Elif Inanc Gurer

Intra-operative brain tumor detection using elastic light single-scattering spectroscopy: a feasibility study

We have investigated the potential application of elastic light single-scattering spectroscopy (ELSSS) as an adjunctive tool for intraoperative rapid detection of brain tumors and demarcation of the tumor from the surrounding normal tissue. Measurements were performed on 29 excised tumor specimens from 29 patients. There were 21 instances of low-grade tumors and eight instances of high-grade tumors. Normal gray matter and white matter brain tissue specimens of four epilepsy patients were used as a control group. One low-grade and one high-grade tumor were misclassified as normal brain tissue. Of the low- and high-grade tumors, 20 out of 21 and 7 out of 8 were correctly classified by the ELSSS system, respectively. One normal white matter tissue margin was detected in a high-grade tumor, and three normal tissue margins were detected in three low-grade tumors using spectroscopic data analysis and confirmed by histopathology. The spectral slopes were shown to be positive for normal white matter brain tissue and negative for normal gray matter and tumor tissues. Our results indicate that signs of spectral slopes may enable the discrimination of brain tumors from surrounding normal white matter brain tissue with a sensitivity of 93% and specificity of 100%.

Epidural capillary hemangioma: A review of the literature

Hemangiomas in the spinal epidural area are very rare lesions, and most of these lesions are of the cavernous type. Only seven cases of capillary hemangiomas have been reported in the English literature, and all of these cases occurred in adulthood. Here, we report on a 17-month-old girl who presented with an inability to walk. MRI revealed an epidural mass, which was diagnosed as an epidural capillary hemangioma in the thoracic region. To our best knowledge, this case is the first epidural capillary hemangioma case to occur in childhood that has been reported.

Angiomyofibroblastoma of the retrorectal region: a case report

Angiomyofibroblastoma (AMFB) is a rare benign subcutaneous mesenchymal lesion. AMFB is mostly described in the vulvovaginal region with occasional cases reported in other female urogenital tract sites in women of reproductive age and early menopause, and in the male inguinoscrotal region. AMFB can clinically be misdiagnosed for Bartholin’s gland cyst or lipoma. A. 44-year-old female patient admitted firstly in December 2016 to gynecologic oncology department of Akdeniz University Medical Faculty. She had complaints of pelvic pain for the previous 8 months. A palpable, nontender solid mass lesion protruding to the left lateral wall of the vagina was observed. Bimanual examination detected a mobile mass measuring 8 x 7 cm in the retrorectal region, communicating with vagina. The patient was operated in January 2017 in collaboration with department of general surgery. Her postoperative period was uneventful, and she was discharged and future control visit was arrange. Surgical specimen appeared as an opalescent-white solid mass measuring 7 x 6 cm.Its microscopic examination revealed a well-circumscribed lesion containing spindle, and epitheloid cells. Based on histological findings, the diagnosis of angiomyofibroblastoma was made. Close postoperative follow-up was decided for the patient. Postoperative 7. month gynecologic controls of the patient did not reveal any pathologic finding. In summary, AMFB of the retrorectal region is extremely rare and is diagnostically challenging. Because of the benign behavior of AMFB with rare local recurrence, excluding other neoplasms and making the accurate diagnosis based on histological features is important.

Deep Palmar Tumors of the Hand

Purpose: Tumorous conditions of the hand are frequently encountered by hand surgeons. Deep palmar tumors of the hand are very rare, reported cases were usually benign, but the most important issue is frequent anatomical variations with challenging surgical exposure and excision of these lesions. When we review the literature, only case reports or small series of patients were reported. The aim of this study was to demonstrate our experience with the deep palmar tumors of the hand. Materials and Methods: A multicenter retrospective analysis was designed. Medical records were reviewed with searching the database of two hospitals. Fifty-one cases were identified who were operated between the period of January 1998 to May 2015, and patients were invited for final examination. Forty-three patients who were available for the final follow-up examination were included in the study. All patients were evaluated with physical examination and preoperative magnetic resonance imaging (MRI) for surgical planning; x-ray studies were obtained if necessary. Recurrences were confirmed with physical examination and MRI. The analyzed parameters include age, gender, localization, preoperative symptoms, size, site, treatment methods, histopathologies, complications of surgery, and recurrences. Palmar space was divided in to five zones: thenar, carpal tunnel, hypothenar, distal radial, and distal ulnar. Statistical analyses were performed. Results: The mean age at the operation was 38.5 (9-83). Twenty-one (49%) male and 22 (51%) female participants were included in the study. Nineteen (44%) right and 24 (56%) left hands were involved. The most common preoperative symptom was enlarging mass in all patients (100%) followed by nerve compression in 24 patients (44%; 2 motor involvement at Guyon canal), functional impairment in 12 patients (28%), pain in 5 patients (12%), and pruritus in 1 patient (2.3%). The mean follow-up period was 56.7 months (12-168). All 43 pathologies were benign, and there were 10 lipomas (23.3%), 8 ganglions (18.6%), 5 giant cell tumor of the tendon sheath (11.6%), 4 schwannomas (9.3%), 3 hemangioma, 3 palmar fibromatosis, 2 epidermal cysts (4.6%), 2 neurofibroma (4.6%), 1 angiolymphoid hyperplasia with eosinophilia (ALHE) (2.3%), 1 granuloma, 1 calcifying aponeurotic fibroma (CAF), 1 digital fibroma, 1 foreign body granuloma, and 1 lipofibromatous hamartoma. The most common complication was temporary numbness, and paresthesias of the digital nerves were detected in 10 (23%). Only 3 (7%) recurrences (2 ganglions and a lipoma) were observed in the postoperative first year. Two cases were re-operated and one case with ganglion was refused reoperation and followed up with the recurrence. Iatrogenic arterial injury in 2 patients (4.6%) were primarily repaired intraoperatively, local tenderness in one patient (2.3%), weakness of fifth finger adduction in one patients, and stiffness of index finger in one patient. Conclusion: Updated knowledge and understanding nature and demographic characteristics of the tumorous conditions of the hand is crucial for an accurate diagnosis and appropriate treatment. In the deep palmar space of the hand, tumors usually occurs close relationship between tendons, muscles, nerves, and vascular structures. Preoperative MRI is essential for the diagnosis and the successful surgical planning.

Extensive ameloblastic fibroma of the mandibula in a female adult patient: A case report with a follow-up of 3 years

Ameloblastic fibroma (AF) is rare benign odontogenic tumour which usually occurs in the first two decades of life. It can occur either the mandible or maxilla but it is most frequently found in the posterior region of the mandible. Treatment of AF in usual is a conservative approach, such as enucleation and curettage but the aggressive lesions require a radical approach. A more radical approach should be considered in older patients who have likely high recurrence tendency. This report describes a case of AF in a 38-year-old female patient identified during a routine radiographic exam. Tomographic examination through three-dimensional reconstruction indicated vestibular fenestration of the cortical bone, with involvement of lingual cortical bone as the lession extended to the posterior region. We removed the tumor under local anesthesia. In this case patient has continued to be followed frequently and has been disease-free for 3 years.