Hikmet Akgül

Primary Hydatid Cyst of the Axillary Region: Report of a Case

Abstract A 53-year-old woman presented to our hospital with a painful mass in her axilla. Magnetic resonance imaging revealed a lobular cystic mass localized in the right pectoralis major muscle, with no significant invasion of the peripheral soft tissue or bone structures and no pulmonary or hepatic involvement. An echinococcal hemagglutination test was positive. Excision of the cystic mass as definitive therapy and histopathologic examination of the resected specimen confirmed that it was a hydatid cyst. For treating hydatidosis in uncommon sites, the cyst must be totally removed whenever possible. The combination of albendazole and praziquantel seems to be the most effective medical treatment, but not an alternative to surgery. This case report serves to demonstrate that hydatid disease should be borne in mind as the possible cause of a palpable lesion in the breast, axillary region, or chest wall, especially in endemic locations.

The Role of 18F-FDG PET/CT in the Primary Staging of Gastric Cancer.

Objective: The aim of this study is to explore the role of 18F-FDG PET/CT in the primary staging of gastric cancer in the comparison of ceCT as routine staging method and evaluate influencing parameters of 18F-FDG uptake. Methods: Thirty-one patients (mean age: 58.9±12.6) who underwent 18F-FDG PET/CT for primary staging of gastric cancer between June 2011 and June 2012 were included to the study. 18F-FDG PET/CT findings were compared with pathological reports in patients who underwent surgery following PET/CT. 18F-FDG PET/CT findings of primary lesions, lymph nodes and adjacent organs were compared with ceCT findings and pathological reports. Since 6 patients were accepted as inoperable according to 18F-FDG PET/CT and/or ceCT and/or laparotomy and/or laparoscopy findings, pathological confirmation could not be possible. Results: In the postoperative TNM staging of patients, while 1 (4%), 1 (4%), 4 (16%), 2 (8%), 12 (48%) and 5 (20%) patients were staged as T0, Tis, T1, T2, T3 and T4, respectively, 8 (32%), 6 (24%), 6 (24%) and 5 (20%) patients were N0, N1, N2 and N3 respectively. 18F-FDG PET/CT was totally normal in 2 patients. While primary tumors were FDG avid in 27 patients, in 17 and 6 patients FDG uptake was observed in perigastric lymph nodes and distant organs, respectively. Mean SUVmax of FDG avid tumors was calculated as 13.49±9.29 (3.00-44.60). However, SUVmax of lymph nodes was computed as 9.28±6.92 (2.80-29.10). According to sub-analysis of histopathological subtypes of primary tumors, SUVmax of adenocarsinomas was calculated as 15.16 (3.00-44.60), of signet ring cells as 9.90 (5.50-17.70), of adenocarcinomas with signet ring cell component as 11.27 (6.20-13.90) (p=0.721). In the comparison with histopathological examination while ceCT was TP, TN, FN in 23, 1 and 1 patients, 18F-FDG PET/CT was TP, FP, FN in 20, 1 and 4 patients, respectively. Sensitivity, specificity, accuracy, PPD and NPV of ceCT in the detection of lymph node metastasis was calculated as 83.3%, 75%, 80%, 87.5% and 66.6%, respectively. These parameters for 18F-FDG PET/CT were 64.7%, 100%, 76%, 100% and 57.1%. Conclusion: Despite lower sensitivity than ceCT, diagnostic power of 18F-FDG PET/CT in the preoperative staging of gastric cancer is acceptable. Because of its high PPV, it might be beneficial in the evaluation of patients with suspected lymph nodes. The role of 18F-FDG PET/CT seems to be limited in the early stage and signet ring cell carcinomas due to lower 18F-FDG uptake.

Retroperitoneal soft tissue sarcoma: effect of hyperthermic total abdominal perfusion.

Aims and Background Soft tissue sarcomas (STS) of the retroperitoneum are rare tumors. Surgery remains the principal modality of therapy in the management of primary and recurrent retroperitoneal STS. However, little is known about the effect of regional chemotherapy using hyperthermic total abdominal perfusion (HTAP). We analyzed independent prognostic variables in 33 patients with STS in the retroperitoneum admitted from November 1990 through December 1996. Methods and Study Design Data regarding patients’ age, gender, tumor size, histological tumor type, tumor location, type of operation (primary or secondary surgery), extent of surgical management (marginal or extended), use of HTAP, tumor grade, and tumor stage according to the TNM classification were examined by univariate and multivariate analyses. Results All 33 patients underwent complete resections (marginal or extended). Eleven of them received locoregional chemotherapy by HTAP. The overall cumulative 5-year survival rates in patients with stage IIA and advanced disease were 82% and 22%, respectively (log-rank test, P <0.01). Using Coxs proportional hazard model, tumor stage, use of HTAP and type of operation were found to have significant influence on overall survival (P <0.05). Conclusions Our results showed that complete resection along with HTAP chemotherapy may improve survival in patients with retroperitoneal STS. These phase II data could be used to support the initiation of a phase III trial to test HTAP in patients submitted to complete resection of retroperitoneal STS.

Early Stomach Cancer in Turkey

The Stomach cancer has been encountered as the most common tumor in gastrointestinal system in Turkey.We have periodically performed the upper gastrointestinal endoscopy for the patients with precancerous lesions such as intestinal metaplasia, atrophic gastritis and polyps. We have used dyes such as metilen blue, indigocarmin during the examination in selective cases.We have preoperatively diagnosed forty one cases ,31 male and 10 female, in early stage of the cancer since 1987 up to now.In order to diagnose the early stomach cancer, it is necessary to perform periodically endoscopic examinations and dye endoscopy in high risk groups for gastric cancer.

Primer meme kanserinin lokal kontrolünde radyofrekans ablasyon bir seçenek olabilir mi

Meme kanseri tedavisi icin radyofrekans ablasyon gorece yeni bir tekniktir. Radyofrekans ablasyon uygulama- lari konusunda literaturde her gun artan yayinlara karsin meme kanserinde uygulamalardaki deneyim sinirli bu- lunmaktadir. Sinirli sayidaki klinik calismanin sonuclarina bakildiginda bu yontem, tumor boyutu kucuk olan (T1) lokalize olgularda tercih edilebilir minimal invaziv bir yontem gibi gorunmektedir. Doku harabiyeti nedeniy- le ablasyon sonrasi histopatolojik degerlendirmenin yapilamamasi ve hastalarin takibinde belirli bir standardi- zasyonun olmayisi bu islemin cozum bekleyen onemli sorunlaridir. Radyofrekans ablasyonun ameliyat edilebi- lir meme kanserinde bir tedavi secenegi olabilmesi icin, literaturdeki hasta sayisi dusuk olan az sayidaki hete- rojen calismalara eklenmis, uzun takip sureli ve genis serili klinik calismalara ihtiyac vardir.

Early Diagnosis in Gastric Cancer: Pilot Project

ABS TRACT Objective: Gastric cancer, fourth most common cancer type around the world is the second leading cause of cancer related deaths. Nevertheless when appropriately treated at early stage 5 year survival rates are higher than 90%. In eastern countries extensive endoscopic screening increased early gastric cancer (EGC) diagnosis rate up to 70%. In Turkey EGC diagnosis rate is low, a pilot screening project therefore is planned by Department of Surgical Oncology, Ankara University School of Medicine. Material and Methods: 7316 subjects were included in the study to whom upper gastrointestinal endoscopy was applied. From 1120 of these participants 1139 biopsy samples were taken. Results: In gastric cancer patients (n:21) 4 had a diagnosis at the early stage. Also 14 (1.41%) mild dysplasia and 2 (0.2%) severe dysplasia were detected. In addition, 54.8% of volunteers with endoscopic biopsies were Helicobacter pylori positive and a rate of 41.23% and 22.47% for atrophic gastritis and intestinal metaplasia was detected, respectively. Previously EGC detection rate was 6.3% among the subjects admitted to a hospital with gastric cancer in Turkey. By this screening programme we found an almost 4 fold increase in EGC rate. Conclusion: We therefore recommend that endoscopic screeening for gastric cancer is a requirement for Turkey. This preliminary study should be followed by a more extensive project evaluating the cost effectiveness of screening and its effect on mortality rates.

Mide kanseri cerrahisinde fast-track ve geleneksel yöntemlerin karşılaştırılması

GIRIŞ Mide kanseri sik karsilasilan bir hastaliktir. Dunyada her yil yaklasik bir milyon yeni olgu teshis edilmektedir (1). Billroth tarafindan ilk basarili gastrektominin yapildigi 1881 yilindan bu yana cerrahi mide kanserinin kuratif tedavisinde hala tek umuttur. Geleneksel elektif gastrik rezeksiyon %10-45 komplikasyon orani ve 8-13 gunluk postoperatif hastanede yatis suresiyle uygulanmaktadir (2-5) . Mide kanser cerrahisinde fasttrack cerrahi (FTC) uygulamalarla ilgili, literaturde cok az veri bulunmaktadir. Tek prospektif randomize calisma Wang ve ark. (6) ait olup FTC’nin mide kanser cerrahisine guvenle uygulanabilecegi rapor edilmistir.