Establishment and Validation of an Automated System for the Antifactor IIa Assay: A Case Study of Potency Assessment of a Pharmaceutical Gel Formulation.

Antithrombotic agents and anticoagulant drugs, such as those from the heparin family, are employed in clinical settings for the prevention and treatment of clotting, thromboembolism, and wound healing. The potency assessment of antithrombotic agents is typically conducted using antifactor IIa assay with manual systems which are time-consuming and often lack repeatability. Here, we present a novel automated system that significantly enhances assay repeatability, attaining an outstandingly low relative standard deviation (RSD) % of only 0.6% for repeatability. This system has been applied to a pharmaceutical gel formulation for wound healing developed by Abdi Ibrahim Pharmaceuticals R&D Center as a case study for validation. The automated system demonstrated substantial improvements over manual systems in linearity (R2 = 0.9927), precision, accuracy, specificity, and robustness. The system aligns with the European Pharmacopoeia specifications, promising to enhance quality control across pharmaceutical formulations and conduct absorbance-based end-point assays within the pharmaceutical industry while offering increased throughput and cost-effectiveness.

Double Cu-Catalyzed Direct Csp3 -H Azidation/CuAAC Reaction: A Direct Approach towards Demanding Triazole Conjugates.

The first one-pot procedure for the double copper(I)-catalyzed oxidative Csp3 -H azidation-CuAAC process, implying unstable azide intermediates and easy-to-remove reagents under water-tolerant conditions, is presented. The combination of tert-butyl hydroperoxide as oxidant and TMSN3 as azide source for the C-H bond azidation, which produces harmless side-products such as tBuOH and H2 O, probed to be perfectly compatible with the following cycloaddition step. Highly demanding 1,2,3-triazoles could be then directly obtained in good overall yields by extraction or simple crystallization, thus avoiding chromatography purifications. The potential of this methodology, has also being highlighted by the successful reaction of alkynes presenting interesting complex biological moieties based for example on biotin, DNA base or cinchona alkaloid units.

The Value of Pre- and Intraoperative Adjuncts on the Extent of Resection of Hemispheric Low-Grade Gliomas: A Retrospective Analysis.

BACKGROUND: To achieve maximal resection with minimal risk of postoperative neurologic morbidity, different neurosurgical adjuncts are being used during low-grade glioma (LGG) surgery. OBJECTIVES: To investigate the effect of pre- and intraoperative adjuncts on the extent of resection (EOR) of hemispheric LGGs. METHODS: Medical records were reviewed to identify patients of any sex, ≥ 18 years of age, who underwent LGG surgery at X Hospital between January 2005 and July 2013. Patients were divided into eight subgroups based on the use of various combinations of a neuronavigation system alone (NN), functional MRI-diffusion tensor imaging (fMRI-DTI) guided neuronavigation (FD), intraoperative MRI (MR), and direct electrical stimulation (DES). Initial and residual tumors were measured, and mean EOR was compared between groups. RESULTS: Of all 128 patients, gross total resection was achieved in 23.4%. Overall mean EOR was 81.3% ± 20.5%. Using DES in combination with fMRI-DTI (mean EOR: 86.7% ± 12.4%) on eloquent tumors improved mean EOR significantly after adjustment for potential confounders when compared with NN alone (mean EOR: 76.4% ± 25.5%; p = 0.001). CONCLUSIONS: Using DES in combination with fMRI and DTI significantly improves EOR when LGGs are located in eloquent areas compared with craniotomies in which only NN was used.

Intraoperative Magnetic Resonance Imaging in Intracranial Glioma Resection: A Single-Center, Retrospective Blinded Volumetric Study.

BACKGROUND: Intraoperative magnetic resonance imaging (IoMRI) was devised to overcome brain shifts during craniotomies. Yet, the acceptance of IoMRI is limited. OBJECTIVE: To evaluate impact of IoMRI on intracranial glioma resection outcome including overall patient survival. METHODS: A retrospective review of records was performed on a cohort of 164 consecutive patients who underwent resection surgery for newly diagnosed intracranial gliomas either with or without IoMRI technology performed by 2 neurosurgeons in our center. Patient follow-up was at least 5 years. Extent of resection (EOR) was calculated using pre- and postoperative contrast-enhanced and T2-weighted MR-images. Adjusted analysis was performed to compare gross total resection (GTR), EOR, permanent surgery-associated neurologic deficit, and overall survival between the 2 groups. RESULTS: Overall median EOR was 92.1%, and 97.45% with IoMRI use and 89.9% without IoMRI, with crude (unadjusted) P < 0.005. GTR was achieved in 49.3% of IoMRI cases, versus in only 21.4% of no-IoMRI cases, P < 0.001. GTR achieved was more with the use of IoMRI among gliomas located in both eloquent and noneloquent brain areas, P = 0.017 and <0.001, respectively. Permanent surgery-associated neurologic deficit was not (statistically) more significant with no-IoMRI, P = 0.284 (13.8% vs. 6.7%). In addition, the IoMRI group had better 5-year overall survival, P < 0.001. CONCLUSION: This study shows that the use of IoMRI was associated with greater rates of EOR and GTR, and better overall 5-year survival in both eloquent brain areas located and non-eloquent brain areas located gliomas, with no increased risk of neurologic complication.

Behaviors toward methods of breast cancer early detection in women over 40 years in a rural region of Ankara, Turkey.

BACKGROUND: In this study, we aimed to determine behaviors of women over 40 years toward methods of breast cancer early detection in a rural region of Ankara, Turkey. METHODS: Of the 1277 women aged over 40 years, 910 (71.3%) participated in the study. RESULTS: Not performing breast self-examination was 3.1 times more frequent in those aged 60 years and older (95% confidence interval [CI], 1.8-5.2), 2.1 times more frequent in those who could only read and write (95% CI, 1.5-2.9), and 2.5 times more frequent in housewives (95% CI, 1.5-4.3). The likelihood of clinical breast exam was 1.8 times less in women aged 60 years old and older compared with younger women. Primary school graduates had a 1.9 times (95% CI, 1.3-2.9) greater chance of not having had a mammography compared with those that been at least primary school graduates. CONCLUSIONS: For women to change their behavior and adopt early methods of diagnosing breast cancer, it is necessary to reach priority target groups during the training provided by primary care institutions.

Spontaneous cervical epidural hematoma causing Brown-Sequard syndrome: case report.

OBJECTIVE: Spontaneously occurring epidural hematoma without any identified etiology is a rare phenomenon. These are often neurosurgical emergencies; therefore, prompt diagnosis and treatment are paramount. Because of the rarity of this condition, we illustrated its presentation, evaluation and management in this recent case. CASE: A 63-year-old male presented to our emergency room with right-sided hemiparesis and contralateral hypoesthesia, consistent with a C5 Brown-Sequard syndrome. An initial evaluation for cerebral infarction was unremarkable, including a negative brain computerized tomography imaging. Cervical magnetic resonance imaging (MRI) revealed a cervical epidural hematoma. The patient underwent emergent laminectomy for decompression and evacuation of the hematoma within 24 hours of presentation to the emergency room. The patient's symptoms improved remarkably after surgery and a 4th-month follow-up MRI evaluation was normal. CONCLUSION: This report highlights the various presentations, evaluation, and management options for this rare diagnosis. It emphasizes the necessity of prompt diagnosis for possible emergent intervention.

The inhibitory effect of suramin on telomerase activity and spheroid growth of C6 glioma cells.

BACKGROUND: The significant roles of telomerase in carcinogenesis and drug resistance have attracted growing attention as potential therapies. The aim of the study was to investigate the effect of suramin on the telomerase activity of C6 glioma cells and on the growth of C6 glioma spheroids. MATERIAL/METHODS: C6 rat glioma cells were treated with suramin at doses of 175 and 250 microM, and also with an increasing dosage for 96 hours. The effect of suramin on monolayer and spheroid cultures was determined by evaluating cell proliferation, spheroid growth, bromodeoxyuridine labeling index, changes of spheroid ultrastructure, and telomerase activity. RESULTS: Suramin inhibited telomerase activity in a dose-dependent manner. Suramin at 250 microM and 175 microM reduced telomerase activity and cell proliferation, spheroid growth, and bromodeoxyuridine labeling index. These groups commonly revealed distorted nuclei (i.e., nucleolus segregation at 250 microM, many vacuoles, vacuole fusions, and smoothing of the cell surface). Contrary to the effects of individually applied suramin, the increased dose of suramin increased telomerase activity but inhibited cell proliferation and bromodeoxyuridine labeling index only at the 24th and 96th hours; it inhibited spheroid growth at the 96th hour. The increased dose of the suramin-treated group showed changes of spheroid ultrastructure similar to those of the control group except for rarely observed vacuoles or vacuole fusion and microvilli. CONCLUSIONS: To the best of our knowledge, this is the first study in the English language to show in vitro cytotoxic effect of suramin via telomerase inhibition on C6 glioma cells and spheroids.

Potentiation of cytotoxicity by combination of imatinib and chlorimipramine in glioma.

Rat C6 glioma is a chemo-resistant experimental brain tumor that is difficult to treat with various drug combinations. Previous studies suggested that imatinib mesylate (Gleevec) is effective in pre-clinical trials for glioblastoma. Also, chlorimipramine (Anafranil) is an anti-depressant drug in use in the clinic and shown to have anti-neoplastic activity. We hypothesized that treatment of resistant C6 glioma with combination of imatinib and chlorimipramine may potentiate cytotoxicity and reverse resistance. C6 glioma was examined both as monolayer and as spheroid cultures. Several experimental designs were examined all of which showed synergistic activity albeit at different time kinetics. Combination treatment resulted in inhibition of cell growth and enhanced cell death as determined by dye exclusion. Further, the combination treatment resulted in significant induction of apoptosis as determined by Annexin V-FITC and PI. Also, there was inhibition of DNA synthesis and cAMP. Altogether, these findings supported the anti-proliferative and cytotoxic effects of the combination treatment. Morphological studies were also performed using transmission and scanning electron microscopy. Significant synergistic apoptosis was detected by the combination treatment in both the monolayers and spheroid cultures. There was also a synergistic effect in autophagy by the combination. Several altered morphological features were noted by both the individual compound and enhanced by the combination treatment. The present findings support our hypothesis and demonstrate the potentiation of cytotoxicity by the combination of imatinib and chlorimipramine in C6 glioma. Further, the findings suggest the potential clinical application of the combination in the treatment of drug-resistant glioma.

Are C-reactive protein and homocysteine cardiovascular risk factors in obese children and adolescents?

BACKGROUND: Several prospective epidemiological studies have demonstrated that high-sensitivity C-reactive protein (hsCRP) and plasma homocysteine (hcy) are predictors of future coronary events among healthy men and women. The aim of the present study was therefore to investigate a possible relationship between hsCRP, hcy levels and body mass index (BMI), relative weight (RW), serum leptin levels, and cardiovascular risk factors in obese children and adolescents. METHODS: The study involved 28 obese children and adolescents (13 girls, 15 boys; BMI>95 per thousand for age and sex), 4.5-15 years of age (mean 10.7 +/- 0.6 years), who attended hospital for a basic obesity check-up. The association between hsCRP, hcy levels and BMI, RW, serum leptin levels, and cardiovascular risk factors such as blood pressure (BP), lipid profile, serum fasting insulin levels, and insulin resistance indexes, was investigated. RESULTS: Serum hsCRP level was positively correlated with BMI (r = 0.512, P < 0.01), RW (r = 0.438, P < 0.05), systolic and diastolic BP (r = 0.498, P < 0.01), serum leptin levels (r = 0.457, P < 0.05), but not with serum lipid, glucose, fasting insulin, plasma hcy levels or insulin resistance indexes. For hcy level, in contrast, no correlation was found with BMI, RW, systolic and diastolic BP, serum lipid levels, leptin, hsCRP, glucose, fasting insulin levels, or insulin resistance indexes. CONCLUSIONS: hsCRP is correlated with BMI, RW, BP and leptin, which are risk factors for coronary heart disease, which supports the relationship between obesity, inflammation and atherosclerosis. hsCRP in childhood obesity might be a useful index to predict possible atherosclerotic events.

Clinical outcome assessment in mammography: an audit of 7,506 screening and diagnostic mammography examinations.

PURPOSE: To perform an audit of our routine mammographic practice and to compare our results to performance benchmarks. MATERIALS AND METHODS: We analyzed the outcomes of 7,506 consecutive examinations performed in 1 year. Screening and diagnostic cases were evaluated separately and mammographic assessments were based on the Breast Imaging Reporting and Data System (BI-RADS) classification. RESULTS: In 6,858 (91%) screening and 648 (9%) diagnostic cases, outcomes varied substantially. The recall rate was 10.9%. Estimated sensitivity and specificity were similar (100% vs. 98% and 88% vs. 94%) in the screening and diagnostic groups. Positive predictive values (PPV1, PPV2, and PPV3) were higher in the diagnostic group compared to the screening group (64%, 65%, and 68% vs. 4.9%, 33%, and 39%, respectively). Cancer outcomes in the screening and diagnostic groups were, respectively, as follows: cancer detection rate, 6.1 per thousand vs. 86.4 per thousand; mean invasive cancer size, 15.7 mm vs. 24.5 mm; minimal cancers, 38% vs. 19%; stage 0-1 cancers, 50% vs. 21%; and lymph node negativity, 76% vs. 29%. CONCLUSION: The measures of our screening outcomes were concordant with the literature and the performance benchmarks for screening mammography; however, in our diagnostic group, the reasons for the higher PPV, higher cancer detection rate, and the diagnosis of cancer in a more advanced stage compared to the performance benchmarks should be investigated with more detailed periodic audits.

Can core biopsy be used instead of surgical biopsy in the diagnosis and prognostic factor analysis of breast carcinoma?

PURPOSE: The aim of this article was to investigate the efficacy of ultrasonography-guided core needle biopsy and prognostic factor analysis of breast cancer to plan overall treatment strategy. PATIENTS AND METHODS: A consecutive series of nonpalpable and palpable breast cancers constituted our study group (n= 201 lesions; mean size, 20.4 mm) Mean number of core samples was 3.4. Malignant lesions diagnosed with core biopsy underwent therapeutic surgical excision. Core biopsy and surgical excisions were compared for histologic type, grade, estrogen receptors (ERs), progesterone receptors (PgRs), and c-erbB2 levels. Cutoff values for ER, PgR, and c-erbB2 affecting the management strategy were selected as 10%, 10%, and 50%, respectively. RESULTS: Eighty-five lesions (42.3%) were malignant in core biopsy (mean size, 18.4 mm). Among these, 11 were inoperable and 13 were surgically excised at other institutions. In 61 lesions, core and surgical excision specimens were evaluated in the same institution (mean tumor size, 18.6 mm; range 6-60 mm). Concordance between the 2 biopsy methods was 85.2% (52 of 61) for histologic type of tumor, 68.8% (33 of 48) for tumor grade, 90% (27 of 30) for ER, 86.7% (26 of 30) for PgR, and 79.3% (23 of 29) for c-erbB2 levels. Appropriate site selection for sampling was indicated to be of paramount importance, especially in determining reliable ER, PgR, and c-erbB2 levels. CONCLUSION: Core needle biopsy of breast cancer is equally effective compared with surgical biopsy and can be used in overall treatment planning. However, appropriate site selection for sampling should be guaranteed using ultrasonographic guidance.

Mammography device use in Turkey, and quantity and quality analysis of mammography education.

PURPOSE: To evaluate in detail the ways and methods of mammography education, to survey currently used mammography devices, and to determine the quality of mammography examinations in Turkey in order to increase the quality of said examinations and to offer guidance to standardization studies in Turkey. MATERIALS AND METHODS: This study depended on the analysis of a questionnaire that was completed by volunteering medical centers. The questionnaire was mailed to all institutions in Turkey with a mammography device and which were registered with the Turkish Atomic Energy Commission and individual city health administration databases (n = 456). RESULTS: It was not possible to determine the exact number of mammography devices in Turkey. In all, 270 questionnaires were completed and returned from the registered centers. Among the mammography devices declared (n = 291), automatic exposure control (AEC), spot view, and magnification view were not used at 21%, 34%, and 43% of the centers, respectively. Preoperative wire localization was not practiced at 180 centers (62%) despite the ability to do so. At 16% of the centers, mammograms were not labeled and at 57% of the centers labeling was handwritten. At 23% of the centers only small cassettes were used, and at 58% the heat and at 94% the humidity of film storage areas were inappropriate or unknown. At 25% of the centers light and at 15% radiation exposure of the film was present. Mammography quality control tests were performed at 40%, and in 70% control records were not well kept. There were no thermometers in 49% of the centers, no phantom breast at 80%, no sensitometer at 93%, and no densitometer at 81%. At 50% of the centers, regular periodic maintenance was not performed. Second look was performed consistently at 12% of the centers and BI-RADS (Breast Imaging Reporting and Data System) categorization was used at 40%. CONCLUSION: The exact number of mammography devices is not officially known in Turkey, and it is apparent that registration of some devices was not made by the Turkish Atomic Energy Commission. Questionnaire responses about mammography education and procedures revealed that there was a serious lack of quality across regions. Education, accreditation, inspection, and sanctions are needed immediately to institute standardization and improve quality. This is a critical situation that should be addressed by the Turkish Society of Radiology.

Clinical evaluation of breast dose and the factors affecting breast dose in screen-film mammography.

PURPOSE: To investigate the factors affecting the mammographic breast dose. MATERIALS AND METHODS: The assessment was done on 622 qualified mammograms obtained with use of "variable kV" technique, i. e., semiautomatic mode, in screen-film mammography. Actual breast doses were calculated and analyzed to determine the roles of two screens and three films, two anode/filter selections (Mo/Mo and Mo/ Rh), three imaging projections (craniocaudal, 45 degrees and 60 degrees mediolateral oblique [MLO]), breast thickness, and breast composition. RESULTS: Min R 2190 screen provided about half dose of Min R screen. All films used with the faster screen resulted in similar doses in < 50 mm thicknesses (mean, 0.9-1.1 mGy) (P > 0.05). The doses were significantly greater in thicker (> or =50 mm) breasts, in dense breasts, and in 45 degrees MLO view, compared to the < 50 mm breasts, fatty breasts and in 60 degrees view (P < 0.05). CONCLUSION: The affecting factors of dose are many, and their complex interrelations are difficult to control in clinical settings. Well tailoring of kVp/anode/filter combination, selection of faster screens and well matched films are mandatory, while 60 degrees instead of 45 degrees in oblique projection can help reducing the dose. However, tailoring of kVp/anode/filter, which should be based on both breast thickness and composition, is difficult to achieve accurately at all times. Therefore, automatic beam quality control should replace the semiautomatic mode in screen-film mammography practice in order to provide easier and more effective control on breast dose and image quality.

The effectiveness of training for breast cancer and breast self-examination in women aged 40 and over.

BACKGROUND: Training on breast health is required to increase awareness of early detection of breast cancer, especially in countries with limited resources. METHODS: Of the 784 invited women, 462 participated in the study (58.9%). The training included both theoretical and breast self-examination (BSE) training between preeducation and posteducation tests. Following the theoretical presentation, breast examination training was performed using a breast simulator. The competency of the participants on breast examination was assessed by an evaluation guide. RESULTS: All breast cancer symptoms were stated at significantly higher rates compared to those before education (P < .05). The most commonly stated risk factor in both preeducation and posteducation tests was "no breast-feeding," with ratios of 15.2% and 56.3%, respectively. Early detection modalities for breast cancer were also stated more often in the posteducation test compared to the preeducation (P < .05). In the preeducation test, only 4.3% to 18.7% of the participant women could state most of the BSE steps. After BSE training, 85% to 92% of the participants were competent in BSE steps. CONCLUSIONS: Theoretical education on breast cancer and BSE training in low-educated women, even illiterate, is highly effective.

Evaluation of the effect of cola drinks on bone mineral density and associated factors.

The aim of the study was to determine bone mineral density changes caused by consumption of cola drinks and the associated factors. Thirty Sprague-Dawley rats were divided into four groups. Groups 1 and 2, consisting of 10 male and 10 female rats, respectively, were provided with as much food, water and cola drinks as they wanted. Groups 3 and 4, consisting of five rats each, received only rat chow and water. The bone mineral density of the rats was measured using dual energy X-ray absorptiometry at the end of 30 days. The blood values and weights of the animals were also determined. The oesophagus and kidneys were removed for histopathological examination. The weight gain was higher in the groups consuming cola drinks than the control group rats (P < 0.05). Water consumption decreased 5.9 times while total fluid consumption increased 1.6-1.9 times in the group consuming cola drinks. No significant change was detected in the blood calcium levels. There was a significant decrease in the bone mineral density of test groups when compared to the control groups (P < 0.05). While we did not detect any pathological oesophageal changes in the rats consuming cola drinks, examination of the kidneys revealed general glomerular congestion and intertubular bleeding. We suggest that the decrease in bone mineral density might be related to the renal damage caused by cola drinks in addition to other related factors.

Association of serum levels of IGF-I and IGFBP-1 with renal function in patients with type 2 diabetes mellitus.

OBJECTIVE: Our aim was to determine whether serum Insulin-like growth factor-I (IGF-I) and Insulin-like growth factor binding protein-1 (IGFBP-1) levels were different between type 2 diabetic patients and non-diabetic control group. We also aimed to establish any relationship that might exist between the serum IGF-I and IGFBP-1 levels with the urinary albumin excretion (UAE), creatinine clearance and urinary N-acetyl-beta-D-glucosaminidase (NAG) excretion (as a marker of renal tubular dysfunction) and other parameters (such as age, duration of diabetes, treatment, etc.) in patients with type 2 diabetes mellitus (DM). DESIGN: Fifty-nine type 2 diabetic patients and thirty-one non-diabetic controls were included in this study. RESULTS: Mean serum IGF-I levels in diabetic patients were lower than the non-diabetic controls (158+/-12 vs. 287+/-26microg/l), (p<0.001). Serum IGFBP-1 levels were also higher in type 2 diabetic patients compared to the control group (67+/-5 vs. 35+/-4microg/l), (p<0.001). No relationship was obtained between IGF-I and IGFBP-1 levels with neither UAE nor urinary NAG excretion. A significant negative relationship was observed between creatinine clearance and serum IGFBP-1 level (r=-0.39, p=0.004). In multiple regression analysis IGF-I was independently and negatively associated with age and insulin treatment. On the other hand, IGFBP-1 was negatively related with creatinine clearance and positively related with the duration of diabetes. CONCLUSION: These results suggest that type 2 DM leads to a decrease in the IGF-I while elevating the IGFBP-1 levels. Further studies are needed to clarify a potential role of increased levels of IGFBP-1 in decreased creatinine clearance in type 2 DM.

Standardization of spine and hip BMD measurements in different DXA devices.

AIM: To compare BMD values of lumbar and hip regions measured in two different DXA scanners in one laboratory, and to investigate the efficiencies of implemented and specifically derived standardization formulas. MATERIALS AND METHODS: PA lumbar (L2-L4) and right femoral neck BMD values were obtained in 100 women (aged 26-75), consecutively in GE-Lunar DPX-NT and Hologic QDR 4500 C DXA scanners. Standardization of BMD values obtained in two different DXA devices was done according to the method developed by International DXA Standardization Committee (IDSC), using the European Spine Phantom (ESP) to obtain the specific constant value. Mean corrected standardized BMD (sBMD) values in two scanners have been compared with each other and with the mean reported sBMD values, respectively. RESULTS: The mean lumbar BMD values were 0.950+/-0.117 g/cm(2) for Hologic and 1.068+/-0.135 g/cm(2) for GE-Lunar (p<0.05); mean corrected sBMD values were 1.035+/-0.128 g/cm(2) for Hologic and 1.035+/-0.131 g/cm(2) for GE-Lunar (p>0.05). The mean femoral neck BMD values were 0.798+/-0.114 g/cm(2) for Hologic and 0.895+/-0.111 g/cm(2) for GE-Lunar (p<0.05); mean corrected sBMD values were 0.869+/-0.124 g/cm(2) for Hologic and 0.867+/-0.108 g/cm(2) for GE-Lunar (p>0.05). The difference between the mean values of BMD and sBMD, both corrected and reported, were statistically important in each scanner (p<0.05). The mean values of corrected and reported sBMD were also statistically different in each scanner (p<0.05; mean standard error in the spine was 1.3 for GE-Lunar and 1.8 for the Hologic device). CONCLUSION: The originally proposed standardization formulae may not optimally correct for manufacturer, model and device-specific differences. Therefore, use of sBMD is not recommended to compare results of individual patients obtained on scanners of different type and brand. The residual error of reported sBMD, however, is substantially smaller than for manufacturer-specific results, and therefore, reporting standardized results is useful for population studies.

Interdigitating dendritic cell tumor with breast and cervical lymph-node involvement: a case report and review of the literature.

Interdigitating dendritic cell tumor (IDCT) is an extremely rare malignancy. It occurs primarily in lymph nodes, but extranodal involvement has also been reported. A 38-year-old woman with IDCT with breast and cervical lymph-node involvement is reported in this paper. To our knowledge, this is the first case of IDCT originating from the breast. In the breast and lymph node, the tumor displayed diffuse sheets, fascicles and storiform growth pattern. It was composed of oval to spindle cells with pale to eosinophilic cytoplasm, ill-defined cell outlines, oval nuclei with vesicular chromatin and prominent eosinophilic nucleoli. Mitotic activity was three per ten high-power fields. The neoplastic cells were intermingled with small mature lymphocytes and plasma cells. Immunohistochemical studies showed that the tumor cells were strongly and diffusely positive for vimentin, CD68, S-100 protein, CD45/leukocyte common antigen and fascin and focally positive for lysozyme, alpha-1 antitrypsin and CD4. Ki-67 labeling index was 10%. The patient was treated with combined therapeutic approaches, including surgery, radiotherapy and chemotherapy. IDCT has the potential for an aggressive clinical course. However, 32 months after the initial diagnosis, the patient is still alive and being followed with a stable tumor burden.

[Differential diagnosis of axillary lymph nodes: Usefulness of gray-scale and color-power doppler sonography]. / Aksiller lenfadenopatilerin ayirici tanisinda griskala ve renkli-power Doppler ultrasonografi.

PURPOSE: To evaluate and compare the usefulness of gray-scale and color-power Doppler sonography in differentiating benign from malignant axillary lymph nodes, and to find out whether the combined usage of both modalities increased the diagnostic accuracy. MATERIALS AND METHODS: Sixty lymph nodes in 59 patients were evaluated by gray-scale and color-power Doppler sonography. Color-power Doppler evaluation was based on the morphological patterns of vascularity. Spectral wave form analysis was also performed. Sensitivity, specificity, positive and negative predictive values and overall accuracy were calculated for each modality and for the combined usage of both modalities. When two modalities were used in combination a lymph node was accepted to be 'malignant' if it was diagnosed as 'malignant' by either or both of the modalities. RESULTS: Forty lymph nodes were confirmed to be malignant and 20 were benign by histopathologic or sytologic examination or by clinical and sonographic follow-up. Gray-scale and color-power sonography had sensitivities of 92%, 89%; specificities of 70%, 75%; positive predictive values of 86%, 87%; negative predictive values of 82%, 79%; and overall accuracies of 85%, 85% respectively. The combined usage of both modalities yielded a sensitivity of 98%, specificity of 70%, positive predictive value of 87%, negative predictive value of 88%, and an overall accuracy of 88%. CONCLUSION: Gray-scale sonography and color-power Doppler examination have the same overall accuracy for the differentiation of benign from malignant axillary lymph nodes. Spectral wave form analysis was proved to be statistically insignificant. The combined usage of both modalities would decrease the number of false negative cases.