Evaluation of blood supply and metabolism in tumor, axillary lymph node and normal breast tissue with F-18 FDG PET/CT in breast cancer: comparison with pathological prognostic factors.

BACKGROUND AND PURPOSE: Perfusion parameters obtained in F-18 FDG PET/CT performed for staging purposes in breast cancers may provide additional information about tumor biology as well as glucose metabolism. The aim of this study was to evaluate throughout F-18 FDG PET/CT the relationship between blood flow and glucose metabolism and histological parameters of the primary tumor, normal mammary gland, and axillary lymph nodes in breast cancer patients. MATERIALS AND METHODS: Sixty six female patients (mean age 51 y ± 12,81) were prospectively included to this study. We performed dynamic blood flow (f) study that started with 296-444 MBq (8-12 mCi) F-18 FDG injection and lasted for 10 minutes, and glucose metabolism (m) imaging one hour later. On each frame, mean activity concentration (AC) values (Bq/mL) were recorded on a spherical volume of interest (VOI) having a volume of ~ 1 cm3 on the hottest voxel of primary tumor (T), across normal breast gland (NG) and ipsilaterally axillary lymph nodes (iLN). Correlations among PET parameters and estrogen receptor (ER), progesterone receptor (PR), human epidermal growth factor receptor 2 (c-erbB2) and Ki67 index were analyzed. RESULTS: T volume (TV) ranged from 1.1 to 85.28 cm3 [median (IR): 6.44 (11.78)]. There were positive correlations between c-erbB2 and TACf and between c-erbB2 and iLNACf (p = 0.045, r = + 0.248; p = 0.050, r = + 0.242). In the ER positive (ERP) patients, TV and TACm were significantly lower than those of ER negative (ERN) (respectively p = 0.044 and p = 0.041). In patients with two positive Ki-67 indices, iLN-SUVmax was significantly higher than one-positive patients (p = 0.020). There was a negative correlation between NGACm and histological grade of tumor (p = 0.005, r = - 0.365). CONCLUSIONS: Breast cancer shows differences in progression, metastasis and survival due to its diversity in terms of molecular, biological and angiogenesis. High glucose metabolism in breast cancers is associated with tumor aggressiveness. Being able to examine tumor tissue characteristics such as blood flow and glucose metabolism with a single diagnostic technique and to reveal its relationship with histological parameters can provide a reliable pretherapeutic evaluation in breast cancers.

Long-term Results of Low Grade Appendiceal Mucinous Neoplasm (LAMN): A Retrospective Analysis of 24 Patients.

BACKGROUND: Appendix tumors are rare tumors found in the gastrointestinal tract, observed at a rate of about 0.2%-0.3%. Our aim in this study was to present the clinicopathological classification, treatment and long-term prognosis of patients with low grade appendiceal mucinous neoplasm (LAMN). METHODS: Patients who underwent surgery in the Erciyes University Department of (Kayseri, Turkey), Department of General Surgery between December 2010 and December 2018, and who had LAMN as a result of pathology were included in our study. Demographic data, clinical and pathological features of the disease, their treatment and follow-up results after treatment were reviewed retrospectively. RESULTS: We included 24 patients in the study. Of these patients, 10 (41.6%) were male. The mean age distribution was 56.4 ± 20.3 (21-91) years. Appendectomy was performed in 14 patients, and additional organ resections were performed in 8 patients. The most common symptom at the time of presentation was abdominal pain (79.1%; 95% CI, 58.3-91.7). The most common preliminary diagnosis in the preoperative period was acute appendicitis (50%; 95% CI, 29.2-70.8). Mean postoperative hospitalization time was 7.4 ± 7.96 (2-31) days. On pathological examination, appendectomy resection margins were positive in two patients. The mean (median) postoperative follow-up was 31.25 ± 23.9 (27) (1-90) months. One-year survival was 91.6%, and 5-year survival was 83.3%. Recurrence was detected in three patients during the follow-up period. CONCLUSION: If appendix mucinous neoplasia (AMN) is suspected in patients undergoing surgery with an initial diagnosis of acute or plastron appendicitis, care should be taken to remove the lesion without perforation. Pseudomyxomaperitonei, which may develop as a result of perforation, is associated with recurrence and decreased survival.

Is Histopathological Evaluation of Hernia Sacs Necessary?

BACKGROUND: Our aim was to investigate the pathologies in the hernia sac in adults, and the frequency of malignancy as well as to confirm the necessity of maintaining the current applications in histological examination of the hernia sac. METHODS: Patients who were operated for hernia in our clinic from 2013 to 2019 were included in the study. Patient data were evaluated retrospectively. We divided the patients into four groups, according to the type of hernia. We evaluated the demographic characteristics of the patients, the pathologies within the hernia sac, histopathological examination outcomes of the hernia sac and clinical features of malignancy in patients with malignancy. RESULTS: A total number of 556 adult patients underwent inguinal, femoral, umbilical or incisional hernia repair in our hospital. Nine patients (0.61%) had malignancy in the hernia sac. Three out of nine patients (33%) had no preoperative diagnosis of malignancy. Six patients (67%) had a known history of malignancy. Two tumors were located in the inguinal (22.0%), six tumors in the incisional (67%), and one in the umbilical (11%) hernia sacs. Among these, 56% were of gastrointestinal, 22% of gynecological, 11% of breast and 11% of epididymis origin. Most of the other pathologies found in the hernia sac were herniated bowel segments, lipomas and omentum. CONCLUSION: Since the hernia sac might be the first clue for an underlying cancer, if abnormal pathological findings are detected during surgery, histopathological examination should be performed to exclude malignancy. The purpose of histological examination is to detect a hidden malignancy.

Surgical Trends in Breast Cancer in Turkey: An Increase in Breast-Conserving Surgery.

PURPOSE: Breast cancer is the most frequent cancer in women, and there is a great variability in surgical practice for treating that cancer in different countries. The aims of this study were to analyze the effect of guidelines from the Turkish Federation of Breast Diseases Societies on academic institutions that have breast centers and to evaluate surgical practice in Turkey in 2018. PATIENTS AND METHODS: Between January and March 2019, a survey was sent to breast surgeons who were working in breast centers in academic institutions. The sampling frame included 24 academic institutions with breast centers in 18 cities in Turkey to evaluate interdisciplinary differences among breast centers and seven regions in Turkey regarding patients' choices, surgical approaches, and academic institutions. RESULTS: All surgeons responded to the survey, and all 4,381 patients were included. Most of the surgeons (73.9%) were working in a breast center. Multidisciplinary tumor boards were performed in 87% of the breast centers. The average time between clinical evaluation and initiation of treatment was 29 days; the longest time was in Southeast Anatolia (66 days). Only 6% of patients had ductal carcinoma in situ. Sentinel lymph node biopsy was available in every region across the country and was performed in 64.5% of the patients. In 2018, the overall breast-conserving surgery rate was 57.3% in Turkey, and it varied from 72.2% in the Black Sea region to 33.5% in Central Anatolia (P < .001). Oncoplastic breast surgery options were available at all breast centers. However, 25% of the breast centers from the Black Sea region and half the breast centers from Eastern Anatolia and the Mediterranean region did not perform this type of surgery. CONCLUSION: Increasing rates of nonpalpable breast cancer and decreasing rates of locoregional recurrences favored breast-conserving surgery, especially in developed countries. Guidelines from the Turkish Federation of Breast Diseases Societies resulted in more comprehensive breast centers and improved breast health in Turkey.

Traumatic rupture of a hydatid cyst of the liver presenting with skin lesions.

The hydatid cyst is the evolution of a parasitic infection caused by Echinococcus granulosus and is an endemic disease in Turkey. The hydatid cysts of the liver can give origin to several complications and the rupture is one of them. Rupture can occur spontaneously or as a result of external trauma. The presentation with skin lesions is very rare. We present a 20-year-old male patient who presented himself after a car accident, and was diagnosed with a rupture of traumatic hydatid cysts due to hives rash. In the operation, a scolicidal gent was administered to the cyst, the cyst wall was partially excised and the germinative membranes were removed. Medical treatment with albendazole was started. The postoperative period was quiet. The intraperitoneal traumatic rupture of a hydatid cyst is rare, but it can cause severe anaphylactic reactions and biliary peritonitis. Although a rare and broken hydatid cyst due to trauma may present with skin lesions in a patient in an endemic region, it should be considered in the differential diagnosis. KEY WORDS: Primary hydatid cyst, Trauma, Urticaria.