Site specific genetic differences in colorectal cancer via Next-Generation-Sequencing using a multigene panel.

AIM: Next-generation sequencing (NGS) has been proposed as a comprehensive and efficient genomic profiling tool to guide personalized therapy for colorectal cancer. This study aimed to review the site-specific difference and the potential benefits of actionable mutation panel for colorectal cancer in relation to the clinicopathological features. MATERIAL AND METHODS: One hundred and six patients who underwent colorectal surgery with curative or palliative intent for histopathologically confirmed carcinoma between June 2016 and June 2018 were identified from a prospectively maintained database. Formalin-fixed, paraffin-embedded tumor tissues were analyzed for actionable variants in 11 genes via NGS (EGFR, ALK, KRAS, NRAS, KIT, BRAF, PDGFRA, ERBB2, ERBB3, ESR1, and RAF1). RESULTS: Most of the primary tumors were in the rectum (49 patients; 46.2%) followed by the right colon (32 patients; 30.1%) and left colon (25 patients; 23.5%), respectively. Of sequenced cases, 43 KRAS mutations, 7 EGFR mutations, 6 NRAS mutations, 6 BRAF mutations, 3 KIT mutations, 1 ERBB2 mutation, 1 PDGFRA mutation, and 1 RAF1 mutation were identified in 106 patients. The frequency of mutations is mostly concentrated on the right colon group. The highest drug resistance observed in all patients was against Cetuximab and Panitumumab, and the highest drug resistance was found in the right colon group (53.1%). CONCLUSIONS: The utility of actionable multigene panel revealed the value of a well-designed next-generation sequencing workflow in the practical use of clinical outcomes via the prediction of responsiveness to therapeutic agents or indications for novel treatment modalities in addition to prognosis estimate. KEY WORDS: Colorectal Cancer, Drug Resistance, Next-Generation Sequencing.

Synchronous and metachronous neoplasms of different histogenesis with gastrointestinal stromal tumor (GIST): 10 years experience of a single institution.

AIM: Gastrointestinal stromal tumors (GISTs) are the most common primary mesenchymal neoplasms of the gastrointestinal tract. Significant advances have been made in its pathogenesis, diagnosis, and treatment over the past few decades. However, little is known about the occurrence of synchronous or methacronous tumors with other histogenesis in addition to GISTs. The aim of this study was to present a series of 15 patients diagnosed with a second primary neoplasm in addition to GIST. MATERIAL AND METHODS: Patients who were diagnosed with both GIST and other primary neoplasm between January 2010 and December 2019 were included in the study. Demographic, clinicopathologic and immunohistochemical parameters of the patients were analyzed along with the follow-up results RESULTS: This study included 12 men and 3 women with a median age of 68 years (range: 57-83 years). Of the GISTs, 93.3% were localized in the stomach and 73.3% were at very low / low risk category. Of the second primary tumors, 66.6% were in the gastrointestinal tract. Detection of the GIST was synchronous in 9 cases, metachronous in 2 cases and preceded the GIST diagnosis in 4 cases. GIST was incidentally found intra-operatively in 3 of the cases. The mean size of the synchronous GISTs was 20 mm while the most common GIST-associated malignancy was gastric adenocarcinoma. The median follow-up times was 62 months (range: 13-129 months). CONCLUSIONS: The prevalence of secondary malignancies in GIST patients is significantly higher than the healthy population. The high occurrence rate of additional primary tumors in GIST patients has focused the attention of surgeons on this problem. While it is not yet clear if there is a causal association or a common genetic mechanism for the concomitant occurrence of GIST with other malignancies, a closer surveillance of GIST patients is needed due to their proved increased prevalence of a second primary tumor especially during the first year after diagnosis. KEY WORDS: Gastrointestinal stromal tumor, Coexistence, Synchronous malignancy, Second neoplasm, Gastric adenocarcinoma.

Aesthetic outcomes of breast-conserving surgery and oncoplastic surgery with the new scale named Quality of Life Questionnaire Breast Reconstruction Module-23.

Purpose: Oncoplastic surgery (OPS) has been developed with the aim of improving breast-conserving surgery (BCS) to provide better aesthetic and functional outcomes for breast cancer patients. We aimed to compare overall quality of life (QoL) and satisfaction with breast reconstruction in patients undergoing BCS and OPS using the Quality of Life Questionnaire Core 30 (QLQ-C30) and recently validated QLQ-Breast Reconstruction module (QLQ-BRECON23). Methods: A total of 87 patients were included in this single-center study between January 1, 2018 and December 31, 2021; 43 underwent OPS (49.4%) and 44 underwent BCS (50.6%). The data on patient, tumor, and treatment characteristics were obtained from the prospectively collected database at the hospital. QLQ-C30 and QLQ-BRECON23 were used to evaluate psychosocial well-being, fatigue symptoms, overall QoL, sexual well-being, sensation of the operative area, and satisfaction with the reconstruction. Results: According to QLQ-C30 evaluation there were significantly better outcomes for patients treated with OPS than BCS in terms of psychosocial well-being, fatigue symptoms, and overall QoL (P = 0.005, P = 0.016, and P = 0.004; respectively), according to QLQ-BRECON23 evaluation there were also significantly better outcomes in terms of sexual well-being, sensation of the operative area, and satisfaction of the reconstruction (P < 0.001, P = 0.002, and P < 0.001; respectively). Conclusion: We found that the overall QoL and satisfaction with breast reconstruction in patients undergoing OPS are better than those undergoing BCS. Our study is critical because it is the first study comparing OPS and BCS using the QLQ-BRECON23, which was recently validated.

Peritoneal sarcomatosis due to undifferentiated pleomorphic sarcoma: A case report and review of the literature.

Undifferentiated pleomorphic sarcoma (UPS), which was previously known as malignant fibrous histiocytoma (MFH), rarely presents in the abdomen, and sarcomatosis due to UPS has not yet been reported in the literature. Here, we present a 62-year-old man who had abdominal sarcomatosis due to UPS with a poor prognosis.

The role of C-reactive protein ratio in predicting mortality in patients with Fournier gangrene.

PURPOSE: This study aimed to determine the C-reactive protein (CRP) ratio for the survival of patients with Fournier gangrene (FG). METHODS: Fifty-two patients with FG between January 2011 and September 2018 were retrospectively analyzed. Data on clinical presentation, Fournier Gangrene Severity Index (FGSI), CRP ratio, management, and outcome were analyzed. The CRP ratio was calculated as preoperative CRP/postoperative CRP value that measured 48 hours after surgical intervention. Possible alternative cutoff points for the FGSI and CRP were determined by receiver operating characteristic (ROC) analyses. The risk factors related to the prognosis were evaluated by univariate and multivariable logistic regression analyses. RESULTS: The mean CRP ratios were 6.7±6.6 in the survivor group and 1.2±0.8 in the nonsurvivor group (P=0.001). FGSI was significantly higher in the non-survivor group compared to survivor group (8.5±2.5 vs. 3.5±2.2, P=0.001). There was a negative correlation between FGSI and CRP ratio (r=-0.51). ROC analysis determined the cutoff value as 1.78 for CRP (sensitivity, 86%; specificity, 82%; area under the ROC curve, 0.90) to predict death. The incidence of death for patients with CRP ratio of ≤1.78 increased 26.7 fold for those with CRP ratio of >1.78 (95% confidence interval [CI], 4.8-146.5; P=0.001). In the multivariable logistic regression model, CRP ratio (odds ratio [OR], 10.3; 95% CI, 1.5-72.2; P=0.019) and FGSI (OR, 17.8; 95% CI, 2.6-121.1; P=0.003) were independent risk factors for death. CONCLUSION: The CRP ratio is a simple method to use to predict mortality in FG.

Incidental gallbladder cancer: a retrospective clinical study of 40 cases.

Purpose: Cholecystectomy is one of the most common surgeries today due to gallbladder diseases. The most prevalent malignancy of the biliary tract is gallbladder cancer. We aimed to discuss the results of our patients who underwent cholecystectomy for benign reasons in our clinic and who had gallbladder cancer due to pathology. Methods: The results of cholecystectomy performed in General Surgery Clinic of Seyhan Government Hospital were evaluated. Cases diagnosed as gallbladder as a result of histopathological examination were included. Preoperative ultrasonography, laboratory findings, and postoperative pathology results of the patients were reviewed retrospectively. The pathologist repeated histopathological evaluations. Results: Between 2010 and 2019, incidental gallbladder cancer (IGBC) was detected in 40 patients (0.3%) in 11,680 cholecystectomy operations. Of the patients diagnosed with IGBC, 14 (35.0%) were T1a, 11 (27.5%) were T1b, 11 (27.5%) were T2, and 4 (10.0%) were T3. T4 tumor was not seen in any patient. Three patients who were T1b at initial evaluation were identified as T2 at evaluation for the study. The pathology results of 37 patients (92.5%) were adenocarcinoma, 2 (5.0%) were adenosquamous type, and 1 (0.5%) was squamous cell carcinoma. Conclusion: There has been a remarkable increase in the number of IGBCs over the past 20 years. Appropriate staging and histopathological evaluation are essential in guiding the surgeon's operation. It is crucial to accurately determine the T stage, the most influential parameter on patient survival and residual recurrences. The distinction between pathologic (p) T1a and pT1b should be made carefully. Surgery is the only potentially curative method.

Modified techniques versus Hadfield's procedure in patients with periductal mastitis.

BACKGROUND: Periductal mastitis (PM) is a rare disease characterized by chronic inflammation of the terminal mammary ducts. Complete removal of terminal lactiferous ducts with Hadfield procedure is a previously defined technique in treatment but carries various complications risks. This study aims to evaluate the effectiveness of modified techniques in the treatment of PM. METHODS: Twenty women who underwent surgery due to PM between January 2012 and December 2019 were retrospectively analyzed. Types of PM were determined. All patients were operated on with three different incisions [Hadfield's operation with periareolar incision (n:11), periareolar combined radial incision (n:7), and round block incision (n:2)]. RESULTS: The mean age was 37.5 ± 6.5 years (range: 24-49). Sixty percent of patients had type 3 PM. In Hadfield's procedure, NAC retraction (n:2), seroma (n:1), and hematoma (n:1) were seen. In the periareolar incision combined radial incision group only one patient had complications (seroma) and none in the round block method. Follow-up was 12 ± 1.5 months and disease relapse occurred in two patients in the Hadfield group. Patients who underwent round block were more satisfied with the appearance of the nipple. CONCLUSIONS: In the treatment of PM, the main principle of surgical treatment is the excision of the affected canal with a clear margin. Apart from the classical Hadfield procedure, the round block method and periareolar combined radial incision techniques can be performed in the treatment of PM.

The effect of transverse fascia inversion on postoperative seroma in direct hernias treated with laparoscopic TAPP procedure.

AIM: This study aims to reveal the results of the transverse fascia inversion technique applied in laparoscopic transabdominal preperitoneal (TAPP) procedure to reduce the risk of seroma in direct hernias. MARIAL AND METHODS: Patients who underwent elective inguinal hernia repair with the laparoscopic TAPP procedure were retrospectively evaluated. Indirect inguinal or femoral hernias and emergency operations were excluded, and only patients with direct or indirect + direct inguinal hernia were included in the study. The patients were divided into two groups as those with and without transverse fascia inverted. Operative and postoperative clinical features were compared. RESULTS: Sixty-two patients with 75 inguinal hernias were included in our study. Six of the patients were women. Thirty-one patients had a right inguinal hernia, 18 patients had left, and 13 patients had a bilateral inguinal hernia. The operation time was longer in the inversion group, but this was not statistically significant. One-day postoperative pain and postoperative hospital stay were similar in the two groups. In the inversion group, the peritoneal breach occurred in 4 patients, and gonadal vessel injury occurred in 1 patient (p = 0.435, p = 0,376, respectively). When postoperative complications are examined, there was no statistical difference between subcutaneous emphysema, urinary retention, and hematoma development (p>0.005); however, seroma formation was lower in the inversion group (p = 0.031). CONCLUSION: Inversion and fixing the direct hernia pouch to the cooper ligament reduces the risk of seroma formation in the laparoscopic TAPP procedure. KEY WORDS: Direct hernia, Laparoscopy, Seroma, Transabdominal preperitoneal procedure.

Parasitic Appendicitis in 14.797 Cases: A Retrospective Cohort Study

Objective: This study aimed to determine the frequency of Enterobius vermicularis in appendectomy specimens and evaluate the histopathological characteristics of adult and pediatric cases with E. vermicularis infection. Methods: Appendectomies examined from 1 January 2010, to 1 December 2020, were analysed retrospectively. Cases were divided into two groups: under 18 years (children) and 18 and over (adults). Demographic and histopathological characteristics of patients were also examined. Results: Out of 14.797 patients that underwent appendectomy, 6.130 were children and 8.667 were adults. E. vermicularis was detected in 268 patients, wherein 64.2% were children and 35.8% were adults. In the detection of E. vermicularis in appendectomy specimens, the frequency was higher in children compared to that in adults (2.85%, 1.1%, respectively) (p<0.001). Histopathologically, acute appendicitis was defined in 31.7% (n=85) of 268 cases, and E. vermicularis was found to cause a higher rate of acute appendicitis in adults (p<0.001). Conclusion: The frequency of E. vermicularis in appendectomy specimens is higher in children. However, E. vermicularis causes acute appendicitis more frequently in adults.

Surgical myotomy and anterior fundoplication for achalasia disease. Short-term outcomes.

AIM: Achalasia is a well-known disease among esophageal motility disorders, and all treatments for this disease are aimed at relaxing the lower esophageal sphincter (LES). Recently, endoscopic and surgical myotomy techniques are used more frequently because they give better results than other conservative techniques. In this study, we aimed to present the early results of surgical myotomy and anterior fundoplication techniques in the treatment of achalasia-related dysphagia. METHODS: Our study enrolled patients who operated with laparoscopic myotomy and anterior fundoplication for achalasia between 2014 and 2019. Patients' demographic and clinical properties, operative details, and postoperative shortterm outcomes were retrospectively analyzed. RESULTS: A total of 25 patients (11 women, 14 men) were enrolled. The mean age was 40.72±13.6 (range 18-66) years. The mean LES pressure was 26.6±11.2 (range 16-50) mmHg. The mean esophageal myotomy length was 7.83±1.88 (range 7-12 cm). Esophagus perforation developed in one patient during myotomy. The mean time to start oral feeding was 2.56±0.76 (range 2-4) days, and the mean length of hospital stay was 4.96±1.17 (range 3-8) days. During the follow-up, symptom regression was observed in 92 % of patients at the end of a 1-year. CONCLUSION: According to our results and available literature, myotomy with Dor fundoplication is an effective technique that can be used to treat achalasia disease. KEY WORDS: Achalasia, Dor fundoplication, Heller myotomy.

Assessment of demographic, clinical and histopathological features of patients who underwent appendectomy due to a presumed diagnosis of acute appendicitis.

BACKGROUND: To compare the clinical, biochemical, and histopathological features of patients who underwent appendectomy due to a presumed diagnosis of acute appendicitis (AAp). METHODS: The demographic, biochemical and histopathological data of 8206 patients who underwent appendectomy for AAp between January 2006 and March 2014 were retrospectively analyzed in this study. Patients were compared regarding the following characteristics: disruption by season (autumn vs. winter vs. spring vs. summer), working days (weekdays vs. weekends), histopathological findings (AAp vs. normal appendix [NAp]) and histopathological subgroup (non-perforated AAp vs. perforated AAp vs. NAp). RESULTS: Of the 8206 patients aged between 16 and 89 years, 4763 (58.0%) were male. Appendectomy distribution by season was as follows: autumn (n=1959; 23.9%), winter (n=2062; 25.1%), spring (n=2061; 25.1%) and summer (n=2124, 25.9%). NAp rates were higher in summer than those in other seasons. White blood cell (WBC) and neutrophil levels were significantly higher in autumn and winter compared with those in other seasons. In total, 6120 (74.6%) appendectomies occurred on weekdays and 2086 (25.4%) on weekends. WBC and neutrophil levels were significantly higher on weekends than those on weekdays. Appendectomy distribution by histopathological groups as follows: AAp (n=7414; 90.3%) and NAp (n=792; 9.7%). Appendectomy distribution by histopathological subgroups was as follows: non-perforated AAp (n=6966; 84.9%), perforated AAp (n=448; 5.5%), and NAp (n=792; 9.7%). WBC, neutrophil, and TBil levels in the non-perforated and perforated AAp groups were significantly higher than in the NAp group. While most of the patients with perforated AAp (62.1%) and non-perforated AAp (59.6%) were males, most of the patients with NAp (58.1%) were females. CONCLUSION: This study suggests that a relationship exists between demographic features, histopathological findings of appendectomy specimens, seasons, days of the week, and working days in patients undergoing appendectomy.

Laparoscopic revisional surgery for failed anti-reflux procedures.

AIM: Failure ratio of an anti-reflux surgery is 2-17% in adults. After unsuccessful fundoplications, if necessary, revisional surgeries can be performed. Revisional surgeries are technically difficult to perform and require professionally advanced experience. On the other hand, it is still controversial which technique should be used in revisional surgery. The aim of this study is to present our experience with revisional surgical procedures for complications or recurrences after anti-reflux surgeries. MATERIAL AND METODS: A total of 18 patients, 16 of whom were referred to our clinic from other centers, and who underwent revisional surgery for failed fundoplication between 2014 and 2019 were retrospectively analyzed RESULTS: Five patients were male and 13 were female. The mean age was 40.3±11.7 years. The most common symptom was the persistence of reflux symptoms (61.2%). Indications for revisional surgery were recurrent hiatal hernia in 10 patients, thightness in 4 patients, mesh migration in 2 patients, mesh migration with recurrent hiatal hernia in 1 patient, and mesh migration with thightness in 1 patient. The mean operative time was 107.2+29.2 minutes. The median hospital stay was 2.9 days (range: 1-6 days). The most common surgical procedure performed was the repair of hiatal crura with mesh, and reconstruction of fundoplication and fixation of neo-fundoplication to the right crus (44.4%). In addition, other surgical procedures performed were takedown of the previous fundoplication (16.6%), takedown of the previous fundoplication and reconstruction of fundoplication (11.1%), cruroplasty and fundoplication with gastric wedge resection (11.1%), removal of the mesh and takedown of the previous fundoplication (5.6%), removal of sutures from the hiatal crura (5.6%), and gastric wedge resection (5.6%). Four patients (27.8%) developed morbidity due to gastric perforation and pleural opening during these procedures. The median follow-up period was 29 months (range: 6-69 months). Two cases (11.1%) who underwent revisional surgery failed, and re-revisional surgery was performed. CONCLUSIONS: Revisionary surgical procedures performed for failed anti-reflux surgery are not limited to re-fundoplication. Different procedures such as takedown of the previous fundoplication, reconstruction of fundoplication, removal of the mesh, removal of the sutures or wedge resection may be necessary. These procedures can successfully be performed laparoscopically by experienced surgeons in well-equipped centers. KEY WORDS: Fundoplication, Gastroesophageal reflux, Laparoscopy, Revisional Surgery, Antireflux surgery.

Laparoscopic versus open total radical gastrectomy for advanced gastric cancer: surgical outcomes.

AIM: The aim of this study is to compare the oncologic efficacy of laparoscopic total gastrectomy (LTG) versus open total gastrectomy (OTG) for gastric cancer and to provide our experiences regarding this surgery. METHODS: A total of 107 patients who underwent curative total gastrectomy for gastric adenocarcinoma between September 2015 and September 2018 were included in this study. Demographic characteristics, operative parameters, histopathological results, postoperative morbidity and mortality results of the patients were evaluated. RESULTS: Of 107 patients, 70 were men and 37 women. OTG consisted of 89 patients and LTG consisted of 18 patients. The mean age in OTG was 59.4 years, the mean age in LTG was 57.3 years. The mean number of lymph nodes harvested was 30.5 14.6 in OTG and 33.0 10.1 in LTG. The number of metastatic lymph nodes harvested was 7.4 10.5 in OTG and 10.0 11.8 in LTG (p= 0.366), and there was no statistical difference between the two groups. The time of onset of oral intake, anastomotic leakage, and postoperative mortality was similar in both groups. Operative duration and length of hospital stay were significantly higher in LTG. Postoperative survival duration was similar in both procedures CONCLUSION: Laparoscopic total gastrectomy for gastric cancer is an oncologically safe procedure but had a longer operation time and a longer hospital stay. There was no significant difference number of harvested lymph nodes, number of metastatic lymph nodes, and tumor localization between the two groups KEY WORDS: Gastric cancer, Laparoscopy, Gastrectomy.

Laparoscopic versus open total radical gastrectomy for advanced gastric cancer: surgical outcomes.

AIM: The aim of this study is to compare the oncologic efficacy of laparoscopic total gastrectomy (LTG) versus open total gastrectomy (OTG) for gastric cancer and to provide our experiences regarding this surgery. METHODS: A total of 107 patients who underwent curative total gastrectomy for gastric adenocarcinoma between September 2015 and September 2018 were included in this study. Demographic characteristics, operative parameters, histopathological results, postoperative morbidity and mortality results of the patients were evaluated. RESULTS: Of 107 patients, 70 were men and 37 women. OTG consisted of 89 patients and LTG consisted of 18 patients. The mean age in OTG was 59.4 years, the mean age in LTG was 57.3 years. The mean number of lymph nodes harvested was 30.5±14.6 in OTG and 33.0±10.1 in LTG. The number of metastatic lymph nodes harvested was 7.4±10.5 in OTG and 10.0±11.8 in LTG (p= 0.366), and there was no statistical difference between the two groups. The time of onset of oral intake, anastomotic leakage, and postoperative mortality was similar in both groups. Operative duration and length of hospital stay were significantly higher in LTG. Postoperative survival duration was similar in both procedures CONCLUSION: Laparoscopic total gastrectomy for gastric cancer is an oncologically safe procedure but had a longer operation time and a longer hospital stay. There was no significant difference number of harvested lymph nodes, number of metastatic lymph nodes, and tumor localization between the two groups KEY WORDS: Gastric cancer, Laparoscopy, Gastrectomy.

Giant pedunculated colonic lipoma causing colo-colic intussusception in a patient with mechanical ileus.

A giant colonic lipoma causing colo-colonic intussusception is extremely rare in adults. A 35-year-old woman visited our emergency room with abdominal pain, abdominal distension, nausea and vomiting. Physical examination showed a painful distended abdomen. Abdominal computed tomography revealed that there was a soft-tissue mass with a fat density of approximately 6 cm in diameter in the distal part of the transverse colon. Since the clinical presentation was that of a mechanical ileus, a laparotomy was performed. An intussusception was detected in the transvers colon. A soft and mobile mass was palpated in the transverse colon. Therefore, an extended right hemicolectomy with ileo-transversostomy was performed. Pathological examination revealed a giant pedunculated lipoma of 7 cm in diameter with no evidence of malignancy. Colonic lipomas are the third most common benign pathology seen in the colon. They are more common in women with a peak incidence between 50 and 60 years of age. The most common site of lipomas in the large bowel is the right hemicolon. Colonic lipomas are usually asymptomatic but may cause bleeding, obstruction, intussusception, or abdominal pain. Colonic lipoma causing colo-colic intussusception is extremely rare in the current literature. Surgical approach remains the treatment of choice for giant colonic lipomas. A colonic lipoma causing colo-colic intussusception should be considered in the differential diagnosis of mechanical bowel obstruction. The most important factor for establishing the diagnosis of intussusception caused by a colonic lipoma is awareness of the possibility, especially in adult patients with abdominal symptoms and episodes of intestinal obstruction. KEY WORDS: Colon, Lipoma, Colonic lipoma, Intussusception, Intestinal obstruction, Ileus.

Recent classifications systems for gastroenteropancreatic neuroendocrine tumors A single-center experience.

AIM: In this study, we aimed to review the demographic histopathological and clinical findings and long-term results of our GEP-NET cases, as well as to re-evaluate our cases according to the new classification systems. MATERIAL AND METHOD: 46 patients diagnosed as GEPNETs were presented. Immunohistochemical studies were performed in all cases. The cases were divided into 3 groups according to their embryogenic origin (Foregut, Midgut and Hindgut). All cases re-evaluated according to recent WHO (2019) and AJCC (2017) TNM calcification. Investigation was made to find differences between the embryonic origins and to find correlation between stage and grading systems with each other. RESULTS: The most common localization was appendix (52.3%) The distribution of cases according to embryologic origin were as follows: foregut tumors 13 cases (27.7%), midgut tumors 27 cases (57.4%) and hindgut tumors in 6 cases (12.8%). The Ki-67 ratio was evaluated in all patients, with a mean of 6.34%±2.51 (range: 1-80). The Ki-67 ratio was less than 3% in 82.6% of patients. Mitotic count was less than 2 per/10 HPF in 76% of patients. According to WHO 2019 most of patients were Grade 1 Neuroendocrine Tumor (65.2%) and there were only 2 Neuroendocrine Carcinoma (NEC) cases. According to AJCC 2017 most cases were Stage 1 (52.1%) and only 4 cases were Stage 4. The grades and stages of our cases were statistically significantly correlated. Overall survival did not differ significantly with regard to embryologic origin (log-rank test, p=0.062). The median overall survival was 106±7.4 months. The 5-year cumulative survival rate was 84.1±5.6 years. Seven patients died during this time with a median time of 5 months (range: 1-31 months). In the Cox regression analysis, the percentage of Ki- 67 was found to have a statistically significant effect on overall survival (p=0.000) CONCLUSION: Correlation was noticed between WHO 2019 and AJCC 2017 classification for grade and stage and controlled trials must be undertaken to develop a single diagnostic algorithm and to change the future management of such patients. KEY WORDS: Neuroendocrine Tumors, Gastroenteropancreatic neuroendocrine tumor.

Relationship between clinical and histopathological features of patients undergoing cholecystectomy.

INTRODUCTION: Cholelithiasis is most common disease of the gallbladder and cholecystectomy is the one of the most performed surgical procedure worldwide. AIM: To assess the relationship between the demographic, biochemical, and histopathological variables of patients who underwent cholecystectomy. MATERIAL AND METHODS: Demographic, biochemical, and histopathological data of 5077 patients undergoing cholecystectomy were compared in terms of two different aspects: open cholecystectomy (OC group; n = 2090) versus laparoscopic cholecystectomy (LC group; n = 2987), and an elective group (n = 4814) versus an emergency group (n = 263). RESULTS: A total of 5077 patients aged between 13 and 97 years were included in the study. Aspartate aminotransferase (AST) levels, alanine aminotransferase (ALT) levels, mean platelet volume, and prevalence of acute/chronic cholecystitis were significantly higher in the LC group than in the OC group. On the other hand, age, direct bilirubin level, thrombocyte count, and prevalence of gallbladder cancer/gangrenous cholecystitis were significantly higher in the OC group than in the LC group. Levels of AST, ALT, white blood cells, neutrophils, and some prevalence of acute/chronic active cholecystitis were higher in the emergency group than in the elective group. On the other hand, the lymphocyte count and prevalence of chronic cholecystitis/hyperplastic polyps were higher in the elective group than in the emergency group. Histopathological analysis identified 32 patients with malignant gallbladder cancer as follows: adenocarcinoma (n = 21), mucinous adenocarcinoma (n = 3), papillary adenocarcinoma (n = 3), adenosquamous carcinoma (n = 1), clear cell adenocarcinoma (n = 2), squamous carcinoma (n = 1), and hepatocellular carcinoma metastasis (n = 1). CONCLUSIONS: Even when the appearance of gallbladder specimens is normal, histopathological assessment allows for early diagnosis of many unusual findings such as gallbladder cancer.

Retained gallbladder stones in trocar site hernia.

AIM: Retained stones after laparoscopic cholecystectomy occur after perforated gallbladder during surgery. A trocar site hernia with 8 retained gallstones is presented. PATIENT-METHOD: A 54-year-old female presented to our clinics with a paraumbilical hernia in trocar site. The patient had laparoscopic cholecystectomy in another hospital one year ago. Retained stones were noticed in the trocar site while preparing patients for hernia surgery. The patient had laparoscopic hernia repair with the removal of retained stones. 8 stones sized up to 2 cm were taken out of the abdomen. It seems to be the first case of retained stones in trocar site hernia. CONCLUSION: Gallbladder perforations are common during laparoscopic cholecystectomy due to traction with forceps or inflammation. Careful inspection for spillage stone should be done. KEY WORDS: Laparoscopic cholecystectomy, Retained Stones, hernia, Trocar Site.

Assessment of the relationship between clinical and histopathological features in cases of thyroidectomy.

AIM: The aim of this study is to evaluate the relationship between clinical parameters and ultimate histopathologic features of patients underwent thyroid surgery. METHOD: Demographic and clinicopathologic parameters of patients who underwent thyroid surgery for benign or malignant disease in our clinic between June 2006 and March 2014 were retrospectively reviewed. Pearson's Chi-Square, Independent Sample T test, ROC Curve and Youden J Index were used to investigate whether there was any relationship between the clinical parameters and permanent histopathologic features of patients. RESULTS: A total of 3059 patients (Benign: 2727; Malign: 332) aged between 15 and 90 years were reviewed. The patients age was higher in malign group (mean ± SD: 46.8 ± 4.2) than benign group (mean ± SD: 43.7 ± 12.9 yr) and this difference was statistically significant (p <0.001). The nodule diameter (mean ± SD: 30.8 ± 13.5 mm) was greater in malign group than the benign group (mean ± SD: 28.3 ± 13.4 mm) and this difference was statistically significant (p = 0.002). The sensitivity and specificity rates of the most appropriate cut-off point (> 26 mm) for the nodule size were 60% and 49.05%, respectively. Sensitivity, specificity, positive predictive value, negative predictive value and accuracy of FNAB were calculated as 4.17 %, 100 %, 100 %, 89.96% and 90 %, respectively. CONCLUSION: This study showed that higher age and greater nodule diameter (> 26 mm) are associated with malignancy. KEY WORDS: Age, Large Nodule Diameter, Risk factors, Thyroid disease,Thyroid Cancer.

Bochdalek hernia: A rare case report of adult age.

INTRODUCTION: Bochdalek hernia is the most common type of congenital diaphragmatic hernia and constitutes 85% of cases. Bochdalek hernia (BH) in adults is extremely rare. We present a BH case in an adult patient and discuss the literature. PRESENTATION: 22-year-old female patient with abdominal pain, occasional cramps, dysphagic problems, constipation, shortness of breath and choking for about 2 years applied to our clinic. DIAGNOSIS: A defect about 5 cm in the left hemidiaphragm posterior area and herniation of intra-abdominal fat plan in the left hemithorax was seen in intravenous and oral whole abdominal CT. TREATMENT: Patient was operated laparoscopically. Transverse colon and a large portion of the omentum entering into hemidiaphragm were pulled in to intraperitoneal area carefully. Approximately 10 × 8 cm intraabdominal mesh was fixed to the defect area with the help of laparoscopic tacker. CONCLUSION: Adult BH is very rare and when confronted laparoscopic treatment with mesh fixation can be performed safely.