and vvithout atypia.

Objective: Dermoscopic features of basal cell carcinoma (BCC) have been well described in the literature, however, blue white variant of BCC has recently been described as a mimicker of melanoma. When reviewing the literature, it seems that there is just one original research about this special type of BCC. Here we aimed to evaluate this special and challenging variant of BCC cases of two dermatology departments from different regions of Turkey. 

Material and methods: Dermoscopic images of the histopathologically approved BCC cases  from two centers between the years 2015-2018 were reviewed. The cases showing diffuse blue white areas on dermoscopy were included in the study. The clinical and histopathological features, dermoscopic images and demographic data of all the cases were evaluated

Results: We detected 15 (9.74 %) lesions of BCC with diffuse blue-white dermoscopic pattern from 15 different patients among 154 cases of histopathologically confirmed basal cell carcinomas. All of the cases were located on the head region. All of the cases were excised with two main differantials: melanoma and BCC. The most common findings after blue white diffuse areas were irregular serpentine vessels (60.0 %), peripheral maple leaf like areas (46.6%) and ulceration (46.6%). The histopathological examination of all the cases were in keeping with nodular or noduloulcerative subtypes.

Conclusion: The present study, to the best of our knowledge, is the most comprehensive study regarding this rare and challenging presentation of BCC. The main differential diagnosis is melanoma. We suggest that it would be logical to consider blue white BCC in the lesions showing diffuse blue-white color. A careful dermoscopic examination regarding the presence of specific dermoscopic clues to basal cell carcinoma can provide a well-directed preliminary diagnostic evaluation. 

Keywords: Basal cell carcinoma, blue white, dermoscopy

Purpose: Cross sectional imaging technigues more widely available in the recent years for evaluation of pelvic and tubo-ovarian lesions. We discussed the primary contribution of these methods in the diagnosis of uterine masses in the patients with tubo-ovarian lesions. Materials and Method: IVe present 41 tubo-ovarian lesion with pathologic correlation. Transabdominal sonography, enhanced and nonenhanced CT seans were performed in ali cases. Moreover sagittal and axial T1-weighted as well as T2- vveighted, and fat-saturated unenhanced and gadolinium- enhanced MR images of the pelvic region. kVe compared our radiologic findings with histopathological results. Results: Three of 41 cases had corpus luteum eyst, 10 had eystadenoma, 7 had ovarian carcinoma, 7 had dermoid eyst, 4 had endometrioma, 3 had abcess, 2 had eyst hydatid, and 1 had ovarian fibroma on histopathological examination. Correct diagnosis was established in 33 (80%) out of 41 lesions with US, in 29 (80%) out of 36 lesions with CT scan and in 33 (83%) out of 40 lesions with MRI. Correct diagnosis was established in 33 (83.3%) out of 36 lesions with US, in 29 (77.7%) out of 36 lesions with CT scan and in 33 (86.1%) out of 36 lesions with MRI. Conclusion: Because of ability to detect invasion and in defining the extent of disease, MRI is better than sonography, and CT, and appears to be the modality of choice for evaluated of the pelvic masses. Although US pas potantial advantages and limitations, it should be preferred as the first method of searching for pelvic pathologies.

In this study, the pathologic types of the tuberculosis of the parotid gland and the necessity of performing open biopsy in the cases who can not be diagnosed preoperatively were discussed in the three cases. Two of these cases were nodular (localized) type and the other was diffuse type. The diagnoses were established in the localized type and the other was diffuse type. The diagnoses were established in the localized type by extracapsular dissection and the diffuse type by open biopsy. In the parotid gland mass, minimal surgical approach is superficial parotidectomy and open biopsy or extracapcular dissection surgeries should not be performed routinely. The diagnosis of the parotid gland involvement with tuberculosis has traditionally been made after superficial parotidectomy, then applied medical therapy. Due to similarity to mucoepidermoid carcinoma and diffuse fibrosis was in the paranchymatous case, open biopsy was performed planning the surgery according to the histopathologic diagnosis. If the differential diagnosis cannot be made with fine needle aspiration biopsy (FNAB) in as these cases preoperatively, open biopsy can be performed for diagnosis.

Objective: To present a case of pulmonary hyalinizing granuloma (PHG). Case Report: The patient was a 48-year-old female who had abnormal chest X ray showing bilateral mass shadows incidentally. She was asymptomatic. Subpleural two nodules removed by open lung biopsy revealed a homogenous cut surface. Histological diagnosis was PHG consisting hyalinized collagen fibers and bundles infiltrated with chronic inflamatory cells. Conclusion: The case was presented to attract attention to take this rarely benign disease in to account in the differantial diagnose of multiple pulmonary nodules.

Evaluation of Turkish cases reported as Kikuchi lymphadenitis, together with an additional case report. Excisional lymph node biopsy is performed on a 26 years old female patient, who is admitted to the hospital with complaints of a palpable mass at axilla and fever. Pathological examination revealed multiple foci of necrosis with sharp, irregular borders. Dense histiocytic proliferation without presence of neutrophil leukocytes is seen in these foci. Clinical and morphological findings of this case are found to be concordant with Kikuchi’s lymhadenitis. As a rare type of lymphadenitis, Kikuchi’s disease has a special importance due to its inclusion in differential diagnosis of lymphoma. Since it is uncommon to be counted in clinical pre-diagnosis, it must be absolutely taken into consideration in pathological evaluation. Together with this case report, mean age of totally 31 cases from Turkey is 31. Female to male ratio of these cases is 1.45. The most common clinical findings are palpable mass and fever. Masses may be painful or painless, as if fever may be subfebrile. Most common location is cervical region and the second common location is axillary region. As laboratory findings, ESR, CRP and LDH levels are increased and leukopenia is found. This pathology must be included especially in differential diagnoses of cases with clinical pre-diagnoses of lymphoma and fever of unknown origin.

Purpose: Cross sectional imaging technigues more widely available in the recent years for evaluation of uterine lesions. We discussed the primary contribution of US, CT, and MRI methods in the diferential diagnosis of uterine masses. Materials and methods: We evaluated the spectrum of US, CT, and MRI findings of the 15 uterine masses. Transabdominal sonography, enhanced and nonenhanced CT seans were performed in ali cases. Moreover, sagittal and axlal T1 weighted as well as T2 weighted, and fat-saturated unenhanced and gadolinium-enhanced MR images of the pelvic region. We compared our radiologic diferential diagnosis with pathologic diagnosis. Results: Seven of 15 cases had myoma, 3 had adenomyosis, 3 had endometrial carsinoma, and 2 had servix carcinoma. Correct diferential diagnosis was established in 11 (73%) out of 15 cases with US, in 12 (80%) with CT, and in 13 (87%) with MRI. Conclusion: MRI is the imaging method best suited for evaluation of uterine lesion than other imaging technigues. Since ultrasonography allows deiiation of the uterine masses in at least two scanning planes, this method should be preferred as the first method of searehing for uterine lesions.

Lipomas are the most common extratesticular scrotal neoplasms and they most often originate from the spermatic cord. The etiology is unknown but linked to a constitutional factors, obesity, an its presentation is more frequent in the sixth or fifth decade. In this case, an unusual massive scrotal lipoma that occured in 70 years old man is described.

Tuberculosis remains to be a serious public health problem in our country and all over the world. Extrapulmonary tuberculosis causes major clinical problems because of difficulties encountered in the differential diagnosis. In this case report, we aimed to discuss a case of tuberculous lymphadenitis mimicking mediastinal tumor in chest CT and PET-CT examination. Eighty years old female patient with right paratracheal enlargement in the chest radiography was admitted to our hospital. Thorax CT and MR imaging was supporting this expansion as concordant with the mediastinal tumor. The PETCT showed increased FDG uptake in favor of malignant masses. However, mediastinoscopic biopsy was reported as tuberculous lymphadenitis and antituberculous therapy was started. It should be kept in mind that even in adults patients, tuberculous lymphadenitis should be thought in differential diagnosis of mediastinal masses suspecting malignancy with imaging techniques and also it should not be forgotten that tuberculous lymphadenitis may be presented with elevated FDG uptake at PET-BT.

Langerhans cell histiocytosis is a group of idiopathic disorders characterized by the abnormal proliferation of specialized bone marrow-derived Langerhans cells. In this report, we present a rare case of Langerhans cell histiocytosis with CT and MRI in a 2 yearold-boy who developed symptomatic diabetes insipidus and multiple bone ,cranial, lung and spleen metastases during the disease course. A 2-year-old male patient was hospitalized due to complaints of cough, fever, vomitting, diarrhea, achromasia, weakness and rash. Chest X-ray revealed reticulonodular infiltration in both lung fields. Thorax CT revealed diffuse micro and macro nodular type infiltration in both lung parenchyma. On CT and MRI revealed common lytic lesion of skull, vertebra and iliac bone. There are infundibular thickening and absence of posterior pituitary intensity on MRI of pituitary gland. The spleen involvoment is determined by abdominal CT. The diagnosis is confirmed with biopsy of iliac bone. Langerhans cell histiocytosis should be in the differential diagnosis in children having widespread lung, bone, pituitary gland, and spleen involvement on MRI and CT.

Cerebrospinal fluid alkaline phosphatase enzyme level was investigated in this research for the differential diagnosis of meningitis. Cerebrospinal fluid alkaline phosphatase enzyme levels were de-terrnined en a group of 58 pediairic cases which were constituted of 30 normal individuals, 14 pa-'lents with bacterial meningitis and 14 patients with aseplic meningitis. In the normal group, the levels of alkaline phosphatase in cerebrospinal fluid ıvere estimated as 0,13 ± 0,8 Kuld.I.The values of alkaline phosphatase levels in bacterial and aseptic meningitis were obtained as 1,33 ± 0,78 KU/ dl, 0,29 ± 0,12 KUM], respectively. In cases of bacterial meningitis, a significant difference was founcl in comparison to the other groups which normal group and aseplic meningilis group (p<0,001). Based on these findings its is concluded that the determinations of alkaline phosphatase levels in the cerebrospinal fluid are helpful in differentiating bacierial from aseptic meningitis, especially in the cases which were negative cultures.

In a fifteen years old girl compleining from lom-her and inguinal pain hydropyonephrosis with sto-nes in pelvic kidney has been determined after an in-vestigation with pelvic mass. Not very seldom this sort of patients apply to other clinics.

Asymptomatic huge overial benign mucinous cystadenoma: A case report. Overial benign mucinous cystadenoma can grove huge sizes. Abdominal cysts are usually asymptomatic unless they have huge sizes. It is a rare condition asymptomatic clinical course of a huge abdominal cyst as like in our case. We aim to examine abdominal cysts by presenting a case of huge overial benign mucinous cystadenoma in this article. Abdominal ultrasound imaging is a useful exemination in diagnosis of abdominal cysts. For differential diagnosis abdominal tomography and magnetic resonance must perform as a advenced imaging method. Surgical treatment is usually open surgery performed by a median incision. Although open surgical tecniques are protecting importance as a convential prosedure laparoscopic surgical methods are increasingly having popularization.

It was examined iwo hundreci and seven cases havıng the unders-cended iestis and scrotal patholo-gy by ultrasonography. Ultrasonographic findings were discussed in association with clinical and op-eration findings. It was discussed that, ultrasonography coıdd give US positive chıes in Ille investiga. tion of dillerential diagnosis of clinic and subclinic varicocele and undescended testis.

Endometriosis is the presence of normal endometrial tissue outside the uterus. Scar endometriosis is a rare pathology resulting after obstetric and gynecologic surgery procedures on abdominal wall which is not pre-diagnosed in differential diagnosis by general surgeons. Six cases referred to General Surgery outpatient clinic with mass on abdominal wall that have been totally excised and diagnosed as endometriosis in pathology laboratory between 2008-2012 , have been reviewed retrospectively with clinic, radiologic and pathologic findings. The presenting symptoms of six pateints were different; four of them referred with cyclic pain and swelling and two with nonspesific symptoms to general surgery outpatient clinic. All of the masses have been totally excised and diagnosed as endometriosis in pathology laboratory. Scar endometriosis should be considered in differential diagnosis of incisional abdominal wall masses in females referring to General Surgery.

Aim: This study aimed to determine which of these parameters is effective in surgical decision making. Material and Method: The study population consisted of 87 patients, 56 (64%) male and 31 (36%) female [mean age, 8.18±1.25 years (±SD); range, 1 to 16 years], who were examined and investigated in our department. Two groups were studied: Operated group (O group) who underwent surgery and included 76 children and nonoperated group (NO group) who did not undergone surgery and included 11 children. In both groups age, gender, preoperative temperature, leukocyte count in blood and urine, the plain XRay film of the abdomen, abdominal ultrasonography (USG), nasogastric drenage (NGD), preoperative diagnosis and treatment were identified. Results: In preoperative period temperature were significantly high in only perforated appendicitis compared with other causes of abdominal pain (P=0.028). Gase-liquid level in perforated appendicitis and gase image in acute appendicitis were significantly high compared with other causes of abdominal pain in plain graphy (P=0.001). USG was rather significant in the differential diagnosis of intussuception and mesenteric lymphadenopathy compared with other causes of abdominal pain in this period (P=0.000). In addition, USG was found as a valuable parameter in surgical decision making. Leukocyte count in blood (P=0.346), the leucocyte in urine (P=0.131), NGD (P=0.205) were not significant in surgical making decision. Conclusion: It was shown that temperature were significantly high and gase-liquid level in the patients who are suspected to be perforated appendicitis of the patients who have abdominal pain in preoperative period. We may say that abdominal USG is effective especially in the differential diagnosis of intussuception and mesenter lymphadenitis to avoid unnecessary surgical procedures.

Myotonic dystrophy is the most common muscular dystrophy of adulthood. Neurological manifestation of the disease is typical, however diagnosis could be challenge in patients presentig with predominant cardiac or systemic symptoms. 46 year old male was suffering from presyncope attacks for 16 years, and first examined by a cardiologist. Because of the recent complaints including walking difficulty, he was referred to neurology department. Following a detailed neurological examination and electrodiagnostic workup, he was finally diagnosed myotonic dystrophy type 1. The case highlights the necessitiy of neurological consultation in patients who present with conduction defects, arythmias or cardiomyopathies of unknown origin, accompanied by overt or subtle neurological symptoms. In such patients, neuromuscular disorders should be considered in the differential diagnosis; and in order to provide thorough diagnostic evaluation, multidisciplinary approach is essential.

Chest pain is a common complaint in children. It doesn’t usually indicate a cardiac problem but it is considered as heartache by the patients and their families. In this article, the patients with chest pain in pediatric cardiology clinic for the last 18 months have been evaluated and the etiology of chest pain has been discussed. The study includes 441 patients with chest pain, who were admitted to the Department of pediatrics, Division of pediatric cardiology, Faculty of Medicine, Selçuk University between May 2011 and November 2012. The data of the patients has been reviewed retrospectively. Medical history and family history of the patients, cardiac physical examination, electrocardiography, echocardiography, 24-hour rhythm holter monitoring, exercise testing and laboratory tests have been evaluated. In our study the mean age of the patients was 11 (5-18 year-old). 217 (49.2%) of the patients were male and 224 (50.8%) of the patients were female. Medical history, physical examination, electrocardiography and echocardiography of all the patients have been evaluated. Cardiac pathology has been recognized in 10 (2.3%) of the patients. The reasons that cause chest pain are idiopathic in 378 (85.7%) patients, psychological in 22 (5%) patients, lung diseases in 20 (4.5%) patients, gastrointestinal disorders in 6 (1.4%) patients, musculoskeletal system diseases in 3 (0.7%) patients, Familial Mediterranean Fever in 1 (0.2%) patient and pectus excavatum in 1 (0.2%) patient. According to this study, the etiology of chest pain in children is extra cardiac factors in majority. Differential diagnosis should be made carefully due to possibility of life threatening consequences of cardiac disorders. If there is no cardiac pathology as a result of medical history, physical examination and laboratory tests the patient and the family should be informed about this.

Purpose: The role of gray-scale ultrasonography and color Doppler ultrasonography in the differential diagnosis of breast masses detected on mammography. Materials and Methods: Sixty-eight patients were included with breast masses in mammographic and sonographic examinations. The average age of presentation was 44,0 years. On color Doppler sonogram, vascularity of the lesions, the vascular patterns such as Central, peripheral were also evaluated. Results: There were 31 bening, 8 enflamatory and 29 malignant masses. By mammographic examination 48% of malignant lesions determined irregular spicular contour, 17% determined microcalcification. 75% of malign lesions and 100% of infection lesions shovved vascular flow in color Doppler imaging. 11% of benign lesions only shovved vascular flovv. Conlusion: Mammography is the primary method in the diagnosis of breast masses. Gray scale ultrasonography is a effectual method, particulary by experienced physician. The best use of color Doppler imaging as the combination with conventional sonography and mammography.

Aim: Lipoma arborescens is a rare intra-articular disease whose etiopatogenesis remains unknown.It was the aim to describe the radiological findings and to discuss the differential diagnosis. Case Report: Lipoma arborescens is a lesion characterized by the replacement of the subsynovial tissue by fat cells giving rise to a villous proliferation. It commonly affects the knee. Accurate diagnosis is important for surgical treatment. A 34-year-old patient who was suffering from a pain in his knee joint was examined by convansional radiography, computerized tomography, and magnetic resonance imaging. The lesion was diagnosed as lipoma arborescens especially with magnetic resonance imaging. Conclusion: The characteristic MR features of lipoma arborescens which has nonspecific clinical findings allows an accurate diagnosis.

Lesions in the peripheral lung area chest roentgenograms may be examined by ultrasonography. Solid and cystic lesions may be differentiated with ultrasonography (Us). ln 49 of 57 patients the US diagnosi.s of cases was correct. In 25(%51) of 49 patients lung !umar was diagnosed. In 6(%12) cases pneumonia, in 6(%12) cases hydatid cyst, in '" 5(%6) cases empyerna. in 3 (%6) cases encapsuie fluid collection, in 2(%4) cases absces5', in 1(%2) cases left ventrikül anevriysm and in 1(%2) case pericardial hydatid cyst were diagnosed. Consolidations were imagined in solid structures that include hypoechoic and branching sutructures. Tumors were imagined ta be more echogenic and homogeneus solid maseses. Atelectasis waüs imagined in structures consist of hypoechois bronchial and vascular echoes.

Difficulty in walking, pain, numbness and other symptoms may occur in geriatric patients during walking, depending on various pathologies of waist, hips, knees and other areas. However claudication is an important symptom that is watched in specific clinic tables. That often appears by walking and it is described as not localized pain in one or two legs, weakness, numbness, parestesia and cramp by patients. Vascular claudication, especially monitored in peripheral arterial disease and neurogenic claudication monitored in lumbar spinal stenosis are the most important and initial clinical symptoms of these statements. In the presence of lower extremity pain in geriatric patients there are many diseases to be considered in the differential diagnosis. Therefore, patients with claudication should not be neglected as defined for the differential diagnosis and a guiding symptom. In this text, we present a case which described a variable claudication and diagnosed with lumber spinal stenosis and peripheral artery disease the aim of rewiewing the process from symptoms to diagnosis.

Absent pulmonary valve syndrome (APVS) is a rare congenital heart disease. It can be seen isolated or with other congenital heart diseases. Here, we presented a neonate with cyanosis and dyspnea because of APVS. A-female-newborn was referred to pediatric cardiology due to cyanosis, respiratory distress and prenatally diagnosed right ventricular dilatation. Rudimentary pulmonary valves and severe pulmonary and tricuspid regurgitations were determined postnatally with echocardiography and magnetic resonance imaging. Additionally, main pulmonary artery and its branches were seen dilated. Unfortunately she died on third day of her life, although supportive and medical treatments were administered intensively. Most of APVS cases are a variant of Tetralogy of Fallot. But clinical findings, prognosis and hemodynamic conditions can be different. Infants requiring mechanical ventilation shold be undergone operation as soon as possible. Our case could not be operated because of unstable vital functions. Absent pulmonary valve syndrome should be considered as a differential diagnosis in neonates with cyanosis and respiratory distress. If prenatal diagnosis is present, we suggest that parturition should happen in a medical center includes pediatric cardiology and cardiovascular surgery and also neonatal intensive care unit.

in this manuscript a cervical vagal schwannomo is reported. Von Reckiirzklıausen disease was associated to the schwannoma. The relationship between two entilles is discussed. The imporiance of the vagal schwannoma in the dillerantial diagnosis of the head-neck massed rs impressed and the pertinent literature reviewed.

Anaphylaxis is a multi-systemic disease, which develops associated with the sudden expression of mast cell mediators into the systemic circulation, and can be life-threatening. The majority of cases are reactions to food, drugs, or insect stings, mediated by immunoglobulin E (IgE), and may cause a process resulting in degranulation of mast cells. Severe asthma, mastocytosis, cardiovascular disease, elevated basal serum triptase, the use of beta blockers or ACE inhibitors, exercise, acute infections and emotional stress are some of the reasons increasing the risk of anaphylaxis. As cardiac functions and respiration can halt within minutes during an anaphylaxis attack, treatment must be applied rapidly immediately after diagnosis. Adrenalin is the first and most important drug which should be given in treatment. In this review, the diagnosis and treatment of anaphylaxis are summarised in the light of current literature.

Organ tuberculosis is an important problem for the public health in devoloping countries. Tuberculosis can be seen on any part of the gastrointestinal tract from mouth to anus. Esophageal tuberculosis is very rarely seen with 0.14% prevalance. It usually originates from mediastinal tuberculous lymphadenopathy. We report a 55-year-old woman who admitted to our hospital with complaints of dysphagia, weight loss, audinophagia and epigastric pain. The chest radiography revealed a linear opacity compatible with fibrotic tape was seen on chest x-ray. Thorax CT examination revealed milimetric calcified lymph nodes at subcarinal and the right hilar region, thickening of proximal part of esophageal wall through carinal leveland subsegmenter collapse on left lower lobe. Ulcerative lesion with dimension of 1×1 cm localized in the 19th cm of the esophagus was seen on upper gastrointestinal endoscopy, suggesting esophageal carcinoma. Biopsy revealed necrotizing granulomatous ulceration which resembled tuberculosis. After antituberculous chemotherapy, the endoscopy repeated in end of the 2nd month of antituberculous therapy and the recovery of ulcer lesion was seen and the biopsy showed no signs of tuberculosis. Conclusion; esophageal tuberculosis should be kept in mind at differential diagnosis in patients who have complaints of dysphagia and loss weight and radiological signs.

Melkersson- Rosenthal syndrome (MRS) is a rare disorder of unknovvn etiopathogenesis. This syndrome is characterized by a triad of recurrent orofacial edema, relapsing facial palsy, and scrotal tongue. İn this report a 24 year old man with the typical clinical symptoms and signs of MRS is reported. İn addition, the literatüre on MRS is revievved with respect to incidence, etiology, clinical features, pathology, diagnosis and treatment.

\r\n Silent thyroiditis and Graves’ disease are autoimmune disorders which are common cause of thyrotoxicosis and should be given different treatments. Anamnesis and physical examination are not sufficient in the differential diagnosis of these two diseases, and advanced examinations such as thyroid scintigraphy, iodine reuptake study and thyroid stimulating receptor antibody could be needed. In this case, we present a patient diagnosed with a silent thyroiditis as a result of a thyrotoxicosis of a patient who was following up due to Graves' disease in remission and we aimed to emphasize the importance of differential diagnosis of these two diseases.

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Ultrasonographic features of tumor lesions in 15 patients with hepatocellular carcinoma and 18 with metastatic liver cancer were analyzed. Hepatocellular carcinomas and metastatic liver cancers originating from the gastrointestinal tract were frequently hyper-echoic. Bull's-eye (target sign) pattern was spesific for metastases. Most of metastatic liver cancers showed hypoechoic pattern. These results indicate that ultrasonography is useful for the dillerantial di-agnosis of hepatocellular carcinoma and metastatic liver cancer.

Systemic Lupus Erythematous, autoimmune character, is a inflammative disease holding many systems. The disease can sometimes follow insidiously with symptoms of fever, asthenia and prostration for years. Central nervous system is common. It is the clinical variable and may be very mild or very severe. In most patients, the age of onset is between 16-55 years old and is found in cases diagnosed in advanced age. Here, it is presented an elderly patient developed dizziness and right side prostration when she was 80 and diagnosed lupus when she was 85. We thought as worth for presenting because of that both the patient is elder and that the lesions have similar features with demyelinating plaques. The lupus should not be forgotten in the central nervous system involvement in advanced age cases and separator diagnosis.

\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. 

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In contrast to the common knowledge on the tethered cord synd•ome, various reports note that co-nus medullaris may have a normal location. In this manuscript a case of tethered cord syndrorrıe which has a conus at Lı level and fatty filum terminale has been presented and liwrature is reviwed.

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.