Pediatric Giant Cerebral Candida Abscess: A Case Report.

Fungal infections of the central nervous system and pediatric brain abscess are rare but serious conditions in terms of morbidity and mortality that need immediate diagnosis and treatment. It can be seen in congenital or acquired immunosuppressed patients as opportunistic infections as well as in low-birth-weight, premature infants with ventriculoperitoneal shunt, external ventricular drainage, or with a history of craniotomy. Our aim is to emphasize the giant cerebral Candida abscess of a 13-month-old female infant who previously had eight ventriculoperitoneal shunt operations due to hydrocephalus. The patient was taken to pediatric emergency care with complaints of feeding difficulty and discomfort and was hospitalized due to the detection of an intracranial mass by contrast-enhanced brain tomography. After total excision of the mass with its capsule, the patient was pathologically diagnosed with Candida abscess, and the treatment was started. The patient was discharged by the end of the 6th week.

Predictors of Survival in Turkish Patients with Primary Glioblastoma.

AIM: An increasing number of biomarkers of primary glioblastoma (GBM) have recently been described. We aimed to investigate the biological and clinical factors that affect survival in Turkish patients with primary GBM. MATERIAL AND METHODS: The clinical and demographic data of all patients with primary GBM diagnosed between 2007 and 2016 were evaluated. In all the patients? pathological specimens, O6 methylguanine-DNA methyltransferase (MGMT) methylation and isocitrate dehydrogenase (IDH) 1 mutation were detected retrospectively by immunohistochemistry. Kaplan-Meier survival analysis, log-rank test, and multivariate analyses of the Cox hazard proportional model for all the variables were performed using the SPSS statistical package. The treatment details and other patient-related factors were identified, and their correlations were analyzed. RESULTS: We enrolled 137 primary GBM patients to the study. Median progression free survival (PFS) was 8.57 months (95% CI:6.8-9.5) and median overall survival (OS) was 12 months (95% CI:10.8-13.3). IDH-1 mutations were detected in 21 primary GBMs (15.3%). PFS was 15.43 ± 1.95 months. Survival rates were higher, but no statistically significant difference (p=0.074). MGMT methylation was detected in 40 primary GBMs (29.2%). OS and PFS of MGMT (+) cases were higher than MGMT(-) cases (p=0.001; p=0.001 respectively). Ki67 (%) measurement (10%-90%) average is 32.64 ± 16.56. No statistically significant between higher and lower ki67 levels (p=0.510, p=0.505 respectively). KPS (%) more than 70 at the time of diagnosis statistically significant longer median OS and PFS (p=0.001). PFS and OS were higher in all treatment modalities. CONCLUSION: The most important factors that affected survival were performance score, MGMT methylation status, systemic oncologic therapy, and IDH mutation in the Turkish population with primary GBM. We demonstrated that MGMT methylation and higher KPS levels were associated with significiantly longer OS and PFS.

Extracranial Metastasis of IDH-1 Wild Type Glioblastomas.

AIM: To identify the effects of different immunohistochemical features of glioblastomas with spinal metastases based on the metastatic spread and survival rate. MATERIAL AND METHODS: A total of 214 patients who were diagnosed with and operated for brain tumor in our clinic between 2007 and 2018, and pathologically diagnosed with glioblastoma were retrospectively evaluated. Among them, 141 medical records were reviewed, and 23 of them underwent spinal magnetic resonance imaging postoperatively due to various complaints. RESULTS: All patients with glioblastoma with spinal metastases had negative isocitrate dehydrogenase 1 (IDH-1) in the immunohistochemical examination. The incidence of spinal metastasis is 1.91%. The median Ki-67 index is 30 (range, 4-90; median Ki-67 index: 30+/-18.5). IDH mutation is wild in 55%, mutant in 33%, and not otherwise specified in 12%. Four patients with spinal metastasis has wild-type IDH with mean Ki-67 index of 60, and one of them was a woman (25%) and the remaining three were men (%75), with mean age of 32 years. CONCLUSION: Gliomas with high immunohistochemical proliferation indexes and wild-type IDH with poor prognostic features based on the new classification tended to metastasize to the spine in the early disease stage; therefore, early spinal scanning and radiation therapy might extend the life expectancy. High Ki-67 index and the presence of wild-type isocitrate dehydrogenase may be the predictive factors for spinal screening.

Assessment of Factors Influencing Lymph Node Count in Colorectal Cancer.

OBJECTIVE: To evaluate the factors that influence pericolorectal lymph node (LN) retrieval from colectomy specimens in colorectal in cancer staging. STUDY DESIGN: Descriptive study Place and Duration of Study: Ortadogu Private Hospital Adana, Turkey, between January 2012 and March 2018. METHODOLOGY: The inclusion criteria was right hemi-colon, left hemi-colon and rectum carcinoma specimen, respectively. The exclusion criteria was total colectomies due to synchronous colorectal carcinomas and cancers developed on the basis of ulcerative colitis and familial polyposis coli. Age and gender of the patients, the length of the colectomy specimen, the location and size of the tumor-node-metastasis (TNM) stage, and the count of retrieved lymph nodes were evaluated. RESULTS: Among the 145 patients in this study, the mean count of recovered and metastatic lymph nodes was 32.5 and 2.9, respectively. Sufficient lymph node assessment was done in 130 of the 145 patients. The number of lymph node yields was independently associated with depth of invasion, T-classification, tumor size, AJCC/UICC stage as well as right-sided tumor location. The count of harvested lymph nodes significantly decreased in patients who received preoperative therapy. Increased node counts were associated with increased overall survival (OS). CONCLUSION: Tumor site and size, length of the surgical specimen, T-classification, depth of invasion and AJCC/UICC stage are predictors for the lymph node numbers in colorectal cancer surgery. Retrieval of removed nodes and counting helps in staging and number of removed nodes, and affects survival.

Prognostic Value of CDX2 and Villin Expression in Advanced Stage Colorectal Carcinoma.

OBJECTIVE: To determine the frequency of expression of CDX2 and Villin in a subsection of advanced stage primary colorectal cancers and detect its association with tumour differentiation, lymph node metastasis, invasion and survival. STUDY DESIGN: A descriptive study. PLACE AND DURATION OF STUDY: Ortadogu Private Hospital, Adana, Turkey, from January 2012 to March 2017. METHODOLOGY: Formalin-fixed, paraffin-embedded tissue specimens were obtained from 70 patients who underwent surgery for colorectal carcinoma. Inclusion criteria were patients who underwent surgery with stage 3 and stage 4 colorectal cancer. The exclusion criteria were patients who had recurrent colorectal cancer and/or accompanying cancer in another region. Immunohistochemical technique was used for the localisation of CDX2 and Villin in colorectal cancer tissues. The catagorical variables between the groups was analysed by using the Chi-square test or Fisher Exc. test. Overall survival time was defined as the years elapsed between date of after operation and death as a result of disease (or the last follow-up date). Overall survival was analysed using the Wald test, and the log-rank test was used to examine their relationship when different parameters were applied. The survival curve was plotted using the standard Kaplan-Meier methodology. Values of p <0.05 were considered statistically significant. RESULTS: Both CDX2 and Villin had relation with gender (p=0.045, p=0.016), male and female expression of CDX2 was n=31 (67.4%), n=15 (32.6%), respectively and Villin was n=34 (68.0%), n=16 (32.0%), respectively; age (p=0.804, p=0.791), had no relation with tumor site (p=0.131, p=0.921) and histologic grade (p=0.209, p=0.579) and lymph node metastasis (p=0.063, p=0.392) and perineural invasion (p=0.476, p=0.053) and lymphovasculer invasion (p=0.080, p=0.791) and overall survival ( p=0.121, hep=0.059). CONCLUSION: CDX2 and Villin were not associated with any of the clinicopathologic parameters. Overall survival analysis also did not show a significant association with immunoexpression of these molecules and survival. CDX2 and Villin might not be useful as a prognostic factor in advanced stage colorectal carcinoma.

Periosteal chondroma of the ischium; an unusual location.

Periosteal chondroma is a rare benign tumor of hyaline cartilage. Periosteal chondroma arising in the ischium is an extremely rare event. By presenting this case report, we aim to remind that differential diagnosis of these lesions should be carefully performed especially for unusual locations. A 51-year-old man visited the orthopedics clinic with the complaints of left pelvic mass and pain lasting about one year. Computed tomography showed a solid mass with abundant specks of calcification that was 4x5 cm in diameter and associated with the ischium of the left pelvic bone. There was no evidence of penetration into the medullary cavity and cortical sclerosis. No radiological aggressive appearance was observed. The lesion was removed with the covering periosteum. Microscopically, there were lobules of hyaline cartilage composed of chondrocytes with foci of endochondral ossification and calcification. The case was reported as 'periosteal chondroma'. In conclusion, this case report presents a case of periosteal chondroma, a rare tumor, which occurred in an unusual location and age range. The differential diagnosis of periosteal chondroma from malignant lesions is necessary for avoiding aggressive and inappropriate treatment.

Coexistence of acral syringomas and multiple trichoepitheliomas on the face.

BACKGROUND: An extremely rare variant of syringoma is an acral form, which affects the upper extremities as an isolated finding. The acral syringomas may also be associated with syringomas on the feet or usual distribution around the eyelids. Of the eight previously documented cases of acral syringomas, all were located on the dorsal aspect of the upper extremities (fingers, hand, wrist, or forearm) dominantly. OBJECTIVE: We report a 41-year-old woman who presented with multiple flesh-colored to reddish brown papules on the inner aspect of the forearms and many pearly, small papules on the periorbital regions. RESULTS: The clinical picture and histopathology indicated the coexistence of acral syringomas and multiple trichoepitheliomas on the face. CONCLUSION: To the best of our knowledge, this is the first case of acral syringomas coexisting with multiple trichoepitheliomas.

[Problem of cystic echinococcoss in Hatay]. / Hatay Ili'nde Kistik Ekinokokkozis Sorunu.

Echinococcosis is a zoonotic infection caused by Echinococcus granulosus and E. multilocularis. It continues to be a serious public health problem in many countries including Turkey. In Hatay, no previous study has been carried out; therefore, in this study, in order to determine its prevalence and to attract scientific attention to this issue, we have retrospectively evaluated cases of cystic echinococcosis in human patients presenting at the pathology laboratory of the Mustafa Kemal University, Faculty of Medicine, Research Hospital, as well as Antakya and Iskenderun State Hospitals. We have identified a total of 26 cases, of which 18 were in female patients (69.23%) and 8 in male patients (30.76%). The highest rate of cystic echinococcosis was found in the liver (57.6%), and lungs (19.23%). It was also found in the peritoneal region, spleen, cervical region, muscle, and an incision scar. In addition, the presence of cystic echinococcosis was investigated in 35,812 cattle slaughtered in Antakya slaughterhouse and 5,448 (3.23%) were found to have cystic echinococcosis.