The Effectiveness of Adjuvant PD-1 Inhibitors in Patients With Surgically Resected Stage III/IV Acral Melanoma.

Our aim was to assess the efficacy of adjuvant programmed cell death protein-1 (PD-1) inhibitors and compare the other adjuvant treatments in patients with surgically resected stage III or IV acral melanoma. This study is a multicenter, retrospective analysis. We included 114 patients with stage III or IV acral malignant melanoma who underwent surgery within the past 10 years. We analyzed the effect of adjuvant programmed cell death protein-1 inhibitors on disease-free survival (DFS). The mean follow-up was 40 months, during which 69 (59.5%) patients experienced recurrence. Among the participants, 64 (56.1%) received systemic adjuvant therapy. Specifically, 48.4% received anti-PD-1 therapy, 29.7% received interferon, 14.1% received tezozolomide, and 7.8% received B-Raf proto-oncogene/mitogen-activated protein kinase inhibitors. Patients who received adjuvant therapy had a median DFS of 24 (10.9-37.2) months, whereas those who did not receive adjuvant therapy had a median DFS of 15 (9.8-20.2) months. Multivariate analysis for DFS revealed that the receipt of adjuvant therapy and lymph node metastasis stage were independent significant parameters ( P = 0.021, P = 0.018, respectively). No statistically significant difference was observed for DFS between programmed cell death protein-1 inhibitor treatment and other adjuvant treatments. Regarding overall survival (OS), patients who received adjuvant treatment had a median OS of 71 (30.4-111.7) months, whereas those who did not receive adjuvant treatment had a median OS of 38 (16.7-59.3; P = 0.023) months. In addition, there were no significant differences in OS observed between various adjuvant treatment agents ( P = 0.122). In our study, we have shown that adjuvant therapy had a positive effect on both DFS and OS in patients with stages III-IV acral melanoma who underwent curative intent surgery. Notably, we found no significant differences between anti-PD-1 therapy and other adjuvant therapies.

Increased circulating interleukin-23 level in patients with sarcoidosis.

BACKGROUND: Sarcoidosis is a Th1-mediated chronic inflammatory disease characterized by non-caseating granulomas. Its pathogenesis is not yet clear, but the possible role of various proinflammatory cytokines is being discussed. AIM: This study aims to determine serum cytokine (IL-6, IL-12, IL-17, and IL-23) levels in patients with sarcoidosis, and to determine a possible correlation with clinical and laboratory findings of the disease. MATERIAL AND METHOD: Forty-four biopsy-proven sarcoidosis patients followed up at a single centre and 41 healthy volunteers were included in the study. Demographic, clinical, laboratory, and radiological data of all patients were recorded. Serum samples from the patients and the control group were taken and IL-6, IL-12, IL-17, IL-23 were measured by ELISA method. RESULTS: Of the 44 sarcoidosis patients, 13(29.5%) were male and 31(70.5%) were female. Average patient age was 47.4 years, mean disease duration was 3.2 years. Twenty-one (47.7%) patients had erythema nodosum, three (6.8%) had uveitis, 40(90.9%) had arthralgia, 23(52.3%) had ankle arthritis, 15(34.1%) had enthesitis. Laboratory evaluation showed increased serum ACE levels in 24(54.5%) patients, increased serum calcium levels in 11 (25%) patients, increased serum D3 levels in 5(11.4%) patients, increased ESR and CRP levels in 22(50%) and 23(52.3%) patients, respectively. Compared with the control group higher serum IL-23 levels were found in the patients with sarcoidosis (p=.01). Serum IL-23 was associated with ankle arthritis (p=.02). Serum IL-6, IL-12, and IL-17 levels were similar in the sarcoidosis patients and the control group (p=.128, p=.212, p=.521 respectively). CONCLUSION: In our study, we found increased serum IL-23 in patients with sarcoidosis, while serum IL-6, IL-12, and IL-17 were detected as normal. Although our results are somewhat contradictory to other studies in the literature, the question should still be whether sarcoidosis is a Th1/Th17 disease. Multicentre studies are needed in this regard.

Increased circulating interleukin-23 level in patients with sarcoidosis / Incremento del nivel circulante de interleucina 23 en los pacientes con sarcoidosis

Background: Sarcoidosis is a Th1-mediated chronic inflammatory disease characterized by non-caseating granulomas. Its pathogenesis is not yet clear, but the possible role of various proinflammatory cytokines is being discussed. Aim: This study aims to determine serum cytokine (IL-6, IL-12, IL-17, and IL-23) levels in patients with sarcoidosis, and to determine a possible correlation with clinical and laboratory findings of the disease. Material and method: Forty-four biopsy-proven sarcoidosis patients followed up at a single centre and 41 healthy volunteers were included in the study. Demographic, clinical, laboratory, and radiological data of all patients were recorded. Serum samples from the patients and the control group were taken and IL-6, IL-12, IL-17, IL-23 were measured by ELISA method. Results: Of the 44 sarcoidosis patients, 13(29.5%) were male and 31(70.5%) were female. Average patient age was 47.4 years, mean disease duration was 3.2 years. Twenty-one (47.7%) patients had erythema nodosum, three (6.8%) had uveitis, 40(90.9%) had arthralgia, 23(52.3%) had ankle arthritis, 15(34.1%) had enthesitis. Laboratory evaluation showed increased serum ACE levels in 24(54.5%) patients, increased serum calcium levels in 11 (25%) patients, increased serum D3 levels in 5(11.4%) patients, increased ESR and CRP levels in 22(50%) and 23(52.3%) patients, respectively. Compared with the control group higher serum IL-23 levels were found in the patients with sarcoidosis (p=.01). Serum IL-23 was associated with ankle arthritis (p=.02). Serum IL-6, IL-12, and IL-17 levels were similar in the sarcoidosis patients and the control group (p=.128, p=.212, p=.521 respectively). Conclusion: In our study, we found increased serum IL-23 in patients with sarcoidosis, while serum IL-6, IL-12, and IL-17 were detected as normal.(AU)

Antecedentes: La sarcoidosis es una enfermedad inflamatoria crónica mediada por Th1, caracterizada por granulomas no caseificantes. Su patogenia no está clara todavía, aunque se está debatiendo el posible rol de las diversas citocinas proinflamatorias. Objetivo: El objetivo de este estudio es determinar los niveles de citocinas séricas (IL-6, IL-12, IL-17 e IL-23) en los pacientes con sarcoidosis, así como establecer una posible correlación con los hallazgos clínicos y de laboratorio de la enfermedad. Material y método: Se incluyó en el estudio a 44 pacientes con sarcoidosis verificada mediante biopsia, cuyo seguimiento se realizó en un único centro, y 41 voluntarios sanos. Se registraron los datos demográficos, clínicos, de laboratorio y radiológicos de todos los pacientes. Se tomaron muestras séricas de los pacientes y el grupo control, midiéndose los niveles de IL-6, IL-12, IL-17 e IL-23 mediante el método ELISA. Resultados: De los 44 pacientes con sarcoidosis, 13 (29,5%) fueron varones y 31 (70,5%) fueron mujeres. La edad media de los pacientes fue de 47,4 años, y la duración media de la enfermedad fue de 3,2 años. Veintiún (47,7%) pacientes tenían eritema nudoso, 3 (6,8%) tenían uveítis, 40 (90,9%) tenían artralgia, 23 (52,3%) tenían artritis de tobillo y 15 (34,1%) tenían entesitis. La evaluación de las pruebas de laboratorio reflejó un incremento de los niveles séricos de ECA en 24 (54,5%) pacientes, de los niveles séricos de calcio en 11 (25%) pacientes, de los niveles séricos de D3 en 5 (11,4%) pacientes y de los niveles de ESR y PCR en 22 (50%) y 23 (52,3%) pacientes, respectivamente. En comparación con el grupo control, se encontraron niveles séricos de IL-23 más elevados en los pacientes con sarcoidosis (p=0,01). Los niveles séricos de IL-23 estuvieron asociados a artritis de tobillo (p=0,02)...(AU)

The Prognostic Nutritional Index (PNI): A New Biomarker for Determining Prognosis in Metastatic Castration-Sensitive Prostate Carcinoma.

Prognostic nutritional index (PNI), which is calculated using the albumin level reflecting nutritional status and lymphocyte count reflecting immune status, is useful in showing nutritional and immunological status related to survival and prognosis in many cancers. In this study, we aimed to evaluate the biomarker potential and effect of PNI in determining the prognosis of metastatic castration-sensitive prostate cancer (mCSPC). This retrospective observational study included the complete data of 108 patients with mCPSC who were treated for at least three months between 1 January 2010, and 1 June 2021. The relationships between cancer-specific survival (CSS), overall survival (OS), progression-free survival (PFS), and PNI were evaluated. The Kaplan-Meier method for OS, PFS, and CSS, as well as univariate and multivariate Cox regression models, were used for the statistical analyses. The median age of 108 patients included in the study was 68.54 (61.05-74.19) years. A value of 49.75 was determined to be the best cut-off point for the PNI. OS (months) was found to be significantly lower in patients with low PNI (median: 34.93, 95% CI: 21.52-48.34) than in patients with high PNI (median: 65.60, 95% CI: 39.36-91.83) (p = 0.016). Patients with high PNI (median: 48.20, 95% CI: 34.66-61.73) had significantly better CSS (months) than patients with low PNI (median: 27.86, 95% CI: 24.16-31.57) (p = 0.001). There was no statistically significant difference in PFS between patients with high PNI values (median: 24.60, 95% CI: 10.15-39.05) and patients with low PNI values (median: 20.03, 95% CI: 11.06-29.03) (p = 0.092). The PNI is a good predictor of OS and CSS in patients with mCSPC. The prediction of PFS, albeit showing a trend towards significance, was not statistically significant, probably due to the small number of cases.

Paraneoplastic Hypereosinophilia in Locally Advanced Clear Cell Renal Carcinoma.

Renal cell carcinoma (RCC) can cause various paraneoplastic syndromes, including metabolic and hematologic disturbances. Paraneoplastic hypereosinophilia has been reported in a variety of hematologic and solid tumors. Hypereosinophilia due to RCC is very rare and is only available as case reports in the literature. A 66-year-old male patient's thoracoabdominal computed tomography (CT) performed showed an increase in size in the right kidney and a heterogeneous contrasting solid mass of approximately 12 cm × 9 cm, which formed lobulations in its contours. The patient was diagnosed with clear-cell renal carcinoma as a result of a kidney biopsy. In the patient with stage cT4NxM0, the leukocyte count was 40.000/µl and the eosinophil count was 20% in biochemical tests. With these results, the patient was evaluated as having severe paraneoplastic hypereosinophilia due to RCC. The patient was started on sunitinib 50 mg for two weeks on/one week off. No symptoms were observed due to hypereosinophilia. In the evaluation made two weeks after the start of the treatment, it was observed that eosinophil levels decreased to normal rates. Paraneoplastic hypereosinophilia due to renal cell carcinoma may indicate poor prognosis and rapid disease progression. Myelosuppressive therapy is required for symptomatic patients.

The prognostic indicator in breast cancer treated with CDK4/6 inhibitors: the prognostic nutritional index.

Aims: The aim of this study was to evaluate the effect of prognostic nutritional index (PNI) on prognosis in patients with hormone receptor-positive, HER2-negative metastatic breast cancer who received CDK4/6 inhibitor + endocrine therapy. Methods: Patients receiving a CDK4/6 inhibitor were evaluated retrospectively. The PNI was calculated as: (10 × serum albumin [g/dl]) + (total lymphocyte count [×109/l] × 5). Results: In a study of 106 patients, a statistically significant survival advantage was observed in the high-PNI group over the low-PNI group (mean overall survival: 28.03 ± 0.487 months vs 22.46 ± 1.14 months; p = 0.013). Conclusion: For the first time in the literature, this study demonstrated the prognostic role of PNI in patients with hormone receptor-positive, HER2-negative metastatic breast cancer treated with CDK4/6 inhibitors.

cERBB-2/Her-2 Neu Overexpression and Prognostic Significance in Uterine Carcinosarcoma.

OBJECTIVE: There is not enough data in the literature regarding Her-2 overexpression in uterine carcinosarcomas or its association with the prognosis. The aim of this study was to determine the Her-2 overexpression rate in uterine carcinosarcoma and to evaluate its relationship with the prognosis. MATERIAL AND METHOD: Her-2 protein and gene status were evaluated by immunohistochemistry (IHC) and fluorescence in situ hybridization (FISH), respectively, in hysterectomy specimens from 51 patients with uterine carcinosarcoma. RESULTS: Her-2 protein expression in the epithelial component was negative in 42 patients (score 0 in 33 cases, score (+1) in 9 cases), score (+2) in 7 patients and score (+3) in 2 patients. None of the patients had Her-2 protein expression within the sarcomatous component of the tumors. Her-2 gene was not amplified in epithelial or mesenchymal tumor areas according to the FISH method. There was no difference between the Her-2 overexpression negative and positive groups in terms of disease-free survival (DFS) and overall survival (OS). Her-2 overexpression was significantly higher in tumors of patients diagnosed at 65 years or older (p=0.046). CONCLUSION: In our study, no relationship could be shown between Her-2 overexpression and prognosis in uterine carcinosarcoma. More comprehensive studies are needed to illustrate the relationship between Her-2 overexpression and carcinosarcoma prognosis.

Is CRP/Albumin Ratio (CAR) a New Parameter to be Added to Risk Stratification Systems in Metastatic Renal Cell Carcinoma Patients?

OBJECTIVE: To evaluate the effect of pretreatment C-reactive protein (CRP)/Albumin ratio (CAR) on prognosis and its association with IMDC (International metastatic renal cell carcinoma database consortium) risk score and overall survival (OS) in metastatic renal cell carcinoma (mRCC) patients. STUDY DESIGN: Descriptive study. PLACE AND DURATION OF STUDY: Department of Medical Oncology, Dokuz Eylul University, Izmir, Turkey, between 2007 and 2020. METHODOLOGY: Clinico-pathological and treatment-related data of mRCC patients were retrospectively evaluated and included in the study. CAR was used as a prognostic inflammatory score. CAR threshold value for OS has been obtained by ROC analysis. The prognostic value of CAR was tested using Kaplan-Meier and Cox-regression models. IMDC-CAR model was created by adding CAR to IMDC risk stratification. RESULTS: OS was 91 months in patients with CAR below the threshold value of 0.072 (<0.072), while OS was 51 months in patients with CAR of 0.072 and above (p=0.005). According to IMDC risk stratification, intermediate and poor risk groups showed similar survival times (p>0.05). However, when CAR was added to the IMDC risk score in the intermediate group, it was divided into 3 subgroups with different prognoses (p=0.02). CONCLUSION: CAR is an independent predictor of OS in mRCC patients. In this study, it has been demonstrated that more accurate prognosis prediction could be made by adding CAR to IMDC indicators in the intermediate risk group, which constitutes a highly heterogeneous group according to IMDC risk stratification. KEY WORDS: Renal cell cancer, Albumin, C-reactive protein, IMDC, Prognosis.

Colonic Metastasis from Primary Tonsillar Squamous Cell Carcinoma: A Rare Cause of Large Bowel Obstruction.

Tonsillar squamous cell carcinoma is a subtype of head and neck cancer that rarely metastasizes to the colorectal system. Colonic metastasis secondary to primary tonsillar squamous cell carcinoma is a very rare clinical occurrence with unclear pathogenesis. Palliative chemo-radiation and surgery are recommended for this rare condition, which is generally seen in advanced stages. Here, we aimed to report a case of a 70-year male who underwent palliative surgery due to the symptoms of mechanical bowel obstruction as a result of colonic metastasis of tonsillar carcinoma and review the relevant literature. Key Words: Tonsillar carcinoma, Colon, Metastasis.

What Is Your Choice for Androgen Deprivation Therapy in Metastatic Prostate Carcinoma: Surgical or Medical?

OBJECTIVE: At the time of diagnosis, approximately 16.5% of prostate cancer patients are metastatic. The main framework of metastatic prostate cancer treatment is androgen deprivation therapy, which is performed surgically or medically. The aim of this study is to evaluate the attitudes of medical oncologists and urologists about orchiectomy as androgen deprivation therapy. MATERIAL AND METHODS: A total of 387 physicians working in the Departments of Urology (n=217) and Medical Oncology (n=170) were included in this descriptive study. Data were collected through an electronic survey. RESULTS: Only 7.5% of participants indicated that they offered surgical castration to their patients. Urologists preferred surgical castration more than oncologists for the treatment of metastatic castration-sensitive prostate carcinoma (P=.003). The reasons why medical oncologists preferred surgical castration less are that it is an invasive procedure, has risk of morbidity and mortality, high cost of hospitalization, and may cause deterioration of the patient's body image (P < .05). CONCLUSION: This study showed that physicians were less likely to perform orchiectomy as an androgen deprivation therapy. Although the most important reason for this is the patient preference, the biased presentation of treatment options to patients, the lack of knowledge of physicians about orchiectomy, and the effect of the pharmaceutical industry should also be kept in mind.

CD47 (don't eat me signal) expression levels and its relationship with clinicopathologic features in early-stage prostate carcinoma.

BACKGROUND: Prostate cancer is a cancer with poor host immune response and could be defined as a non-T-cell inflamed tumor. Therefore, immunotherapy treatments could not be included in the treatment of prostate cancer until recently. Inadequate antitumoral response is one of the main reasons why tumor cells multiply rapidly and cause lethal results. It was shown that CD47 molecule, which is secreted at high levels by leukemia cells, reduces macrophage-mediated phagocytosis and thus facilitates escape from the antitumoral immune response. The aim of this study was to show don't eat me signaling in prostate carcinoma tissues and its relationship with macrophage polarization. MATERIALS AND METHODS: A total of 263 patients with a diagnosis of prostatic adenocarcinoma after radical prostatectomy between 2015 and 2020 at our institute were included in the study. CD47, CD68, and CD163 expression levels were examined immunohistochemically (IHC) in these tissues. The relationship of these expression levels with unfavorable prognostic factors and survival for prostate carcinoma was investigated. RESULTS: In this study, all the operated prostate carcinoma cases had CD47 expression in tumor tissue, but only 52.5% had a high level of expression. Of 263 prostate cancer tissues, 135 (51.3%) showed high expression of CD68 protein and 189 (71.9%) showed high expression of CD163 protein. There was a statistically strong relationship between CD47, CD68, and CD163. CONCLUSIONS: The CD47 molecule is basically a molecule that inhibits macrophage activation. CD68 is mostly used for macrophage classification, while CD163 is used for tumor-associated macrophage classification. Unlike others, we IHC examined CD47, CD68, and CD163 expressions in the surgical materials of patients who were operated for prostate carcinoma. In addition, we concluded that strong CD47 expression was closely associated with strong CD68 and CD163 expression in all tumor samples. However, a significant relationship between these expression levels and survival could not be demonstrated.

Immature Teratoma with Growing Teratoma Syndrome and Gliomatosis Peritonei Coexistence.

Ovarian germ cell tumours constitute 5% of all ovarian cancers. During the natural course and treatment of these tumours , there may be more unusual cases. One of them is gliomatosis peritonei, which is characterised by the spread of glial cells on the peritoneal surfaces, while the other one is growing teratoma syndrome characterised by the rapid growth of benign component and loss or shrinkage of the malignant component in response to systemic chemotherapy during the treatment of germ cell tumours. Herein, we present a case of coexistence of gliomatosis peritonei and growing teratoma syndrome during the treatment of a 29-year female with immature ovarian teratoma. Key Words: Germ cell tumours , Growing teratoma syndrome, Gliomatosis peritonei, Ovaries.

Malignancy in patients with sarcoidosis / Malignidad en pacientes con sarcoidosis

The relationship between sarcoidosis and malignancy is not clear yet. We retrospectively evaluated 131 sarcoidosis patients followed-up at the single Rheumatology center. The incidence of malignancies was investigated in this cohort. A total of 6 (4.6%) patients with malignancy were identified in our cohort of 131 patients with sarcoidosis. Hodgkin lymphoma (HL) was detected in three patients, followed by one patient with breast cancer, one patient with thyroid cancer and one patient with testicular cancer. All patients had chronic sarcoidosis with pulmonary involvement, and only 1 patient had acute sarcoidosis with Löfgren's syndrome. HL developed concomitantly with sarcoidosis in one patient while other two patients developed disease before and after sarcoidosis diagnosis. Two patients with solid tumors developed malignancy years before sarcoidosis diagnosis, while one patient developed thyroid cancer during sarcoidosis follow-up. All 6 sarcoidosis–malignancy patients survived after six year years follow up. We found low incidence of malignancy in patients with sarcoidosis in our small cohort. The sarcoidosis–malignancy relationship can only be a coincidence and/or can be explained by a common pathogenesis. New prospective studies involving large patients series are needed in this regard.(AU)

La relación entre sarcoidosis y malignidad no está clara todavía. Evaluamos retrospectivamente 131 pacientes con sarcoidosis seguidos por un centro de reumatología. En esta cohorte se investigó la incidencia de neoplasias malignas. Se identificó un total de 6 (4,6%) pacientes con neoplasia maligna en esta cohorte. El linfoma de Hodgkin (LH) se detectó en 3 pacientes, seguido de un paciente con cáncer de mama, un paciente con cáncer de tiroides y un paciente con cáncer testicular. El LH se desarrolló concomitantemente con sarcoidosis en un paciente, mientras que los otros 2 desarrollaron la enfermedad antes y después del diagnóstico de sarcoidosis. Dos pacientes con tumores sólidos desarrollaron malignidad años antes del diagnóstico de sarcoidosis, mientras que el paciente con cáncer de tiroides lo presentó durante el seguimiento. Los 6 pacientes con sarcoidosis y malignidad sobrevivieron durante 6 años de seguimiento. Encontramos baja incidencia de malignidad en pacientes con sarcoidosis en nuestra cohorte. La relación sarcoidosis-malignidad puede ser coincidental y/o puede explicarse por una patogénesis común.(AU)

Malignancy in patients with sarcoidosis.

The relationship between sarcoidosis and malignancy is not clear yet. We retrospectively evaluated 131 sarcoidosis patients followed-up at the single Rheumatology center. The incidence of malignancies was investigated in this cohort. A total of 6 (4.6%) patients with malignancy were identified in our cohort of 131 patients with sarcoidosis. Hodgkin lymphoma (HL) was detected in three patients, followed by one patient with breast cancer, one patient with thyroid cancer and one patient with testicular cancer. All patients had chronic sarcoidosis with pulmonary involvement, and only 1 patient had acute sarcoidosis with Löfgren's syndrome. HL developed concomitantly with sarcoidosis in one patient while other two patients developed disease before and after sarcoidosis diagnosis. Two patients with solid tumors developed malignancy years before sarcoidosis diagnosis, while one patient developed thyroid cancer during sarcoidosis follow-up. All 6 sarcoidosis-malignancy patients survived after six year years follow up. We found low incidence of malignancy in patients with sarcoidosis in our small cohort. The sarcoidosis-malignancy relationship can only be a coincidence and/or can be explained by a common pathogenesis. New prospective studies involving large patients series are needed in this regard.

Concomitant Autoimmune Diseases in Patients With Sarcoidosis in Turkey.

OBJECTIVES: This study aims to determine the frequency and characteristics of autoimmune diseases associated with sarcoidosis patients. PATIENTS AND METHODS: The study included 131 sarcoidosis patients (36 males, 95 females; mean age 46.1 years; range, 20 to 82 years). Demographic, clinical, laboratory and radiological data of patients were evaluated retrospectively. The characteristics of autoimmune diseases associated with sarcoidosis (sarcoidosis-overlap group) patients and isolated sarcoidosis (isolated sarcoidosis group) were analyzed and compared. RESULTS: Concomitant autoimmune diseases were detected in 15 (11.5%) (5 males, 10 females; mean age 50.8 years; range, 26 to 58 years) of the 131 patients with sarcoidosis and their mean disease duration was three months (range, 1 to 30 months). When compared with isolated sarcoidosis patients, more hand finger joint involvement, rheumatoid factor (RF) positivity, higher erythrocyte sedimentation rate (ESR) and less nonsteroidal anti-inflammatory drugs (NSAIDs) usage were found in the sarcoidosis-overlap group (p=0.035, p=0.049, p=0.015, p=0.018, respectively). There were no statistically significant differences between the two groups when evaluated for demographic, clinical parameters and disease-modifying antirheumatic drugs usage. CONCLUSION: Concomitant autoimmune diseases in patients with sarcoidosis may be rarely seen. These patients are characterized with more hand finger joint involvement, RF positivity, higher ESR and less NSAIDs usage. Multicenter, prospective studies involving large numbers of patients are needed to understand whether the association of sarcoidosis-autoimmune diseases is based only on coincidence or on a common etiopathogenesis.

Elderly-onset sarcoidosis: a single center comparative study / Estudio comparativo entre la sarcoidosis de inicio en la edad adulta y en la tercera edad. Análisis de 131 casos

OBJECTIVES: Sarcoidosis rarely affect patients older than 65 years old. The purpose of this study is to compare and evaluate the demographic, clinical and laboratory features of elderly-onset (EOS) and young-onset sarcoidosis (YOS) patients. METHODS: One hundred and thirty one patients diagnosed with sarcoidosis according to clinical, radiologic and histopathological evaluation were included in this study. The patients with initial symptoms started after age 65 were accepted as EOS. RESULTS: Twenty (15.3%) of 131 patients were diagnosed as EOS, and 111 (84.7%) patients were evaluated as YOS. Fifteen of 20 EOS patients were female and 5 of them were male. Average duration of the disease was determined as 38.4 months for YOS and 22.5 months for EOS (p = 0.556). Delay of the diagnosis was 12 months for YOS while it was 3 months for EOS (p = 0.001). Higher rates of fatique, comorbid diseases and more hydroxychloroquine (HQ) use were detected in EOS patients comparing to YOS (p = 0.010, p = 0.003 and p = 0.039 respectively). CONCLUSIONS: EOS patients are characterized with higher rates of fatique and comorbid diseases, less inflammatory sign and delayed diagnosis, and less DMARDs use

OBJETIVOS: La sarcoidosis raramente afecta a mayores de 65 años. Este estudio se diseñó para evaluar las características demográficas, clínicas y de laboratorio de pacientes diagnosticados de sarcoidosis en la tercera edad, comparados con sarcoidosis de inicio en la edad adulta. PACIENTES Y MÉTODOS: Ciento treinta y un pacientes fueron diagnosticados de sarcoidosis de acuerdo con la evaluación clínica, radiológica e histopatológica. RESULTADOS: Veinte pacientes (15,3%) fueron diagnosticados de sarcoidosis en la tercera edad y 111 pacientes (84,7%) fueron diagnosticados en la edad adulta. Quince de los 20 pacientes diagnosticados en la tercera edad eran mujeres y 5 varones. La duración media de la enfermedad fue de 38,4 meses para los pacientes menores de 65 años y de 22,5 meses para los mayores de 65 años. El retraso diagnóstico fue de 12 meses para los primeros y 22,5 meses para los segundos (p = 0,001, p = 0,010 y p = 0,003, p = 0,039, respectivamente). CONCLUSIONES: Los pacientes con sarcoidosis de inicio en la tercera edad se caracterizan por mayor incidencia de fatiga y de comorbilidades, menos clínica inflamatoria, menor uso de FAME y mayor retraso diagnóstico

Ustekinumab-induced Sarcoidosis in a Patient with Psoriatic Arthritis.

BACKGROUND: Psoriatic Arthritis (PsA) is a chronic inflammatory disease that may affect different joints. Sarcoidosis is a Th-1 cell-related chronic granulomatous disease characterized by non-caseating granuloma formation. The coexistence of both the diseases is a rare entity. Ustekinumab, an IL12 / 23 inhibitor, has shown efficacy and safety in the treatment of PsA. OBJECTIVE: This study presents a case with ustekinumab-induced sarcoidosis in a patient with PsA. CASE REPORT: A 52 years old female patient with complaints of pain and swelling of the wrists, MCP, PIP and DIP joints and skin lesions was referred to our Rheumatology clinic. On her medical history, she had been under follow up for 5 years with the diagnosis of psoriasis and one year ago, she started to receive ustekinumab prescribed by a dermatologist. On physical examination, she had psoriasis skin lesions and arthritis of both wrists, MCP, PIP, DIP joints. Bilateral hilar lymphadenopathies were detected in the chest X-ray and thorax computed tomography. In laboratory tests, acute phase reactants and serum angiotensin-converting enzyme levels were high. Endobronchial ultrasonography biopsy was performed and non-caseating granuloma consistent with sarcoidosis was reported. Ustekinumab was discontinued, methotrexate and low-dose corticosteroid were started. The patient was clinically stable in the 6th month of the treatment and the findings were regressed. CONCLUSION: Sarcoidosis development appears to be a new paradoxical effect of ustekinumab therapy, being another biological agent.

Serum adipokine levels in patients with sarcoidosis.

BACKGROUND: Sarcoidosis is a chronic inflammatory disease characterized by non-caseating granuloma which etiology is unknown yet. Adipokines are different proteins synthesized by adipose tissue that have an influence on angiogenesis, hemostasis, lipid metabolism, and immune system regulation. Adipokines may play a role in the pathogenesis of sarcoidosis. OBJECTIVES: To evaluate the serum adipokine levels in patients with sarcoidosis and to determine a possible correlation with clinical and laboratory signs of disease. METHODS: Forty-four biopsy-proven sarcoidosis patients followed at a single center and age- and sex-matched 41 healthy volunteers were included in the study. Demographic, clinical, laboratory, and radiological data were recorded and body mass index (BMI) was calculated in all patients. Routine laboratory tests (blood glucose, liver, and kidney function test) were measured. Serum adiponectin and leptin levels were measured by ELISA method. RESULTS: Among 44sarcoidosis patients, 13 (29.5%) were male and 31 (70.5%) were female. Twenty-one (47.7%) patients had erythema nodosum, three (6.8%) had uveitis, 40 (90.9%) had arthralgia, 32 (72.7%) had arthritis, 15 (34.1%) had enthesitis. Laboratory evaluation showed increased serum ACE level in 24 (54.5%) patients, increased serum calcium level in 11 (25%) patients, increased serum D3 level in 5 (11.4%) patients, and increased ESR and CRP levels in 22 (50%) and 23 (52.3%) patients, respectively. Compared with the control group, serum adiponectin levels were significantly higher in patients with sarcoidosis(p = 0.007). Serum adiponectin level was associated with arthralgia and ankle joint swelling (p = 0.007, p = 0.006 respectively). Serum leptin levels were similar in sarcoidosis patients and controls (p = 0.327). There was no relationship between serum leptin level and disease features (p > 0.05). CONCLUSIONS: In this study, high serum adiponectin level was detected in patients with sarcoidosis while serum leptin level was similar in the sarcoidosis and control group. Adiponectin, an anti-inflammatory protein, may play a role in the pathogenesis of sarcoidosis. Studies are needed to shed light on this topic.Key Points• Sarcoidosis is a chronic granulomatous disease characterized by granuloma formation• High serum adiponectin level was found in sarcoidosis patients• Serum adiponectin level was associated with some clinical features such as arthralgia and arthritis• High adiponectin levels in sarcoidosis patients may mitigate the inflammatory response, resulting in a mild form of the disease and/or spontaneous remission.

The Role of Log Odds of Positive Lymph Nodes in Predicting the Survival after Resection for Ampullary Adenocarcinoma.

Lymph node metastasis is a important factor on survival in ampullary adenocarcinoma. Log odds of positive lymph nodes (LODDS) is a novel prognostic indicator on lymph node status. We aimed to evaluate the prognostic impact of LODDS for the patients with ampullary adenocarcinoma who underwent R0 pancreaticoduodenectomy. The study includes 42 patients.. LODDS was calculated as "log (number of metastatic lymph nodes+0.5)/(number of total harvested nodes - metastatic lymph nodes+0.5)". LODDS subgroups were created based on their LODDS value: LODDS1(LODDS≤ - 1.5), LODDS2(-1.5 < LODDS≤ - 1.0), LODDS3(-1.0 < LODDS≤ - 0.5), LODDS4(LODDS> - 0.5). The mean survival time was 72.7 ± 7.82 months. Survival rates for 1, 3 and 5 years were 93%, 65% and 45%, respectively. The mean LODDS value was -1.0466 ± 0.51. LODDS subgroups show strong correlation with Overall Survival(OS). The mean survival were 114.8, 81.8, 56.6 and 25.6 months in LODDS subgroups 1, 2, 3 and 4, respectively (Log-rank; p = 0.002), in addition LOODS values shows correlation with perineural invasion and micro vascular invasion (p = 0.015 and p = 0.001 respectively). Findings in our patient group support the hypothesis that LODDS subgroups correlate with OS, and that value of LODDS has considerable role in prediction of OS as well.

Elderly-onset sarcoidosis: A single center comparative study.

OBJECTIVES: Sarcoidosis rarely affect patients older than 65 years old. The purpose of this study is to compare and evaluate the demographic, clinical and laboratory features of elderly-onset (EOS) and young-onset sarcoidosis (YOS) patients. METHODS: One hundred and thirty one patients diagnosed with sarcoidosis according to clinical, radiologic and histopathological evaluation were included in this study. The patients with initial symptoms started after age 65 were accepted as EOS. RESULTS: Twenty (15.3%) of 131 patients were diagnosed as EOS, and 111 (84.7%) patients were evaluated as YOS. Fifteen of 20 EOS patients were female and 5 of them were male. Average duration of the disease was determined as 38.4 months for YOS and 22.5 months for EOS (p=0.556). Delay of the diagnosis was 12 months for YOS while it was 3 months for EOS (p=0.001). Higher rates of fatique, comorbid diseases and more hydroxychloroquine (HQ) use were detected in EOS patients comparing to YOS (p=0.010, p=0.003 and p=0.039 respectively). CONCLUSIONS: EOS patients are characterized with higher rates of fatique and comorbid diseases, less inflammatory sign and delayed diagnosis, and less DMARDs use.