The Diagnostic Role of Shear Wave Elastography and Superb Microvascular Imaging in the Evaluation of Suspicious Microcalcifications.

OBJECTIVES: The aim of this study was to investigate the role of superb microvascular imaging (SMI) and shear wave elastography (SWE) in the prediction of malignancy and invasiveness of isolated microcalcifications (MC) that can be visualized by ultrasonography (US). MATERIAL AND METHODS: Sixty-seven women with MC, who were considered suspicious on mammography were evaluated. Only those lesions that could be visualized by US and presented as non-mass lesion were included. They were evaluated by B-mode US, SMI, and SWE before US-guided core-needle biopsy. B-mode US, SMI (vascular index (SMIvi)), and SWE (E-mean, E-ratio) findings were compared with histopathologic features. RESULTS: Pathology confirmed 45 malignant (21 invasive and 24 in situ carcinomas) and 22 benign lesions. There was a statistically significant difference between malignant and benign groups in terms of size (P = .015), distortion (P = .028), cystic component (P < .001), E-mean (P < .001), E-ratio (P < .001), and SMIvi (P = .006). For differentiation of invasiveness E-mean (P = .002), E-ratio (P = .002), and SMIvi (P = .030) were statistically significant. According to ROC analysis E-mean (cut-off point at 38 kPa) was the most sensitive (78%) and the most specific (95%) value among four numeric parameters (size, SMI, E-mean, and E-ratio) with AUC = 0.895, PPV = 97%, and NPV = 68% in detecting malignancy. In the evaluation of invasiveness, the most sensitive (71.4%) method was SMI (cut-off point at 3.4) and the most specific (72%) method was E-mean (cut-off point at 91.5 kPa). CONCLUSION: Our study shows that adding SWE and SMI to the sonographic evaluation of MC would be an advantage for US-guided biopsy. Including suspicious areas according to SMI and SWE in the sampling area can help target the invasive part of the lesion and avoid underestimation of core biopsy.

Microorganisms isolated from the bile of the patients who have undergone cholecystectomy and their antibiotic resistance pattern: multicenter prospective study.

BACKGROUND: Gallbladder and biliary tract infections are diseases with high mortality rates if they are not treated properly. Microbiological evaluation of perioperatively collected samples both ensures proper treatment of patients and guides empirical treatment due to the determination of microorganism susceptibility. AIMS: This study aimed to isolate the microorganisms in bile cultures from patients who underwent cholecystectomy and to determine sensitivity results of these microorganisms. METHODS: This study was a multi-center and prospective design, included 360 patients, and was performed between 2019 and 2020. Culture results of bile taken during cholecystectomy were evaluated. RESULTS: Bacterial growth was found in the bile cultures of 84 out of 360 (23.3%) patients. Patients were divided into two groups according to whether they had risk factors for resistant microorganisms or not. While Escherichia coli (n = 11, 13%), Enterococcus spp. (n = 8, 9.5%), and Enterobacter spp. (n = 4, 4.7%) were detected most frequently in patients without risk. Staphylococcus spp. (n = 17, 20.2%), Enterococcus spp. (n = 16, 19%), and E. coli (n = 8, 9.5%) were the most frequently found microorganism at-risk patients. In multivariate analysis, bile culture positivity was found higher in patients who had history of biliary disease (p = 0.004), operation performed concurrently with a cholecystectomy (p = 0.035), and high rate of polymorphonuclear leukocytes (PNL) in total leukocyte count (p = 0.001). CONCLUSIONS: Our study shows that when starting empirical antibiotic treatment for bile ducts, whether patients are at risk for the development of resistant bacterial infection should be evaluated after which antibiotic selection should be made accordingly.

The Role of Superb Microvascular Imaging and Shearwave Elastography in the Evaluation of Intraductal Papilloma-Like Lesions.

OBJECTIVES: The aim of this study was to investigate the role of quantitative values obtained by superb microvascular imaging (SMI) and shearwave elastography (SWE) in the prediction of malignancy in intraductal papilloma-like lesions (IDPL). METHODS: In the study, 61 patients between the ages of 14 to 73 years (mean age 44) diagnosed with IDPL on ultrasound (US) examination between the years 2020 and 2021 were included. The B-Mode US findings (shape, margins, size, echo pattern, and accompanying ductal dilatation), SMI vascular index (SMIvi), E-mean, and SWE-ratio values were recorded. RESULTS: There was a statistically significant difference between malignant (n = 14) and benign (n = 47) groups in terms of symptoms (P = .005), size (P = .042), shape (P = .002), margins (P = .001), echogenicity (P = .023), microcalcifications (P = .009), SMIvi (P = .031), E-mean (P < .005), and SWE-ratio (P = .007). According to receiver operating characteristic (ROC) curve analysis, sensitivity, specificity, accuracy, area under the curve (AUC), positive predictive values (PPV), and negative predictive values (NPV) were 57.1%, 87.2%, 80%, 0.722, 57.1%, 87.2% for US; 71.4%, 49%, 55.7%, 0.692, 30.3%, 85.7% for SMIvi; 85.7%, 71%, 74%, 0.864, 46%, 94.3% for E-mean, and 50%, 75.4%, 83%, 0.707, 91.5%, and 50% for SWE-ratio, respectively. Best results were obtained when SMI and SWE values were used together, achieving a sensitivity, specificity, accuracy, AUC, PPD, NPD of 78.6%, 93.6%, 93.4%, 0.872, 91.7%, and 93.9%, respectively. CONCLUSIONS: The SMI and SWE examinations are successful in the differentiation of benign and malignant intraductal lesions. They complement each other and contribute to B-mode US in managing IDPLs especially when used together. Our study is the first to compare the quantitative data of SWE and SMI in the differentiation of IDPLs.

Idiopathic granulomatous mastitis: introducing a diagnostic algorithm based on 5 years of follow-up of 152 cases from Turkey and a review of the literature.

PURPOSE: The goals of this study were to report our clinical experience in a single center at a high-volume tertiary university hospital in Istanbul and to introduce a diagnostic algorithm based on a 5-year follow-up of 152 women with biopsy-proven idiopathic granulomatous mastitis (IGM). IGM is an uncommon, non-malignant, chronic inflammatory disease of the mammary gland with an unknown etiology. The symptoms, clinical presentation, and radiologic findings of IGM may resemble carcinomas. To our knowledge, this study comprises the largest series of IGM, especially with a 5-year follow-up, yet reported in the English literature. METHODS: The present study reported our single-center clinical experience at a tertiary university hospital in Istanbul, Turkey, and introduced a diagnostic algorithm using our treatment protocol based on a 5-year follow-up of 152 women with biopsy-proven IGM. Our database of 10 years' experience containing over 700 patients with IGM was evaluated. However, to assess recurrence and resistance to treatment, only the 152 patients with a long follow-up period of 5 years were included in the study group. The analysis included 152 women with biopsy-proven IGM who were treated between January 2009 and March 2014. The clinical data of the presentation, histopathology, and treatment modalities were analyzed by reviewing the medical records. RESULTS: Of the 152 patients diagnosed with granulomatous mastitis, 32 (21%) recovered by expectant management, while 14 (9%) responded to antibiotics, 65 (43%) received corticosteroids, 20 (13%) had antituberculosis medication, 16 (11%) underwent excision, and 5 (3%) responded to non-steroidal anti-inflammatory drugs. Fifty-one patients (33%) had recurrence; of these, 30 achieved a cure with second-line treatment, 16 underwent excision, and 5 achieved a cure with observation. CONCLUSION: IGM is a rare benign breast disorder, and clinicians need a high index of suspicion to diagnose it, as IGM can be mistaken for breast cancer. Unlike periductal mastitis, IGM does not evolve secondary to nicotine addiction and is typically seen in women of childbearing age with a recent history of pregnancy and lactation. The diagnosis can be challenging, and an evaluation with a multidisciplinary team is necessary. There is no consensus concerning the definitive treatment approach. We suggested a diagnostic algorithm in the present study, using our treatment protocol based on the 5 years' follow-up of 152 women.

The effect of methotrexate monotherapy on treatment-resistant idiopathic granulomatous mastitis patients.

BACKGROUND: Idiopathic granulomatous mastitis (IGM) is a disease of unknown etiology, involving a chronic inflammatory process, characterized by noncaseating granuloma formation. IGM can mimic a tumor clinically and radiologically. Since we are a tertiary referral center, most of our patients (n = 56, 87.5%) are secondary admissions who have previously had antibiotics and steroid treatments; therefore, we accept these patients as resistant cases. Here, we aim to present our single-center series of 64 patients with resistant IGM who underwent methotrexate monotherapy. To the best of our knowledge, our study includes the highest number of patients described in the literature with IGM who have undergone this treatment. METHODS: This study included 64 patients, 56 of which were resistant cases, diagnosed with IGM between January 2013 and January 2020 at Istanbul University Cerrahpasa, Cerrahpasa Medical Faculty, General Surgery Breast Outpatient Clinic that were followed-up at least once. These patients were administered oral methotrexate monotherapy 15 mg/week for 24 weeks, and in relapsed cases, the treatment was up to 20 mg/week for 1 year. Folic acid 10 mg/week was given as a supplement to all patients. RESULTS: Complete recovery was observed in 52 (81.25%) of the 64 patients. Follow-up was discontinued by 4 patients. The dose was increased and the duration of treatment was extended up to 1 year when relapse was observed in 8 patients and complete response was then obtained in these cases. Only 3 patients (4.69%) experienced side effects and were switched to subcutaneous treatment due to nausea. CONCLUSION: Considering the high patient compliance, low recurrence, minimal side effects, and overall success of the treatment, we believe that methotrexate monotherapy may be used in treatment-resistant IGM patients and may also be the first choice for first-line treatment in the future.

Use of volumetric CT scanning to predict tumor staging and survival in pancreatic cancer patients that are to be administered curative resection.

BACKGROUND: This study evaluates the achievability of CT volumetry of pancreatic cancer and its correlation with pTNM stage and survival. METHODS: Tumor volume was measured from contrast enhanced CT images of 58 patients who undergo curative resection for pancreatic cancer using the Segment Editor module implemented in 3D-Slicer-a free open source software platform. Receiver operating characteristic (ROC) analysis was used to evaluate correlation between Tvol and pTNM staging. RESULTS: The preoperative images of 58 pancreatic adenocarcinoma patients were included. The mean Tvol of pancreatic cancer is an increasing trend with T stage (The mean T1vol = 1.75 cm3 , the mean T2vol = 11.43 cm3 , the mean T3vol = 14.98 cm3 , the mean T4vol = 19.6 cm3 ). There were statistical differences between volumes (p = .000). On ROC analysis, the area under the ROC curve (Az) of Tvol to differentiate T1 stage from ≥T2 stage was 0.966 (p = .000). At a cut-off value of 3.050 cm3 , sensitivity of 92.3%, and specificity of 83.3% were achieved. Az value of Tvol to differentiate ≤T2 from ≥T3 stage was 0.750 (p = .010). At a cut-off value of 10.250 cm3 , sensitivity of 72.7% and specificity of 66% were achieved. In addition Az value of Tvol to differentiate ≤T3 from ≥T4 stage was 0.652 and was not significant (p = .380). At a cut-off value of 11.2 cm3 , sensitivity of 66.7% and specificity of 63.6% were achieved. CONCLUSION: CT volumetry in pancreatic cancer is feasible with excellent reproducibility. It is one of the prognostic factors affecting survival in operated patients with pancreatic cancer.

Preoperative Fibrinogen and Hematological Indexes in the Differential Diagnosis of Idiopathic Granulomatous Mastitis and Breast Cancer.

Background and Aim: Studies on hematological parameters in the differential diagnosis of idiopathic granulomatous mastitis (IGM) and breast cancer (BC) are limited. This study investigated whether preoperative fibrinogen and hematological indexes can be used in the differential diagnosis of patients with IGM and early-onset BC. Methods: Fifty patients with BC, 55 patients with IGM, and 50 healthy volunteer women were included in the study. Results: There was a statistically significant difference between the IGM and the BC with respect to fibrinogen, fibrinogen/albumin (Fib/Alb) ratio, C-reactive protein (CRP), white blood cells (WBC), neutrophils, neutrophil-lymphocyte ratio (NLR), platelet-lymphocyte ratio (PLR), and monocyte values. When fibrinogen (p < 0.001), the Fib/Alb ratio (p < 0.001), CRP (p < 0.001), WBC (p < 0.001), neutrophil (p < 0.001), NLR (p < 0.001), monocyte (p = 0.008), and 2-hour sedimentation rate (p < 0.001) were compared between the groups, the highest levels were found in the IGM group. There was a negative relationship between CRP and albumin, and a positive relationship was observed between CRP and WBC, NLR, PLR, and 2-h sedimentation rate. CRP had the highest sensitivity (95%), whereas the Fib/Alb ratio (86%) had the highest specificity. Patients with recurrent IGM had increased fibrinogen, Fib/Alb, CRP, neutrophils, NLR, and 2-h erythrocyte sedimentation rate (ESR) and decreased lymphocyte levels compared to non-recurrent patients. Conclusions: Preoperative CRP, albumin, fibrinogen, Fib/Alb, WBC, neutrophil, NLR, monocyte, and 2-h ESR have considerable potential to be early and sensitive biomarkers of IGM caused by inflammation compared to BC. These parameters also have a significant effect on the recurrence of the disease, suggesting their potential as a practical guide for the differential diagnosis of BC from IGM.

Sequential analysis of single-center experience of living donor kidney transplants with several vascular anastomosis techniques

Background and aim: Vascular variations of grafts are handled with various reconstruction techniques in renal transplantation. We aimed to analyze the effects of these reconstruction techniques and sites on patient/graft outcomes. Materials and methods: Renal transplantation cases at the Transplantation Unit of the General Surgery Department, Istanbul Uni- versity Cerrahpasa Medical Faculty between January 1st, 2000 and December 31st, 2012 were analyzed retrospectively. Postoperative duplex ultrasound results, urea-creatinine reduction rates, and complications were evaluated. Results: There were 228 living-donor transplantation cases evaluated. For single-renal-artery living-donor transplantations, there were 45 end-to-side external iliac artery, 15 end-to-side internal iliac artery, 152 end-to-end internal iliac artery, and 3 end-to-side common iliac artery anastomoses performed. In cases with double-arteries, 3 had end-to-side external iliac artery anastomoses, and 10 had end- to-end internal iliac artery anastomoses. No statistically significant differences were found between reconstruction techniques with regard to complications or urea-creatinine reduction rates. Conclusion: Internal, external, and common iliac arteries can be safely used for anastomoses. The presence of more than one renal artery creates no short or long-term problems when a side-to-side anastomosis is initially performed.

The Effect of Menstrual Cycle Phase on the Prognostic Factors in Patients with Premenopausal Breast Tumors.

Background: Estrogen receptor and progesterone receptor positivity and c-erbB2 gene expression levels are important in determining breast cancer development and aggression. Although the importance of hormonal factors in tumor cell proliferation, migration and differentiation is increasing, it needs more evidence. The effect of BC surgery timing during the menstrual cycle on prognosis remains controversial. In order to clarify this hypothesis, we aimed to determine the importance of adjusting the timing of surgery according to the menstrual cycle by examining the relationship between estrogen receptor, progesterone receptor, c-erbB2 gene and the menstrual cycle phase in patients with premenopausal breast cancer. Method: Our study was designed retrospectively. 50 patients with premenopausal breast cancer who were operated were included in the study. Results: Our results showed that the patients in the luteal phase had higher ER positivity, PR positivity and c-erbB2 negativity, and the number of metastatic axillary lymph nodes was lower than the patients in follicular phase. Conclusions: BC surgery during the luteal phase in pre-menopausal women is associated with a better clinical outcome. Although larger-scale studies are needed, our results suggest that better results can be achieved by performing surgery in luteal phase in BC patients during premenopausal period.

The effect of preoperative 18F-FDG PET on the surgical decision in early breast cancer: 5-Year follow-up.

OBJECTIVE: The diagnosis, treatment, and management of the breast cancer (BC) require a multidisciplinary approach. In newly diagnosed BC, fluorine-18-fluorodeoxyglucose positron emission tomography (18F-FDG PET) can detect extra-axillary regional nodal and distant lesions. SUBJECTS AND METHODS: Between 2010 and 2015, this study included 101 patients with early-stage BC who were examined with 18F-FDG PET before surgery. Patients were divided into two groups: Group 1 consisted of patients with suspected 18F-FDG uptake and Group 2 with the remaining 18F-FDG-negative patients. Differences between these groups were tested using the Pearson chi-square test, Fisher's exact test, Mann Whitney-U test, independent t-test and ROC analysis. They could be followed-up after 2015 for 5 years. All patients were then rediscussed either neoadjuvant therapy or surgery in the oncology board in 2020 with changing neoadjuvant criteria and oncoplastic surgery techniques. RESULTS: Fluorine-18-FDG PET was found to have a sensitivity of 77.8% and a specificity of 90.8% in detecting axillary lymph node metastasis. During the minimum 5-year follow-up, one patient had bone metastasis, 2 patients had a local recurrence, and 3 patients had metastatic lymph nodes in the axilla. In the re-evaluation of the same patients over 5 years, the decrease in mastectomy decision was remarkable (P-value 0.01). CONCLUSION: We observed that we could not achieve a significant difference in 5-year metastasis/recurrence between the groups. Moreover, due to 18F-FDG-PET high false positivity, it significantly extended the time to surgery (P-value 0.01). In early-stage BC, 18F-FDG PET demonstrated better performance in axillary lymph nodes metastases detection in comparison with other diagnostic imaging methods, even if SLNB remains the gold standard technique.

Ex Vivo Assessment of Sentinel Lymph Nodes in Breast Cancer Using Shear Wave Elastography.

OBJECTIVES: Axillary lymph node status is one of the important prognostic factors in early-stage breast cancer. Despite the combined use of sonography, fine-needle aspiration, and sentinel lymph node (SLN) dissection, there is a gap between the potential effectiveness of those techniques and current success to determine the axillary lymph node status. The main aim of this study was to evaluate the baseline accuracy of shear wave elastography for differentiation of benign versus malignant SLNs in an ex vivo artifact-free environment. METHODS: Thirty patients with breast cancer scheduled for SLN dissection were enrolled prospectively after informed consent and Institutional Review Board approval were obtained. After dissection, lymph nodes were embedded in ultrasound gel and examined with grayscale sonography and shear wave elastography. Findings were compared to histopathologic results. RESULTS: A total of 64 SLNs obtained from the 30 patients were evaluated. Twelve of them (18.8%) were metastatic, and 52 (81.2%) were benign. The mean cortical thickness (benign versus metastatic, 1.6 versus 4.4 mm), short-axis length (4.63 versus 7.50 mm), cortical stiffness (10.7 versus 25.5 kPa), and hilar stiffness (7.5 versus 11.3 kPa) were statistically higher in metastatic lymph nodes (P ≤ .02). Area under the receiver operator characteristic curve values for these variables were 0.814, 0.768, 0.786, and 0.759, respectively. Cortical thickness was found to have the highest diagnostic performance, followed by cortical stiffness. CONCLUSIONS: Shear wave elastography can be used with grayscale sonography for evaluation of cases to decide on needle biopsy sampling. However, it cannot be used as a replacement for fine-needle aspiration or SLN dissection.

Sentinel lymph node biopsy under fluorescent indocyanin green guidance: Initial experience.

OBJECTIVE: Sentinel lymph node biopsy can be applied by using either blue dye or radionuclide method or both in breast cancer. Fluorescent imaging with indocyanine green is a new defined method. This study evaluates the applicability of sentinel lymph node biopsy via fluorescent indocyanine green. MATERIAL AND METHODS: IC-VIEW (Pulsion Medical Systems AG, Munich, Germany) infrared visualization system was used for imaging. Two mL of indocyanine green was injected to visualize sentinel lymph nodes. After injection, subcutaneous lymphatics were traced and sentinel lymph nodes were found with simultaneous imaging. Sentinel lymph nodes were excised under fluorescent light guidance, and excised lymph nodes were examined histopathologically. Patients with sentinel lymph node metastases underwent axillary dissection. RESULTS: Four patients with sentinel lymph node biopsy due to breast cancer were included in the study. Sentinel lymph nodes were visualized with indocyanine green in all patients. The median number of excised sentinel lymph node was 2 (2-3). Two patients with lymph node metastasis underwent axillary dissection. No metastasis was detected in lymph nodes other than the sentinel nodes in patients with axillary dissection. There was no complication during and after the operation related to the method. CONCLUSION: According to our limited experience, sentinel lymph node biopsy under fluorescent indocyanine green guidance, which has an advantage of simultaneous visualization, is technically feasible.

Clinical Application of Six Current Classification Systems for Iatrogenic Bile Duct Injuries after Cholecystectomy.

BACKGROUND/AIMS: Due to being a severe complication, iatrogenic bile duct injury is still a challenging issue for surgeons in gallbladder surgery. However, a commonly accepted classification describing the type of injury has not been available yet. This study aims to evaluate ability of six current classification systems to discriminate bile duct injury patterns. METHODOLOGY: Twelve patients, who were referred to our clinic because of iatrogenic bile duct injury after laparoscopic cholecystectomy were reviewed retrospectively. We described type of injury for each patient according to current six different classifications. RESULTS: 9 patients underwent definitive biliary reconstruction. Bismuth, Strasberg-Bismuth, Stewart-Way and Neuhaus classifications do not consider vascular involvement, Siewert system does, but only for the tangential lesions without structural loss of duct and lesion with a structural defect of hepatic or common bile duct. Siewert, Neuhaus and Stewart-Way systems do not discriminate between lesions at or above bifurcation of the hepatic duct. CONCLUSION: The Hannover classification may resolve the missing aspects of other systems by describing additional vascular involvement and location of the lesion at or above bifurcation.

Corticosteroid treatment in the management of idiopathic granulomatous mastitis to avoid unnecessary surgery.

PURPOSE: Idiopathic granulomatous mastitis (IGM) is a rare benign inflammatory disease of the breast. It can mimic breast carcinoma clinically and radiologically, and usually affects females of childbearing age. There is no commonly accepted optimal treatment for IGM. In this study, we present the clinical and histopathological features and outcomes of the therapeutic management of IGM, as well as the clinical course of the disease when patients were treated with oral corticosteroids. METHODS: This retrospective study included 49 of 87 patients who met the required histological criteria for IGM who were followed up between January 2009 and December 2011. All patients had a disease-free follow-up period of at least 6 months. The data regarding the clinical features at presentation, laboratory values and the treatment modalities were obtained from the medical records of the patients. RESULTS: The mean age of the patients was 34.3 ± 4.37 years. Forty patients were treated with prednisolone, five were started on antituberculosis treatment, two received non-steroidal anti-inflammatory drugs, one received antibiotics and one underwent wide excision. All patients who received steroids responded well to the therapy. CONCLUSION: Systemic therapy with corticosteroids is an effective and appropriate treatment option for IGM. It can provide complete disease resolution and prevent recurrence in the long term. A multidisciplinary approach including specialists in the fields of both general surgery and infectious diseases is essential for the diagnosis, treatment and follow-up of IGM.

Diagnostic value of terminal ileum biopsies in patients with abnormal terminal ileum mucosal appearance.

OBJECTIVE: To investigate the necessity of obtaining routine ileal biopsy during colonoscopy in the patients with abnormal terminal ileum mucosal appearance if the inflammatory bowel disease is not considered. MATERIAL AND METHODS: A retrospective analysis was performed for 57 patients who were referred to a private hospital for colonoscopy between January 2008 and February 2009, in whom terminal ileum intubation was achieved and an abnormal appearance was observed. RESULTS: There were 33 men and 24 women; the mean age was 44.12±11.42 years. In 22 patients, the abnormality was ulcers and/or erosions. In 10 patients, there were mucosal nodularity and in 24, the finding was erythema. The time to reach to ileum from cecum was 28.78±24.30 s. The mean length of the examined ileum was 12.93±6.05 cm. There was no difference between groups according to distance covered in the ileum for diagnostic yield, but going further than 2 cm was important. CONCLUSION: There should be no need to obtain routine biopsy in patients with abnormal terminal ileum mucosa appearance, when inflammatory bowel disease is not considered. In these patients, histopathology also reveals non-specific ileitis. Furthermore, in these patients, the macroscopic pathological diagnosis overlaps the histopathology, and it has a low diagnostic yield and lower clinical significance.

Small bowel intussusception in a pregnant woman with Peutz-Jeghers Syndrome.

Intussusception is the most frequent complication of Peutz-Jeghers Syndrome (PJS), but usually seen in child age. It is a predictable, but infrequent complication in adults with PJS. However, there is no report about intussusception in pregnancy period secondary to Peutz-Jeghers (PJ) polyps in the literature. In this paper, we present a rare intussusception case in a pregnant woman with PJS, which was diagnosed with magnetic resonance imaging, and discuss this condition with a brief literature review.

A case report of primary breast angiosarcoma causing hemorrhagic shock in pregnancy.

Angiosarcoma is a rare breast tumor. In contrary to other breast tumors, primary breast angiosarcomas are seen in the third and fourth decades. Clinically, they present as rapidly growing masses. They can also be seen during pregnancy. The aim of this article is to report on a primary breast angiosarcoma case that occured during pregnancy and resulted in hemorrhagic shock.

Clinical significance of serum synaptophysin-like 1 protein levels in breast cancer.

Background: Mammography, used for breast cancer (BC) screening, has limitations such as decreased sensitivity in dense breasts. Currently used tumor markers are insufficient in diagnosing breast cancer. In this study, we aimed to investigate the relationship between serum levels of synaptophysin-like protein 1 (SYPL1) and BC and compare SYPL1 with other blood tumor markers. Methods: The study group consisted of 80 female patients with a histopathological diagnosis of invasive BC who received no radiotherapy/chemotherapy. The control group was 72 women with no previous history of breast disease and evaluated as Breast Imaging Reporting and Data Systems (BI-RADS 1-2) on imaging. Serum SYPL1, cancer antigen 15-3 (CA 15-3), and carcinoembryonic antigen (CEA) were measured in both groups.

The effect of hormone receptor status on surgical margin in patients undergoing breast conserving surgery.

AIM: Our aim is to identify the subgroups of women undergoing breast conserving surgery (BCS) who are at high risk for positive surgical margins and who require a re-excision procedure and understand the characteristics of tumor and hormone receptors that will allow surgeons to remove larger margins. MATERIAL AND METHODS: One hundred twenty-nine patients with invasive carcinoma in breast who underwent BCS were included in the study. Women with a positive surgical margin (n = 61) required re-excision procedure. RESULTS: Patients with high grade breast cancer, negative hormone receptor status, high Ki-67 status, upper outer quadrant tumor, and associated ductal carcinoma were more likely to undergo tumor removal and re-excision. CONCLUSION: The pathological and clinical predictors described above that meet these criteria require the removal of larger margins for safety in order to minimize the rate of positive surgical margins. KEY WORDS: Estrogen Receptor, Hormone receptor status, Positive surgical margin.