The relationship of tumor budding with GOLPH3 expression and histopathological prognostic parameters in colorectal adenocarcinoma.

OBJECTIVE: Tumor budding is an independent poor prognostic parameter in colorectal carcinoma (CRC). Golgi phosphoprotein 3 (GOLPH3) has been investigated in many solid organ tumors and has been associated with poor prognosis. In this study, the relationship of tumor budding and GOLPH3 and histopathological prognostic markers was investigated. MATERIALS AND METHODS: 140 colon resection materials diagnosed with adenocarcinoma between 2011 and 2018 were included in this study. Cases were reanalysed for their age, gender, tumor localization and size, histological grade, mucinous and signet ring cell differentiation, depth of invasion, lymphovascular and perineural invasion, stromal and intraepithelial tumor infiltrating lymphocyte (TIL), Crohn-like lymphoid reaction, peritumoral lymphocytic response, overall lympocytic score and lymph node metastasis. GOLPH3 antibody was applied to the sections containing the most dense tumor budding. The relationship between tumor budding and GOLPH3 expression, histopathological parameters and overall survival time was evaluated. RESULTS: Tumor budding was detected in 72 (51.4%) of 140 tumors. There was correlation between tumor budding and localization, size, histological type and grade, lymphovascular and perineural invasion, there was no relation with GOLPH3 expression. GOLPH3 expression was positive in 106 (75.7%) of tumors. Significant correlations were found between GOLPH3 expression and signet ring cell differentiation, stromal TIL, peritumoral lymphocytic response and overall lymphocytic score. CONCLUSION: Tumor budding and GOLPH3 expression are not correlated in CRC, but both are correlated to important prognostic histopathological parameters. In addition, tumor budding and GOLPH3 expression were not effective in overall survival, however, both parameters should be evaluated in a larger series.

The Relationship of Microsatellite Instability with BRAF and p53 Mutations and Histopathological Parameters in Colorectal Adenocarcinoma.

AIM: This study aims to elucidate the associations between microsatellite instability (MSI) status, BRAF mutation, and p53 reactions with pathological parameters and survival outcomes in colorectal carcinoma. MATERIAL AND METHOD: MutL homologous 1 (MLH1), Postmeiotic segregation increased 2 (PMS2), MutS homologous 2 (MSH2), MutS homologous 6 (MSH6), BRAF, and p53 antibodies were performed on 130 adenocarcinoma samples, including 65 from the right colon and 65 from the left colon. The relationships of MSI status with BRAF mutation, p53 reaction, clinical and pathological parameters, and survival times were statistically analyzed. RESULTS: A statistically significant relationship was found between MSI and right colon localization, tumor size, histological grade, intraepithelial tumor-infiltrating lymphocytes, Crohn-like lymphocytic reaction, expansive growth pattern, and BRAF mutation (p < 0.05). No significant correlation was found between MSI status and the disease-free or overall survival times (p > 0.05). CONCLUSION: In colorectal adenocarcinoma, MSI and BRAF mutation are associated with parameters, indicating the host immune response and prognostic histopathological parameters, including tumor size and histological grade. The evaluation of MSI status and BRAF mutation can be particularly informative for predicting the prognosis and guiding the treatment management in poorly differentiated colorectal adenocarcinoma. Understanding the mechanisms of molecular carcinogenesis in colorectal carcinoma and organizing treatment algorithms based on molecular foundations will increase the success of the treatment.

Correlation between breast and axillary pathologic complete response after neoadjuvant chemotherapy in breast cancer.

AIM: The aim of this study was to evaluate the correlation of the pathological response in breast tissue and the axilla of patients with breast cancer who underwent surgery following neoadjuvant chemotherapy. METHOD: This retrospective cohort study included patients with T1-4, N1-3, M0 breast cancer who underwent surgery following neoadjuvant chemotherapy at Gaziosmanpasa Training and Research Hospital between 2013 and 2022. The response of the breast tissue to chemotherapy was evaluated with the Miller-Payne grading system, and the response of the axillary lymph nodes to chemotherapy was evaluated with the Pinder grading system. The patients were grouped histopathologically as luminal A, luminal B, Her-2 enriched, or triple negative breast cancer (TNBC). RESULTS: The study was completed with 140 patients. Pathological complete response (pCR) was seen in the breast in 40 patients and in the axilla in 34. Of the patients with pCR in the breast, pCR was also determined in the axilla in 45%. In the patients with pCR in both the breast and axilla, Her-2 enriched subtype, estrogen receptor negativity, progesterone receptor negativity, Her-2 neu positivity, and Ki-67 level >25% were determined to be effective (p<0.05). Her-2 neu positivity was evaluated as statistically significant in the development of pCR in both the breast and axilla (OR: 4.06, 95% CI:1.2-13.6, p=0.023). CONCLUSION: The development of pCR in the breast, especially in the Her-2 enriched subgroup, can be accepted as a predictive factor for the evaluation of axillary response in patients with breast cancer. The least compatibility was seen in the luminal A subgroup. KEY WORDS: Breast cancer, Miller-Payne, Neoadjuvant chemotherapy Pathological complete response, Pinder.

Neoplasms of the appendix: Single institution and ten-year experiences results.

BACKGROUND: Appendix neoplasms are rare tumors of the gastrointestinal system. Appendiceal adenocarcinoma, appendiceal mucinous neoplasm, and neuroendocrine tumors (NETs) are the most encountered appendix-related neoplasms. The patients are usually got diagnosed after histopathological examination. This study aimed to explore the epidemiology, pathological subtypes, and treatment modalities of appendix neoplasms. METHODS: A retrospective examination was made with 2821 patients who underwent appendectomy between April 2010 and August 2020. Demographic, clinical, radiological, surgical findings, and histopathological results were collected from the patient files. RESULTS: Appendix neoplasms were detected in 1.06% of the patients included in the study. The mean age was 44.6±17.5 (17-83) years. Eight NETs, seven adenocarcinomas, fourteen mucinous neoplasms, and one neuroma were diagnosed with patients. CONCLUSION: Appendiceal neoplasms are generally asymptomatic and often diagnosed with postoperative histopathological ex-amination. If the result is adenocarcinoma, right hemicolectomy recommends. Treatment of NETs depends on factors such as tumor size, location, mesoappendix invasion, and lymph node involvement. In the presence of mucinous neoplasm, surgical intervention is determined according to the pathological subtype and involvement of mesoappendix. The need for additional surgical intervention or medical treatment for patients with tumor, histopathological results must be followed carefully after appendectomy.

Histopathological, Radiological, and Demographic Factors Predicting the Response to Neoadjuvant Therapy for Rectal Cancer.

BACKGROUND/AIM: While the treatment for early stage rectal cancer is surgery, when a diagnosis is made at a locally advanced stage, it is recommended to start treatment with neoadjuvant chemoradiotherapy. Therefore, it is important to determine which patients will respond best to neoadjuvant treatment. The aim of this study was to investigate which hematological, histopathological, and radiological parameters can predict the response to chemoradiotherapy. METHODS AND MATERIAL: A retrospective examination was made of 43 patients who underwent surgery following neoadjuvant chemoradiotherapy because of locally advanced stage rectal cancer. Demographic data were collected from the patient files, and the radiological, histopathological, and laboratory findings before neoadjuvant chemoradiotherapy were compared with the findings after treatment. RESULTS: In the postoperative evaluation, a pathological complete response was determined in 25.50% of the patients. Lymphovascular invasion, perineural invasion, and absence of necrosisis were seen to be statistically related to major response (p < 0.05), and in patients where the tumor was closer than 6 cm to the anal verge, the response was better CONCLUSION: When the findings were examined, histopathological lymphovascular invasion, perineural invasion, the presence of necrosis, and the anal verge distance were evaluated as parameters predicting the response to neoadjuvant chemoradiotherapy in rectal cancer.

MRI Radiomics of Breast Cancer: Machine Learning-Based Prediction of Lymphovascular Invasion Status.

RATIONALE AND OBJECTIVES: In patients with breast cancer (BC), lymphovascular invasion (LVI) status is considered an important prognostic factor. We aimed to develop machine learning (ML)-based radiomics models for the prediction of LVI status in patients with BC, using preoperative MRI images. MATERIALS AND METHODS: This retrospective study included patients with BC with known LVI status and preoperative MRI. The dataset was split into training and unseen testing sets by stratified sampling with a 2:1 ratio. 2D and 3D radiomic features were extracted from contrast-enhanced T1 weighted images (C+T1W) and apparent diffusion coefficient (ADC) maps. The reliability of the features was assessed with two radiologists' segmentation data. Dimension reduction was done with reliability analysis, multi-collinearity analysis, removal of low-variance features, and feature selection. ML models were created with base, tuned, and boosted random forest algorithms. RESULT: A total of 128 lesions (LVI-positive, 76; LVI-negative, 52) were included. The best model performance was achieved with tunning and boosting model based on 3D ADC maps and selected four radiomic features. The area under the curve and accuracy were 0.726 and 63.5% in the training data, 0.732 and 76.7% in the test data, respectively. The overall sensitivity and positive predictive values were 68% and 69.6% in the training data, 84.6% and 78.6% in the test data, respectively. CONCLUSION: ML and radiomics based on 3D segmentation of ADC maps can be used to predict LVI status in BC, with satisfying performance.

The effect of the Covid 19 pandemic on the number of patients treated for acute and complex acute appendicitis.

AIM: The aim of this study was to compare the increase in the number of complicated cases in patients who underwent surgery for acute appendicitis during the COVID-19 pandemic and the previous year. MATERIAL AND METHODS: A retrospective examination was made of the files of patients who presented at the Emergency Department and were diagnosed with acute appendicitis and underwent surgery within 24 hours or were followed up between 11 March and 1 June 2020 during the COVID-19 pandemic, and in the same period in the previous year. The patients in the pandemic period were named the pandemic group (PG) and the patients from the previous year, the control group (CG). The definition of complicated appendicitis included peri-appendicular abscess and perforated appendix. RESULTS: The number of patients in the PG was 38.33% lower than in the CG. The duration of symptoms was 2 days in the PG and 1 day in the CG, and the difference was statistically significant (p=0.001). The mean neutrophil count was determined to be higher in the PG than in the CG (p=0.018). The rate of perforated appendix was determined to be 10.9 higher in the PG than in the CG. CONCLUSION: The number of patients presenting at the Emergency Department reduced during the pandemic, especially during periods of lockdown, and it was seen that fewer but more complicated patients presented at our centre. KEY WORDS: Acute appendicitis, COVID-19, Perforation.

Magnetic resonance imaging findings associated with recurrence in idiopathic granulomatous mastitis.

PURPOSE: To evaluate magnetic resonance imaging (MRI) findings related to recurrence of idiopathic granulomatous mastitis (IGM). METHODS: Demographic data [age, number of births, duration of lactation period, body mass index (BMI) and presence of recurrence] of 71 patients who were diagnosed with IGM were analyzed retrospectively. Characteristics of IGM (maximum width, location, involvement of the retroareolar region, deep tissue, skin), fibroglandular density (FGD), background parenchymal enhancement (BPE), distribution and pattern of contrast enhancement, presence of prepectoral edema, abscesses, fistulae, axillary lymphadenopathies on MRI and apparent diffusion coefficient (ADC) values from the pathological area were recorded. RESULTS: The recurrence rate in patients was 59% (42/71). We found a statistically significant relationship between recurrence and BPE (p = 0.028) and mean ADC (p = 0.035) values (for the cut-off of 1.00 × 10-3 mm2/s; sensitivity = 61.9%, specificity = 69%, AUC = 0.648). However, patients' age (p = 0.346), lactation period (p = 0.470), number of births (p = 0.774), BMI (p = 0.630) maximum width of the area of enhancement (p = 0.112), involvement of the retroareolar region (p = 0.290), deep tissue (p = 0.285), skin (p = 0.230), distribution (p = 0.857) and enhancement pattern (p = 0.157), presence of prepectoral edema (p = 0.094), abscesses (p = 0.441), fistulae (p = 0.809), lymphadenopathies (p = 0.571), and FGT (p = 0.098) were not significantly associated with recurrence. CONCLUSION: Our results revealed that recurrent IGM patients showed high BPE and lower mean ADC values. We think that high BPE and low mean ADC (<1.00 × 10-3 mm2/s) on MRI at the diagnosis stage may be a sign of possible future recurrence, and it will be beneficial to follow the patients more closely and arrange the treatment algorithms accordingly.

Characterization of Suspicious Microcalcifications on Mammography Using 2D Shear-Wave Elastography.

Our aim was to investigate the correlations between the findings of two-dimensional shear-wave elastography (2D-SWE) and the histopathologic results of microcalcifications (MCs) visualized using ultrasonography (USG). Fifty people with suspicious MCs without accompanying mass were evaluated. They underwent USG and 2D-SWE before USG-guided tru-cut biopsy. SWE values and histopathologic features were compared statistically. The variables between groups were analyzed using the Mann-Whitney U test. Receiver operating characteristic analysis was performed and cut-off values determined to discriminate malignancy, invasiveness and high grade. Pathology confirmed 27 malignant lesions (18 invasive ductal carcinomas, one invasive lobular and eight ductal carcinomas in situ) and 23 benign ones. There was a statistically significant difference between the SWE values of malignant and benign MCs (p < 0.001). The diagnostic performance of SWE for malignancy, invasiveness and high grade were as follows, repectively: sensitivity (93%, 83%, 88%), specificity (91%, 88%, 53%), positive predictive value (93%, 94%, 44%), negative predictive value (91%, 70%, 90%) and area under the curve (0.952, 0.885, 0.776). Cut-off values were determined as 57 kPa for malignancy, 124 kPa for invasiveness and 124.5 kPa for high grade. In conclusion, SWE is a useful method in clinical practice for characterizing MCs that can be visualized with USG.

The effects on bacterial translocation and tissue damage of selenium treatment in an experimental intestina ischaemia-reperfusion model.

BACKGROUND: The free oxygen radicals formed with reperfusion following intestinal ischaemia are extremely toxic for the cells. Glutathione peroxidase, an important enzyme that prevents the formation of reactive oxygen species, requires selenium as a co-factor. This study aims to demonstrate the effects of selenium administration on reducing ischaemia-reperfusion damage. METHODS: In this study, 28 male Wistar rats were separated into four groups. To Groups 3 and 4, sodium selenite at the dose of 10 µg/kg/day was administered intraperitoneally for five days. In Groups 1 and 3, laparotomy was applied, and in Groups 2 and 4, following laparotomy, ischaemia was created by clamping the superior mesenteric artery for 45 mins, then reperfusion was provided for 90 mins. Blood, liver and ileum samples were taken from all the animals for examination of malondialdehyde. For examination of bacterial translocation, liver, spleen and mesenteric lymph node tissue samples were taken. A sample taken from the ileum was examined histopathologically. RESULTS: There was determined to be significantly more bacterial translocation in the mesenteric lymph nodes of the ischaemia-reperfusion group (p<0.05). In the histopathological evaluation, the score in the ischaemia-reperfusion group was significantly higher than the scores in the other groups (p<0.05). Elevated serum, liver and ileum malondialdehyde levels in the ischaemia-reperfusion group were significantly higher than those in the other groups (p<0.05). CONCLUSION: Selenium was seen to have decreased serum and tissue malondialdehyde levels and increased the histopathological damage developing in the intestines with ischaemia-reperfusion and thereby increased bacterial translocation.

Comparison of the efficiency of systemic therapy and intralesional steroid administration in the treatment of idiopathic granulomatous Mastitis. The novel treatment for Granulomatous Mastitis.

BACKGROUND: Idiopathic granulomatous mastitis that has not had a clear consensus about its treatment since the day it was identified as a rare, benign inflammatory breast disease that mimics malignancy due to its appearance features. AIMS: In our research, we intended to compare the efficiency of intralesional and systemic steroids administration in the treatment of idiopathic granulomatous mastitis. STUDY DESIGN: Prospective randomized controlled study. METHODS: A total of 36 female patients who had been histopathologically diagnosed with idiopathic granulomatous mastitis and whose other factors had been microbiologically excluded were included in the study. The patients were randomized into two sub-groups that would be treated with systemic and intralesional steroids. All patients were evaluated through physical examination one week after the completion of the treatment. Subsequently, the follow-up of the patients was performed thorough physical examination and ultrasonography and/or magnetic resonance imaging at the 1st, 3rd, and 6th months. RESULTS: All patients adapted to treatment. Complete clinical regression occurred in 32 patients, while 30 of 36 patients responded to treatment both radiologically and clinically. A total of 4 patients had minor side effects. It was determined that there was no statistically significant difference between local and systemic steroid groups in terms of complete clinical regression, responded to treatment side effects, and recurrence rates. CONCLUSION: Intralesional steroid administration was also considered just as a successful treatment method as the systemic steroid administration. KEY WORDS: Idiopathic granulomatous mastitis, Intralesional steroid, Systemic steroid.

The comparison of the histopathological results of the thyroid fine-needle aspiration biopsies in the 795 patients with thyroidectomy.

BACKGROUND: We aimed to evaluate the effectiveness of preoperative fine-needle aspiration biopsies (FNAB) by the postthyroidectomy pathology results. METHOD: Seven hundred and ninety-five patients with FNAB and following thyroid operations which have been performed between April 2008 and December 2019 were included in this study. By comparing the results of the FNAB and final pathologies, the specificity, sensitivity, FNR, false positivity ratio (FPR), accuracy and also the effect of nodule diameter on these have been evaluated. In Bethesda III subgroup according to FNAB, we investigated the malignancy rates and in whom this risk has been increased more. RESULTS: In our study, the sensitivity of FNAB is 73.40%, the specificity is 95.33%, the accuracy is 91.81%, FNR is 26.60% and FPR is 4.67%. In the patients with nodules ≥4 cm and < 4 cm respectively, we calculated the sensitivity 20.0% vs 79.76%, specificity 95.73% vs 95.19%, accuracy 89.82% vs 92.78%, FNR 80.0% vs 20.24%, FPR 4.27% vs 4.8%. CONCLUSION: Thyroid FNAB is an easy procedure with a high specificity and sensitivity. Nevertheless, when the nodule diameter was ≥4 cm, increased FNR and decreased sensitivity should be kept in mind while evaluating the patients.

The Relationship of GATA3 and Ki-67 With Histopathological Prognostic Parameters, Locoregional Recurrence and Disease-free Survival in Invasive Ductal Carcinoma of the Breast.

BACKGROUND: In recent years, GATA-binding protein 3 (GATA3) has been indicated as a marker showing good prognosis in breast cancer. In luminal breast cancer, which has good a prognosis, it shows more significant elevation in small-sized and low-grade tumors. In contrast, Ki-67 is defined as a poor prognostic factor. The aim of this study was to emphasise the prognostic importance of GATA3 and the inverse relationship with Ki-67. MATERIALS AND METHODS: In our study, 90 patients with invasive ductal breast cancer were immunohistochemically evaluated for Ki-67 and GATA3 expression. The relationship between GATA3 and Ki-67 expression was examined. In addition, the relationship between these two factors with estrogen, progesterone, human epidermal growth factor 2 receptor antibodies and other prognostic parameters such as disease-free survival and local recurrence was investigated. We accepted the level of ≥5% nüclear reaction as positive for GATA 3. A Ki-67 cut-off value of 20% was accepted as positive. RESULTS: In GATA3 positive breast cancers, good prognostic parameters were seen including high estrogen receptor (ER) positivity, progesterone receptor (PR) positivity, small tumor size and low histological grade as well as low Ki-67 expression. In breast cancers showing high Ki-67 expression, ER, PR, and GATA3 positivity were lower and there was higher human epidermal growth factor receptor 2 (HER2) positivity and high histological grade while the tumor size was larger. CONCLUSION: Our study has revealed that GATA3 has an inverse relationship with Ki-67, whereas it has a positive releationship with good prognostic factors.

Turkish Midwifery Students' Fear of Delivery Process.

Introduction: Fear affects a person's decision-making process and causes a midwife to make a wrong decision about normal vaginal delivery and cesarean delivery, so research was carried out in order to determine the fields related to delivering process in which students experience the most fear and feel sufficient. Methods: A descriptive/cross-sectional study was performed between September and October 2017. The sample consisted of 732 students selected with the convenience maximum variation sampling method from six universities studying in the third and fourth years of a midwifery program. The study measured data collected with a questionnaire entitled "Midwives' Fear of Delivery Process". The data were analyzed in with the SPSS for Windows using percentage and mean values and Spearman correlation test. Results: In general, students are more afraid of practices with which they say they have more experience such as vaginal palpation (3.30 (0.884), rs=0.131, P<0.001), and they are less afraid of practices (interventional) with which they have less experience such as breech delivery (1.70 (0.915), rs=0.048, P=0.197) or no experience at all and of cases in which they can get hurt. The students feel most sufficient when performing prenatal and postnatal practices. Conclusion: The results of our study parallel the conclusion in the literature that students are afraid of the fields that they have practiced most. Before clinical practice, instructors can determine students' fears and deficiencies in relation to procedures and areas of practice and can develop approaches for alleviating their fears and weaknesses.

The effect of ice pressure applied on large intestinal 4 on the labor pain and labor process.

PURPOSE: This study was designed as an experimental controlled study, aiming to identify the effect of ice massage with short duration (40 min) and long duration (80 min) applied on Large Intestinal 4 (LI4) acupressure point on labor process and perception of labor pain. METHODS: The participants, who met the research criteria according to the results of power analysis, were 72 healthy pregnant women divided into experiment and control group. RESULTS: Results show that ice massage applied on the LI4 region was effective in the 80th minute. Moreover, in terms of the effect of ice massage on labor duration, the application was found to reduce the labor duration of the women in the experimental group approximately 1 h on average. CONCLUSION: It was found that the ice massage applied by midwives on the LI4 point during the active phase of delivery could reduce pain and shorten the delivery duration.