A Rare Case of Primary Ovarian Mucinous Carcinoma with Signet-Ring Cells and Literature Review.

The presence of signet-ring cells in the ovary is almost always associated with metastatic mucinous carcinomas known as Krukenberg tumors. Here we report a primary ovarian mucinous carcinoma with signet-ring cells, which is scarcely encountered, and a review of the literature to summarize the clinical and morphological features of these tumors. The patient was a 26-year-old female who had a large multicystic lesion in the right ovary. Macroscopic examination of the cyst revealed a 30 cm-sized multicystic lesion filled with mucinous material. The capsule was intact, and there was no surface involvement. Microscopically, a multicystic mucinous tumor with a predominantly borderline background and three well-demarcated nodules composed of signet ring cells without desmoplastic stroma were noted in the cyst wall. There was only one invasive focus seen. Immunohistochemically, conventional mucinous areas were diffusely positive for Keratin 7 and Keratin 20, and focally positive for PAX8, while negative for CDX2. Signet ring cells were positive for Keratin 20, CDX2, and Keratin 7, while negative for PAX8. In the systemic examinations, no potential primary site was found. The patient has not received any adjuvant treatment and has been followed for six years without disease, which is the longest follow-up time among previously reported cases. Signet ring cells can be present in primary ovarian mucinous carcinomas. The distinction from the more frequently seen metastatic carcinomas needs a complete evaluation of clinicopathological findings. Early-stage primary mucinous carcinomas having localized signet-ring cell nodules seem to have favorable prognosis without adjuvant treatment.

Totally Implantable Venous Access Device Care Practices and Experiences of Pediatric and Adult Oncology Nurses.

This study aimed to determine the practices of nurses working in pediatric and adult oncology clinics regarding totally implantable venous access device (TIVAD) care. The descriptive study was conducted with 227 oncology nurse members of the Oncology Nursing Association. The data were collected online with a survey form, which included questions about the participants' sociodemographic characteristics, professional experience, and TIVAD implementation practices. Descriptive statistics and ꭓ2 tests were used for the analysis of the data. It was determined that 44.1% of the nurses used 0.9% NaCl for active TIVAD flushing; 15.9% of them used a positive-pressure 0.9% NaCl-filled syringe; 12.3% used antireflux connectors; 85.5% used manual positive pressure technique; and 53.7% used the pulsatile technique. A statistical difference was found between nurses' training on TIVAD care and TIVAD occlusion rate in the clinic, TIVAD infection rate, following the guidelines, and using the pulsatile technique (P < .05). This study revealed that there are differences in the practices for TIVAD care and that the recommendations in the literature/guidelines are not implemented at the desired level to ensure continuity and prevent complications.

The Effect of Progressive Muscle Relaxation Exercises on Sleep Quality in Cancer Patients Undergoing Chemotherapy: A Randomized Controlled Study.

OBJECTIVES: This study aimed to evaluate the effect of progressive muscle relaxation exercises (PMRE) on sleep quality in patients undergoing chemotherapy treatment and experiencing disturbed sleep. METHODS: The prospective randomized controlled study was conducted between March and September 2022 with 69 patients (intervention group: 34 patients, control group: 35 patients) in a hospital chemotherapy unit. During the data collection process, the "Personal Information Form" and "Pittsburgh Sleep Quality Index (PSQI)" were utilized. Patients in the intervention group performed PMRE twice a day for 8 weeks. Patients in the control group received routine care at the clinic without additional intervention. For data analysis, Student's t-test, Mann-Whitney U test, Fisher's exact test, and chi-square test were used. RESULTS: The sociodemographic attributes of patients within both the intervention and control groups exhibited comparability. However, notable distinctions emerged in the PSQI Global sleep score and PSQI subdimension scores, encompassing sleep latency and duration, subjective sleep quality, habitual sleep efficiency, sleep disturbance, and daytime dysfunction between the two groups. The study found a notable difference in scores between the patients in the intervention group and those in the control group. The patients who received the intervention had significantly lower scores (P < .001). CONCLUSION: The study revealed that PMRE was beneficial in improving sleep quality in cancer patients undergoing chemotherapy who had poor sleep quality. IMPLICATIONS FOR NURSING PRACTICE: Oncology nurses may consider using PMRE to improve the sleep quality of cancer patients receiving chemotherapy.

Myeloid sarcoma with RBM15::MRTFA (MKL1) mimicking vascular neoplasm.

Extramedullary involvement of acute myeloid leukemia (AML), aka myeloid sarcoma, is a rare phenomenon in acute megakaryoblastic leukemia with RBM15:: MRTFA(MKL1) fusion, which might mimic non-hematologic malignancies. A 7-month-old infant presented with leukocytosis, hepatosplenomegaly, multiple lymphadenopathies, and a solid mass in the right thigh. Initially, the patient was diagnosed with a malignant vascular tumor regarding the expression of vascular markers from the biopsy of the right thigh lesion that was performed after the inconclusive bone marrow biopsy. The second bone marrow biopsy, which was performed due to the partial response to sarcoma treatment, showed hypercellular bone marrow with CD34 and CD61-positive spindle cell infiltration and > 20% basophilic blasts with cytoplasmic blebs. RNA sequencing of soft tissue biopsy revealed the presence of RBM15::MRTFA(MKL1) fusion. Based on these findings, myeloid sarcoma/AML with RBM15::MRTFA(MKL1) fusion diagnosis was made. AML with RBM15::MRTFA(MKL1) fusion can initially present as extramedullary lesions and might cause misdiagnosis of non-hematologic malignancies.

A Case of Nasal Glial Heterotopia That Can Be Misdiagnosed as Storiform Patterned Sclerotic Fibroma/Collagenoma.

OBJECTIVE: Nasal glioma, also known as nasal glial heterotopia, is a rare tumor-like lesion that often affects newborns or infants with no hereditary predisposition. CASE REPORT: A 4-year-old child with a growth on the nasal dorsum since birth was diagnosed with nasal glial heterotopia/nasal glioma. The lesion showed a sclerotic fibroma/collagenoma-like storiform pattern with entrapped glial tissue that was S100 and GFAP positive. CONCLUSION: When a biopsy of the nasal dorsum demonstrates sclerotic microscopic findings with a storiform pattern, nasal glioma should be considered before making a diagnosis in the collagen-rich tissue spectrum (collagenoma or Gardner's fibroma), and an immunohistochemical panel should be requested to demonstrate the presence of an unrecognized light microscopically visible glial component.

Reliability assessment of methylthioadenosine phosphorylase immunohistochemistry as a surrogate biomarker for CDKN2A homozygous deletion in adult-type IDH-mutant diffuse gliomas.

According to the 2021 World Health Organization classification of brain tumors, astrocytomas containing a CDKN2A/B homozygous deletion (HD) are designated as grade 4 even when no microvascular proliferation and/or necrosis is present. In this study, we aimed to investigate the relationship between CDKN2A HD and loss of methylthioadenosine phosphorylase (MTAP) expression in adult-type IDH-mutant gliomas and to assess the sensitivity and specificity of MTAP immunohistochemistry (IHC) along with interobserver agreement as a surrogate biomarker for CDKN2A HD. Eighty-eight astrocytomas and 71 oligodendrogliomas cases that were diagnosed between 2014 and 2021 at Hacettepe University were selected and tissue microarrays were conducted to perform CDKN2A fluorescence in situ hybridization and MTAP IHC. Twenty-five (15.7%) cases harbored CDKN2A HD. MTAP loss was detected in 28 (15.7%) cases by the first observer and 27 (17%) cases by the second observer. The sensitivity and specificity of MTAP were calculated as 88% and 95.52%-96.27% for 2 observers. A very good/perfect agreement was noted between the observers (Cohen kappa coefficient = 0.938). Intratumoral heterogeneity was observed in 4 cases. MTAP IHC was found to be a reliable surrogate biomarker as a possible alternative to CDKN2A HD identification with a high sensitivity and specificity along with high interobserver agreement.

The Effects of Pranayama or Deep Breathing Exercises on Fatigue and Sleep Quality in Women Receiving Radiation Therapy for Breast Cancer.

OBJECTIVES: To evaluate the effects of pranayama and deep breathing exercises on fatigue and sleep quality in women undergoing radiation therapy for breast cancer. SAMPLE & SETTING: This randomized controlled study was conducted on the outpatient radiation oncology unit of a hospital with 20 patients each in pranayama, deep breathing, and standard care groups (N = 60). METHODS & VARIABLES: The Piper Fatigue Scale and the Pittsburgh Sleep Quality Index were used to evaluate the participants' fatigue and sleep quality. RESULTS: The control group showed a significant increase in fatigue levels at the end of radiation therapy compared to the beginning. Sleep quality was improved only in the pranayama group. IMPLICATIONS FOR NURSING: Pranayama can be learned easily, can be performed anywhere, and does not require any equipment, making it a convenient exercise for patients. Oncology nurses can take the lead in suggesting pranayama for symptom management.

Gestational trophoblastic neoplasia of intermediate trophoblasts: Epithelioid trophoblastic tumor and placental site trophoblastic tumor, a study of morphologic, immunohistochemical, and next generation sequencing.

Objective: Gestational trophoblastic tumors are very rare neoplasms. We determined the distinctive morphological, immunohistochemical, and clinical features of placental site trophoblastic tumors (PSTT) and epithelioid trophoblastic tumors (ETT) in our cohort. Materials and Methods: Nine cases of PSTT and four cases of ETT were retrieved from the archives. Histomorphologic, immunohistochemical, and clinical features were noted. A molecular study was performed on one PSTT and one ETT case using next-generation sequencing. Results: While the nodular pattern, geographic necrosis, and extracellular eosinophilic globules were peculiar to ETTs, vessel wall affinity, marked pleomorphism, intranuclear pseudoinclusion, spindle tumor cell, and vacuolar degeneration were more specific for PSTTs in our series. An immunohistochemical panel of p63, hPL, and CD146 were helpful for the exact typing of the tumor. p63 positivity supports the ETT and diffuse staining of hPL and CD146 supports the PSTT diagnosis. Three of the patients with metastatic disease (lung and brain metastasis) except one have a high mitotic count (12 and 8) and a long interval between (8 and 10 years) antecedent pregnancy and diagnosis. While KIT and TP53 mutations were observed only in PSTT, amino acid changes in KDR, APC, and SMAD4 genes were detected both in the ETT and PSTT cases. Conclusion: In the prediction of metastasis, the long intervals between antecedent pregnancy and diagnosis, deep myometrial invasion, mitotic count, and Ki67 proliferation index were involved rather than other histomorphological parameters, but none of the parameters is an absolute predictor of the metastasis.

The level of fatigue, insomnia, depression, anxiety, stress, and the relationship between these symptoms following allogeneic hematopoietic stem cell transplantation: a cross-sectional study.

PURPOSE: This study investigated the incidence of fatigue, insomnia, depression, anxiety, and stress symptoms in patients after allogeneic hematopoietic stem cell transplantation (AHSCT), as well as explored potential relationships among these symptoms. METHODS: A total of 126 patients who had undergone transplantation at a university hospital at least one month prior to the study's commencement were included. The study was conducted as a cross-sectional and relational research, and data were collected using the "Personal Information Form," "Brief Fatigue Inventory," "Insomnia Severity Index," and "Depression Anxiety Stress Scale." Statistical analyses included descriptive statistics, parametric and nonparametric tests, and correlation analyses using the Spearman Correlation Coefficient. Additionally, mediation analyses were conducted using a Structural Equation Model to explore potential causal relationships among the variables. RESULTS: The incidence of fatigue was high among patients, with 94% experiencing this symptom following transplantation. Additionally, 52% had anxiety, 47% had insomnia, 47% had depression, and 34% had stress. Moderate relationships were observed between these symptoms. Regression analysis revealed that one-point increase in fatigue was associated with increases in stress 1.065 points, depression 0.937 points, anxiety 0.956 points, and insomnia 0.138 points (p<0.001). Similarly, one-point increase in insomnia was associated with increases in fatigue 3.342 points, stress 0.972 points, depression 0.885 points, and anxiety 0.816 points (p<0.001). CONCLUSION: After AHSCT, fatigue was the most frequent symptom experienced by patients, followed by insomnia, depression, anxiety, and stress. There was a relationship between these symptoms. Additionally, evidence suggested that insomnia was more strongly associated with fatigue compared to the other symptoms.

Oncology nursing practices in the management of chemotherapy-related oral mucositis in accordance with evidence-based guidelines: a descriptive and cross-sectional study.

PURPOSE: This study aimed to explore the practices of oncology nurses in the management of chemotherapy-related oral mucositis (OM) by MASCC/ISOO guidelines. METHODS: This descriptive and cross-sectional study was conducted between December 25, 2021, and January 31, 2022, with 157 oncology nurses in Turkey. Data were collected through OM Practices Assessment Form. RESULTS: The mean age of the nurses was 29.05 ± 7.40, the majority (90.4%) of them were female and 76.4% of them have a Bachelor's degree. More of the nurses (59.9%) had a written protocol for managing OM in their institutions, 38.9% of them used the MASCC/ISOO guideline, and 63.0% of them used an OM assessment scale. Most of the nurses (99.4%) recommended mouthwash to patients and 65.6% of them recommended mouthwash four times and more a day. 54.1% of the nurses recommended saline (%10.8) or carbonate (%36.9) or a mixture of saline and carbonate (%6.4) solutions for mouthwash. Despite the lack of sufficient evidence in the MASCC/ISOO guidelines regarding black mulberry syrup, 45.2% of the nurses recommended it for the prevention of OM and 43.3% of them suggested the treatment of mucositis. It was found that 82.0% of nurses who followed MASCC/ISOO guidelines recommended to patients implement oral care four times and more a day, while 55.2% of them who did not follow MASCC/ISOO guidelines recommended four times and more a day. The difference was found to be statistically significant (χ2 = 11.836; p = 0.01). CONCLUSION: It was determined that there were deficiencies in the implementation of written protocols for OM and the use of guidelines, and there were differences between the frequency of oral care, oral care products, and the practices of nurses in the prevention and treatment of OM.

Recurrent mucinous neoplasm arising in cesarean scar: A case report and review of literature.

Ovarian mucinous tumors are one of the common epithelial tumors in the ovary, but their recurrence is extremely rare. In a 37-year-old female patient who had had five operations in 7 years due to recurrent mucinous neoplasms, a mass extending to the umbilicus was recently detected during a routine examination. With this finding the patient underwent cystectomy, total abdominal hysterectomy, and left salpingo-oophorectomy. Two of the five operations were performed during cesarean delivery. In the recent surgical procedure, two cysts were removed. A 20 cm cyst in the pelvic region was diagnosed as a mucinous cystadenoma. The other cyst located in the myometrium was a mucinous cystadenoma with focal borderline change and arose in the previous cesarean scar. The authors present what is believed to be the first case of recurrent mucinous neoplasm arising within a cesarean scar. A review of the literature concerning the topic is also presented.

THSD7A expression: a novel immunohistochemical determinant in predicting overall survival of metastatic renal cell carcinoma treated with targeted therapy.

BACKGROUND: The association of thrombospondin type 1 domain-containing 7A (THSD7A) expression, a novel angiogenesis-related marker, with survival outcomes of tumors including renal cell carcinoma (RCC) remains to be clarified. Therefore, we investigated the impact of THSD7A on outcomes of metastatic RCC (mRCC) patients treated with targeted therapy. METHODS: A total of 86 mRCC patients were included. The expression of THSD7A in nephrectomy material of the patients was assessed by immunohistochemistry and expression patterns were categorized into two groups: negative (no staining) and positive. Univariable and multivariable Cox regression models evaluated the impact of THSD7A expression on progression free survival (PFS) and overall survival (OS) of the patients. RESULTS: THSD7A expression was determined in 77.9% of the patients. Kaplan-Meier analyses showed that while the patients with THSD7A expression had significantly inferior OS times than those with negative THSD7A expression (19.9 months vs. 52.2 months, P = 0.024, respectively), there was no association between THSD7A expression and PFS. The univariate analyses demonstrated that the significant variables in predicting OS were presence of bone metastasis (P = 0.030), THSD7A expression (P = 0.028), and International Metastatic Renal Cell Carcinoma Database Consortium (IMDC) scoring system (P < 0.001). However, applying multivariate analyses, the independent variables in predicting OS were THSD7A expression (HR: 2.639, P = 0.037) and IMDC scoring system (P < 0.001). CONCLUSION: We revealed that THSD7A expression was associated with OS of mRCC patients treated with targeted therapy. There might be an important link between THSD7A expression and resistance to targeted therapy.

Primary Ciliary Body Marginal Zone Lymphoma Presenting as Hemorrhagic Hypopyon.

PURPOSE: Our purpose is to report a patient with primary unilateral ciliary body marginal zone lymphoma who initially presented with hemorrhagic hypopyon. METHODS: Retrospective review of the clinical, imaging, and immunohistopathological features of the case was performed. RESULTS: A 59-year-old man was referred with right anterior uveitis of unknown etiology which was unresponsive to systemic treatment. Slit-lamp biomicroscopy showed normotensive hemorrhagic hypopyon in that eye. Anterior segment ultrasound biomicroscopy revealed an iridociliary mass lesion. Because an anterior chamber paracentesis was noncontributory, a diagnostic cyclectomy was performed. Histopathological evaluation showed that the neoplastic cells were positive for CD20, lambda light chain, and BCL 2. BCL 6, CD10, CD5, SOX11, kappa, and Cyclin D1 stains were negative. The final diagnosis was extranodal marginal zone lymphoma of the ciliary body. CONCLUSIONS: Although rare, ciliary lymphoma may be a cause of intractable anterior uveitis. Repeat biopsies could be carried out when there is a high level of clinical suspicion.

Novel similarity measures in spherical fuzzy environment and their applications.

Spherical fuzzy sets (SFSs) have gained great attention from researchers in various fields. The spherical fuzzy set is characterized by three membership functions expressing the degrees of membership, non-membership and the indeterminacy to provide a larger preference domain. It was proposed as a generalization of picture fuzzy sets and Pythagorean fuzzy sets in order to deal with uncertainty and vagueness information. The similarity measure is one of the essential and advantageous tools to determine the degree of similarity between items. Several studies on similarity measures have been developed due to the importance of similarity measure and application in decision making, data mining, medical diagnosis, and pattern recognition in the literature. The contribution of this study is to present some novel spherical fuzzy similarity measures. We develop the Jaccard, exponential, and square root cosine similarity measures under spherical fuzzy environment. Each of these similarity measures is analyzed with respect to decision-makers' optimistic or pessimistic point of views. Then, we apply these similarity measures to medical diagnose and green supplier selection problems. These similarity measures can be computed easily and they can express the dependability similarity relation apparently.

Targeting lysyl oxidase (LOX) overcomes chemotherapy resistance in triple negative breast cancer.

Chemoresistance is a major obstacle in triple negative breast cancer (TNBC), the most aggressive breast cancer subtype. Here we identify hypoxia-induced ECM re-modeler, lysyl oxidase (LOX) as a key inducer of chemoresistance by developing chemoresistant TNBC tumors in vivo and characterizing their transcriptomes by RNA-sequencing. Inhibiting LOX reduces collagen cross-linking and fibronectin assembly, increases drug penetration, and downregulates ITGA5/FN1 expression, resulting in inhibition of FAK/Src signaling, induction of apoptosis and re-sensitization to chemotherapy. Similarly, inhibiting FAK/Src results in chemosensitization. These effects are observed in 3D-cultured cell lines, tumor organoids, chemoresistant xenografts, syngeneic tumors and PDX models. Re-expressing the hypoxia-repressed miR-142-3p, which targets HIF1A, LOX and ITGA5, causes further suppression of the HIF-1α/LOX/ITGA5/FN1 axis. Notably, higher LOX, ITGA5, or FN1, or lower miR-142-3p levels are associated with shorter survival in chemotherapy-treated TNBC patients. These results provide strong pre-clinical rationale for developing and testing LOX inhibitors to overcome chemoresistance in TNBC patients.

Intussusception of the bowel in adults: two different cases.

Intussusception in adults is considered an unusual condition accounting for 5% of all cases of intussusceptions and almost 1%-5% of all cases of bowel obstruction. We present two cases of patients with a complaint of abdominal discomfort and concomitant vomiting who are 43 and 44 years old. Ileocecal intussusception was diagnosed by computed tomography. One patient underwent open whereas the other underwent laparoscopic right hemicolectomy and ileotransversostomy. A histopathological study revealed lipoma in the first case and adenocarcinoma in the second. We described the diagnosis and treatment of intestinal intussusception in adults.

Associations of olfactory bulb and depth of olfactory sulcus with basal ganglia and hippocampus in patients with Parkinson's disease.

Parkinson's disease (PD) is a neurodegenerative disorder characterized by hyposmia in the preclinical stages. We investigated the relationships of olfactory bulb (OB) volume and olfactory sulcus (OS) depth with basal ganglia and hippocampal volumes. The study included 25 patients with PD and 40 age- and sex-matched control subjects. Idiopathic PD was diagnosed according to published diagnostic criteria. The Hoehn and Yahr (HY) scale, the motor subscale of the Unified Parkinson's Disease Rating Scale (UPDRS III), and the Mini-Mental State Examination (MMSE) were administered to participants. Volumetric measurements of olfactory structures, the basal ganglia, and hippocampus were performed using magnetic resonance imaging (MRI). OB volume and OS depth were significantly reduced in PD patients compared to healthy control subjects (p<0.001 and p<0.001, respectively). The OB and left putamen volumes were significantly correlated (p=0.048), and the depth of the right OS was significantly correlated with right hippocampal volume (p=0.018). We found significant correlations between OB and putamen volumes and OS depth and hippocampal volume. Our study is the first to demonstrate associations of olfactory structures with the putamen and hippocampus using MRI volumetric measurements.

Hepatic vein and portal vein Doppler ultrasound of maternal liver in normal pregnancy.

OBJECTIVE: The purpose of our study was to evaluate the changes occurring in maximum flow velocity and waveform patterns of the portal and hepatic veins during pregnancy in second and third trimesters. METHODS: A total of 204 patients were randomly divided into the study and control groups. The control group was classified as group I; the study group was divided into two groups: group II, second trimester pregnancy (14-26 weeks, n = 91) and group III, third trimester pregnancy (26-40 weeks, n = 63). Vein waveforms were classified as triphasic, biphasic and monophasic. RESULTS: Maximum flow velocities of both right hepatic vein and main portal veins were lower in group III compared with group I and group II (p < 0.05). On the basis of hepatic vein and portal vein waveforms, the incidence of biphasic pattern was prominent in group II (p < 0.05) whereas the monophasic pattern was prominent in group III (p < 0.05). CONCLUSION: The results demonstrate that as gestational age progresses, maximum flow velocities of both right hepatic vein and main portal veins intend to be decreased with an increased incidence of monophasic wave form pattern, and may be accepted as sensitive parameters of indicators of physiological adaptations related to pregnancy.