[Determination of Human Papilloma Virus (HPV) Genotype Prevalance and Distrubution in Adana: A Hospital-Based Study Between 2014-2021]. / Adana Ilinde Insan Papilloma Virüs (HPV) Genotip Prevalansi ve Dagiliminin Belirlenmesi: 2014-2021 Yillari Arasi Hastane Temelli Bir Çalisma.

Cervical cancer is the fourth most common cancer among women all over the world. It is accepted that cervical cancer is highly related to the HPV. The International Agency for Research on Cancer (IARC) has classified 13 HPV types as group 1 carcinogens (HPV 16, 18, 31, 33, 35, 39, 45, 51, 52, 56, 58, 59, and 66), which are commonly referred to as high risk-HPVs (hr-HPVs). Among these, hr-HPV-16 is undoubtedly the most carcinogenic based in the burden of cervical cancer (CC) and its precursor lesions. In our study, we analyzed retrospectively the data of a total of 2329 female patients who applied to the obstetrics and gynecology outpatient clinic of our hospital over a seven-year-period, whose cervical smear were carried out by the polymerase chain reaction (PCR) and cytology. In this study, it was aimed to determine the data of of HPV prevalence in our region during the seven-year-period from April 2014 to April 2021 and the most common genotypes and to interpret them together with the cervical smears cytology and biopsy results if it is available. HPV 3, 6, 11, 16, 18, 21, 26, 31, 33, 35, 39, 40, 42, 45, 51, 52, 53, 54, 55, 56, 58, 59, 61, 62, 66, 67, 68, 70, 72, 73, 81, 82, 83, 84 were identified by using linear array HPV genotyping test (Roche Diagnostics, Switzerland) from April 2014 to October 2017. HPV genotypes were identified by using HPV Genotypes 14 Real-TM Quant (Qiagen, Germany) between October 2017 and April 2021. This method detected HPV genotypes 16, 18, 31, 33, 35, 39, 45, 51, 52, 56, 58, 59, 66, 68. The data were analyzed using IBM SPSS Statistics (Version 25.0) predictive analytics software. Continuous variables are indicated as mean ± standard deviation, and discrete variables are indicated as number [percentage (%)]. Chi-square test is used to investigate dependencies between variables. All analyzes were evaluated to provide 95% confidence level and 80% test power. p<0.05 was accepted as significant for the analysis results. Out of 2329 patients, 1283 were found to be HPV negative (54.6%) and the others were found to be HPV positive (45.4%) by using real-time PCR in the cervical smears. It was detected that out of 1046 HPV positive patients, 585 of them (55.9%) had one HPV genotype and 461 of them (44.1%) had more than one HPV genotypes. As we divided all of the patients into two groups as <30 (Group I) ve > 30 (Group II) according to age range, HPV positivity was found 134/296 (45.2%) in Group I and 912/2033 (44.8%) in Group II. When we compared the HPV positive/negative results of Groups I and II by using chi-square test, no significant difference was found between the two age groups in terms of HPV positivity (p= 0.894). In our study, the most common HPV types were HPV 16 (14.2%), HPV 68 (8.2%), HPV 56 (8.2%), HPV 52 (7.1%), HPV 51 (6.8%), HPV 31 (6.5%), HPV 66(6.1%), HPV 39 (5.8%) and HPV 18 (5.6%) among the women with normal and abnormal cytology in the cervical smears. ASC-US was the most common abnormal epithelial cell change detected with HPV16 and 18 genotypes and it was detected 26.07% and 21.88% in patients, respectively. In our study, we found HPV prevalance in our region as 45.4% and the most common type was HPV 16. As a result, we concluded that it is important to determine regional HPV prevalance data, which is an important step in cervical cancer prevention strategies, and regional data of detected HPV genotypes.

Neuroendocrine Tumors of the Breast: Single-Center Experience.

OBJECTIVE: Breast carcinomas with neuroendocrine (NE) differentiation are extremely rare. The aim was to discuss breast cancer cases with NE differentiation in the light of World Health Organization 2019 classification and literature information. MATERIAL AND METHODS: The pathology records of 56 cases diagnosed as neuroendocrine tumor (NET) and/or breast cancers with NE differentiation presenting to a single center between January 2010 and June 2020 were evaluated. The patients were evaluated in terms of age, tumor size, location, histological grade, hormone profiles (ER, PR, HER2), guideline American Joint Committee on Cancer, lymph node status, stage, metastases, progression, survival, radiological features, surgery type and therapy modality. RESULTS: The age of the patients ranged from 34 to 81 years. Average tumor size was 2.3 cm. Median (range) follow up time was 31.5 (1-73 month). Metastatic lymph nodes were found in 20 cases. In our series, NE differentiation mostly accompanied invasive carcinoma of no special type, less frequently solid papillary carcinoma, and mucinous carcinoma.Four patients had a history of neoadjuvant chemotherapy. Response to treatment was very poor in all four cases. Synaptophysin and chromogranin were positive in 38 cases. No correlation was found among tumor size, grade, age, lymph node status, and presence of distant metastasis in our series. CONCLUSION: Clinical features and morphology may not help to distinguish NET from other subtypes of breast cancer. Therefore, the morphologic findings of a nested or trabecular architecture, nuclear or cytoplasmic features of NE differentiation, mucin production, or solid papillary growth pattern should prompt a pathologist to order NE markers.

Accuracy of intra-operative frozen section in guiding surgical staging of endometrial cancer.

PURPOSE: Surgery consists the main treatment of endometrial cancer; however, decision of lypmhadenectomy is controversial. Intra-operative frozen section (FS) is commonly used in guiding surgical staging; nevertheless, there are different reports regarding its adequacy and reliability. Aim of this study is to assess accuracy of FS in predicting paraffin section (PS) results in patients with endometrium cancer. METHODS: Data of 223 cases, who were operated for endometrial cancer at a tertiary hospital in 2012-2019, were analyzed retrospectively. Histological type, grade, tumor diameter, depth of myometrial invasion, and cervical and adnexal involvement in frozen and paraffin section were evaluated. Positive and negative predictive values and accuracy of frozen results in predicting paraffin results for each parameter was assessed. Statistical significance was taken as 0.05 in all tests. RESULTS: Accuracy of FS in predicting PS results were 76.23% for histology, 75.45% for grade, 85.31% for depth of myometrial invasion, and 95.45% for tumor diameter. Surgery, based on FS results, caused undertreatment in 4 patients, while metastatic lymph node ratios were found in only 35.3-50.0% of cases who had high risk parameters at FS. CONCLUSION: Our FS results have reasonable accuracy rates in predicting PS results, in comparison with the previous literature. However, even if the high risk parameters detected in FS predict PS accurately, absence of lymph node involvement in all cases with high risk parameters indicates that FS-based triage cannot prevent unnecessary lymphadenectomies.

Male Breast Cancer: Clinicopathological, Immunohistochemical and Radiological Study.

OBJECTIVE: To evaluate the pathological and radiological features, immunohistochemical profile and treatment methods of primary male breast carcinoma cases diagnosed at our center. MATERIAL AND METHOD: The pathology archive between 2006 and 2019 was reviewed and the data of 27 male patients diagnosed as primary breast cancer were retrospectively evaluated. RESULTS: The age of the patients ranged between 40-86 years. The left breast was involved in 17 patients. The mean tumor diameter was 2.35 ± 1.09 cm. Of the 27 cases, 8 were dead and 19 were alive. The mean follow-up duration was 37.45 ± 24.84 months. The mean estimated life expectancy was 65±14.7 months. The most common complaint was a swelling in the breast. The time interval between the onset of complaints and admittance to hospital ranged from three months to two years. The most common histopathological diagnosis was invasive carcinoma - no special type. The most common surgical procedure was mastectomy with lymph node dissection. Nine patients had metastatic lymph nodes. In terms of the hormone profiles, 24 were Estrogen receptor positive, 21 were Progesterone receptor positive and six were Her2/neu positive. Three patients had triple-negative tumors. CONCLUSION: Male breast carcinoma is a rare disease but its frequency has been increasing recently. As breast cancer is more commonly attributed to women, the diagnosis is usually delayed until later stages in males. Public awareness should therefore be increased and breast cancer should be considered in the differential diagnosis especially in the presence of breast swelling and complaints related to the breast skin so that the appropriate biopsy can be obtained without delay.

Clinicopathologic importance of atypical glandular cells in cervico-vaginal cytology

Objective: To analyze the histopathologic outcomes of patients with atypical glandular cells (AGC) in cervicovaginal cytology examinations. Material and Methods: Patients with AGC in cervicovaginal cytology were included in this study between March 2011 and March 2018 and patient data were collected retrospectively among all cytology results. AGC classification of cervicovaginal cytology were based on the Bethesda 2001 classification system. Results: The total prevalence of cervical epithelial cell abnormality and AGC were found as 4.2% and 0.2%, respectively, in the study cohort. AGC-favor neoplasia (AGC-FN) was the subgroup of AGC with the highest malignancy rate with 62.5% (p=0.06). The incidence of malignancy in the postmenopausal group (33.3%) was detected higher than in the premenopausal group (8.3%) (p=0.07). Conclusion: The probability of malignancy in AGC-FN cytology is more commonly associated with malignancy in the postmenopausal group. Therefore, histopathologic examination is strongly recommended in these patients with AGC smears because of the high risk for malignancy in this group.

Predictors determining the status of axilla in breast cancer: Where is PET/CT on that?

PURPOSE: 18 F-FDG PET/CT has an acceptable specificity but a low sensitivity on the prediction of axillary lymph node (ALN) metastasis in breast cancer. We analyzed the factors that could possibly affect this prediction. METHODS: The records of 270 patients with T1-2 invasive breast cancer who underwent surgery, 116 of whom had been evaluated by preoperative 18 F-FDG PET/CT were reviewed. Prediction of ALN status by PET/CT according to tumor stage, estrogen receptor (ER), progesterone receptor (PgR) and HER2 status, histology, age and sentinel node properties was assessed. RESULTS: ALN metastasis was present in 62 of 131 T1 (43.7%) and 106 of 142 T2 tumors (74.6%), 20 of 46 (43.5%) ER(-) and 146 of 222 (65.8%) ER(+) tumors, 38 of 71 (53.5%) PgR(-) and 127 of 200 (63.5%) PgR(+) tumors. On multivariate analysis only the tumor size (>2 cm) independently correlated with ALN metastasis (Odds ratio/OR=3.1). None of the other parameters had statistical significance in terms of ALN prediction on FDG-PET/CT. CONCLUSION: Though T2 tumors showed increased tendency to metastasize to the axilla, prediction of ALN metastasis in preoperative FDG-PET/CT was not associated with any of the predictive factors.

Atorvastatin for ovarian torsion: effects on follicle counts, AMH, and VEGF expression.

OBJECTIVE(S): To determine if atorvastatin protects ovarian follicles against ischemia reperfusion (I/R) injury and to determine how anti-Müllerian hormone (AMH) and vascular endothelial growth factor-A (VEGF-A) expression is altered. STUDY DESIGN: This experimental study was conducted at the Baskent University Animal Research Laboratory. Forty-four rats were arbitrarily assigned into four groups of 11 rats each. The control group underwent a laparotomy. The atorvastatin group received atorvastatin (10mg/kg/day), by oral gavage 7 days before and 7 days after the sham operation. The torsion group had bilateral torsion and detorsion of the ovaries. The atorvastatin+torsion group received atorvastatin (10mg/kg/day) 7 days before and 7 days after the torsion/detorsion operation. At day 7, the animals were euthanized and their ovaries were removed. Ovarian follicles were counted, and AMH and VEGF-A expression was determined. The Kruskal-Wallis, χ(2), or Fisher's exact test were used when appropriate. RESULTS: Primordial follicles (p=0.001), VEGF-A expression (p=0.018) and vascularization (p=0.02) were significantly higher in the atorvastatin group compared to controls. Primordial (p=0.002), primary (p=0.001), and secondary follicles (p=0.001), AMH expression (p=0.001), and vascularization (p=0.001) were lower in the torsion group compared with the control group. Primordial follicles (p=0.001), AMH (p=0.001) and VEGFA expression (p=0.001), and vascularization (p=0.001) were significantly higher in the atorvastatin+torsion group compared to the torsion group. CONCLUSION(S): Atorvastatin increased the primordial follicle pool and vascularization and protected primordial follicles and vascular structures against I/R injury.

Optimization of b value in diffusion-weighted MRI for characterization of benign and malignant gynecological lesions.

PURPOSE: To explore the optimal b value in diffusion-weighted (DW)-MRI for differentiation of benign and malignant gynecological lesions. MATERIALS AND METHODS: Consecutive 58 patients (66 lesions) with pathologically confirmed diagnosis of gynecological disease were included in the study. Routine pelvic MRI sequences were used for defining the lesions and reviewed independently for benignity/ malignity. Single-shot echoplanar imaging (SH-EPI) DW-MRI with eight b values and nine apparent diffusion coefficient (ADC) maps were obtained. The lesions were analyzed qualitatively on DW-MRI for benignity/malignity on a five-point-scale and quantitatively by measurement of apparent diffusion coefficient (ADC) values. Receiver operating characteristic (ROC) analysis was used to evaluate the diagnostic accuracy of ADC values for differentiating between benign and malignant lesions. Pathology results were the reference standard. RESULTS: Differentiation between benign and malignant gynecological lesions using visual scoring was found to be successful with b values of 600, 800, or 1000 s/mm(2) . The mean ADC values of malignant lesions were significantly lower than those of benign lesions for all b value (P < 0.005). The ADCs with b = 0 and 600, 0 and 1000 s/mm(2) , 0, 600, 800 and 1000 s/mm(2) , and all b values were more effective for distinguishing malignant from benign gynecological lesions (Az = 0.851, 0.847, 0.848, 0.849, respectively). Using ADC with b = 0, 600, 800, and 1000 s/mm(2) , a threshold value of 1.20 × 10(-3) mm(2) /s permitted this distinction with a sensitivity of 83%, a specificity of 81%. CONCLUSION: DW-MRI is an important method, and the optimal b values are between 600 and 1000 s/mm(2) for differentiation between benign and malignant gynecological lesions.

A case of mucosa-associated lymphoid tissue lymphoma of the parotid gland.

Non-Hodgkin's lymphomas of the salivary glands are rare. Most of these tumors occur in the parotid gland. The most common subtype is extranodal B-cell lymphoma, which arises from mucosa-associated lymphoid tissue. A 63-year-old-woman with a painless swelling in the right parotid gland was examined with magnetic resonance imaging and fine-needle aspiration cytology. The mass was excised via superficial parotidectomy. Histological examination revealed a low-grade B-cell lymphoma originating from the lymphoid tissue associated with malignant mucosa. Lymphoma should be considered in the differential diagnosis in patients having a mass in the parotid gland and a systemic or autoimmune disease.