Lütfi Soylu

Invasive Ductal Carcinoma Developing From Fibroadenoma

Fibroadenomas are the most common benign breast lesions in adolescent and young women. It is most frequently observed in the 3rd decade. Although it is considered benign, evidence of malignant transformation is available. Cancer development may be from ground of fibroadenoma or near breast tissue. A case of a fibroadenoma coexisting with an invasive ductal carcinoma of the breast in a 31-year-old female is presented. The patient presented with the chief complaint of having a palpable mass in her right breast for the last 10 years. Mammography revealed a mass with microcalcifications. Core biopsy was performed, and the results indicated an invasive carcinoma. Breast-conserving surgery with sentinel lymph node biopsy was performed. The pathological features revealed a fibroadenoma coexisting with an invasive ductal carcinoma. This case suggests that clinicians and radiologists should always pay attention to the associated malignant imaging characteristics whenever a mass was followed up as fibroadenoma.

Does early removal of double J stents reduce urinary infection in living donor renal transplantation

Introduction Prophylactic use of double J (DJ) stents in recipients is highly accepted in renal transplantation. In this study, the association between the frequency of urologic complications (UC) and urinary tract infections (UTI), and the early or late removal of DJ stents was investigated. Material and methods A total of 116 live-donor renal transplant patients were included in the study during a 4-year period, with a mean follow-up of 29.2 ±15.3 months. In all, DJ stents were used. All patients were clinically monitored for graft function by assessment of the complete blood count, renal biochemistry, urine analysis and blood drug level according to our follow-up protocol. Results The patients were divided into 2 groups according to the time of their stent removal: group I (n = 44), removal within the first 14 days; and group II (n = 72), removal after 14 days. No urinary leaks were detected in either of the groups. Three patients suffered from anastomotic stricture (group I, n = 1; group II, n = 2). The rates of UTI were similar in groups I and II (13.6% vs. 16.6%, respectively, p = 0.79). The rate of UTI in women was found to be 3.8 times higher than in men. Conclusions The results of our study demonstrated that DJ stent removal within 14 days did not reduce the risk of UTI when compared to stent removal after 14 days. Similar effects on complication rates for ureteral stenting for these 2 removal periods were observed.

Single-incision laparoscopic adrenalectomy in a patient with acute hypokalemic paralysis due to primary hyperaldosteronism

Acute hypokalemic paralysis is a relatively rare cause of acute weakness. It may resolve spontaneously; however, it may be a potential life-threatening condition. Hypertension may be considered the most important finding in combination with hypokalemic paralysis for raising the suspicion of primary hyperaldosteronism (PHA). A 55-year-old hypertensive Mexican woman was admitted to the Emergency Unit with a sudden onset of generalized paralysis. An endocrinological workup and an abdominal magnetic resonance imaging revealed PHA with a 1.5 cm left adrenal tumor. After preoperative medication, left adrenalectomy was performed with single-incision laparoscopic surgery (SILS). The duration of the surgery was 45 min, and no postoperative complication was encountered. The patient was discharged after 24 h. Hypokalemic paralysis may be due to different conditions, but it may raise the suspicion of PHA in combination with a history of generally mild hypertension. Laparoscopic adrenalectomy is the preferred operation for unilateral adrenal adenomas that cause PHA. Single-incision laparoscopic surgery is a step-forward technique that improves the cosmesis, decreases access-related morbidity, and increases the postoperative recovery. We report a case with acute hypokalemic paralysis due to PHA and treated with SILS.

Lymph node evaluation and survival after resection of colorectal cancer

Recent studies have demonstrated that lymph nodes ratio (LNR) might provide a significant prognostic role for colorectal cancer. We retrospectively analyzed the data of the patients with colorectal cancer and assessed a possible correlation between lymph node parameters and survival. We conducted a retrospective chart review of patients who underwent a radical colon surgery involving removal of mesocolic lymph nodes due to colorectal cancer. Prognostic significance of the removed lymph node number (LNs), metastatic LNs, lymph node ratio (LNR) and other factors were compared. This retrospective study included 190 patients (117 males and 73 females). The estimated survival period was found to be 87.70 months [confidence interval (CI) of 95% (80.64-94.76)]. LNR, LNs and N stage were found to have significant correlation with survival. Among these factors, LNR had the biggest correlation (r = 0 .138, P =0.028). Multivariate regression analysis of survival with lymph node parameters showed that LNR and N stage were significantly correlated with survival. However, LNR was found to be the most significant prognostic factor [P >0.0001, 95% CI; 3.12 (1.55-5.75)]. LNR is a better prognostic factor in patients with colorectal cancer compared to lymph node stage and number.

Cavernous Hemangioma in the Breast

Although the observation of breast vascular tumors is rare, the most common tumor is hemangıoma in the benign group, and these tumors are observed incidentally in lumpectomy or mastectomy specimens during histological examinations. They are classified into capillary, cavernous, and venous hemangıomas. Cavernous hemangıoma is the most common subtype. Cavernous hemangıomas are benign vascular tumors, which malformatıon from mature blood vessels. Hemangıomas ın the benıgn group may show a suspicion of ductal carcinoma in situ (DCIS) in mammographic analysis. Ultrasonography (US) and magnetic resonance ımagıng (MRI) are the most useful imaging methods for analyzing the structure of breast vessels. In this case, a 54-year-old female who have any complaint. Scanning mammography (MG) detected the tumor, but physıcal examınatıon and US could not identify the mass. According to the MG analysis, the lesion was evaluated as BIRADS 4b, and the patient underwent excisional biopsy after wire localization. Pathological analysis revealed cavernous hemangıoma.