Merih Guray Durak

Invasive micropapillary carcinoma of the breast: a clinicopathologic study of 103 cases of an unusual and highly aggressive variant of breast carcinoma.

Invasive micropapillary carcinoma (IMPC) of the breast is an uncommon, highly aggressive breast cancer that may occur in pure and mixed forms. Our aim in this study is to investigate the relationship between clinical, histopathologic, and immunohistochemical features of pure and mixed IMPC cases diagnosed and treated at our institution. One hundred and three IMPC cases diagnosed at our institution over a period of 19 years have been selected. Clinical, histopathologic features, as well as hormone status and c‐erb‐B2 overexpression of tumors were re‐evaluated. Mann–Whitney U, chi‐squared, Kaplan–Meier, and Fishers exact tests were used for statistical analyses. Results were considered to be significant at p < 0.05. Twenty cases (19.4%) were pure, and 83 cases (80.6%) were mixed IMPC. The most common nonmicropapillary invasive carcinoma component in mixed cases was invasive ductal carcinoma (IDC; 78.3%). Progesterone receptor was significantly less positive in pure IMPC cases (p = 0.031). There was no statistically significant difference between the two groups, in terms of mean age of the patients (53.0 versus 52.8), mean tumor size (26.6 mm versus 27.7 mm), presence of high‐grade tumor (p = 0.631), presence of sentinel lymph node (SN) metastasis (p = 1.000), axillary lymph node metastasis (p = 1.000), lymphatic invasion (p = 1.000) and blood vessel invasion (p = 0.475), c‐erbB‐2 overexpression of tumor cells (p = 0.616), distant metastasis (p = 0.549), or overall survival (p = 0.759). The local recurrence rate of the two groups was not statistically significant either (16.7% versus 4.3%). However, local recurrence was detected 12% more commonly (p = 0.100), and ~8 months earlier (p = 0.967) in pure IMPC cases, compared to mixed cases. In addition, presence of local recurrence was found to be statistically significantly associated with estrogen receptor (ER) status (p = 0.004), progesterone receptor (PR) status (p = 0.001), and c‐erb‐B2 overexpression (p = 0.016) in all patients. Overall survival rate was significantly associated with ER staining of the tumor (log‐rank = 0.028). Our findings suggest that hormone receptor negativity may explain the more aggressive behavior of pure IMPC compared to mixed cases. Besides, longer survival period of patients with ER positivity, and the relationship of hormone status and c‐erb‐B2 overexpression and local recurrence further support favorable prognostic value of hormone receptors in invasive breast cancer.

Warthin-Like Papillary Carcinoma of the Thyroid: A Case Series and Review of the Literature Tiroidin Warthin-Benzeri Papiller Karsinomu: Olgu Serisi ve Literatür Derlemesi

ABSTRACT Warthin-like tumor of the thyroid is a recently described rare variant of thyroid papillary carcinoma. The distinguishing histological feature of this variant is papillary foldings lined by oncocytic neoplastic cells with clear nuclei and nuclear pseudoinclusions, accompanied by prominent lymphocytic infiltrate in the papillary stalks. Its prognosis has been reported to be almost similar to conventional papillary carcinoma. In this case series, we report four cases with Warthin-like papillary carcinoma of the thyroid, diagnosed at Dokuz Eylul University Faculty of Medicine Department of Pathology in 2008 and 2009. Three patients were female. The mean patient age was 39 years (range, 20-56) and the mean tumor size was 1.7 cm (range, 0.9-2.0 cm). All of the cases had lymphocytic thyroiditis in the background. None of the tumors showed lymphovascular invasion. The patients are free of any recurrence and/or distant metastasis with a mean follow-up of 25 months. This rare variant of thyroid papillary carcinoma with distinct histopathological features should be indicated in pathology reports. Further studies and long-term follow-up of patients are needed to highlight the biological behavior of this variant. ÖZ Tiroidin Warthin-benzeri tümörü son dönemlerde tanımlanan, tiroid papiller karsinomunun nadir görülen bir varyantıdır. En önemli histolojik özelliği, nükleer psödoinklüzyonlar içeren berrak nukleuslu onkositik özellikte neoplastik hücrelerle döşeli, santral stromalarında belirgin lenfositik infiltrat bulunan papiller yapılardır. Prognozunun klasik papiller karsinom ile benzerlik gösterdiği bildirilmiştir. Bu olgu serisinde, Dokuz Eylül Üniversitesi Tıp Fakültesi Patoloji Anabilim Dalı’nda 2008 ve 2009 yıllarında tanı almış dört Warthin-benzeri papiller karsinom olgusu sunulmuştur. Hastaların üçü kadın olup, ortalama yaş 39 (20-56 yaş), ortalama tümör boyutu 1.7 cm (0,9-2,0 cm) idi. Olguların tümünde zeminde belirgin lenfositik tiroidit izlendi. Olguların hiçbirinde lenfovasküler invazyon görülmedi. Ortalama 25 aylık klinik ve radyolojik izlem sonucu hastaların hiçbirinde rekürrens ya da uzak metastaz saptanmadı. Tiroidin nadir görülen Warthin-benzeri papiller karsinomu, ayırdedici histopatolojik özelliklere sahip olup patoloji raporlarında belirtilmelidir. Bu varyantın biyolojik davranışını açığa çıkarabilmek için ileri çalışmalara ve uzun dönem hasta takiplerine ihtiyaç vardır.

Differentiation between Phyllodes Tumors and Fibroadenomas Based on Mammographic Sonographic and MRI Features.

Background: This study was performed to compare the mammographic, sonographic, and magnetic resonance imaging (MRI) characteristics of phyllodes tumors and fibroadenomas, which may resemble each other. Methods: Preoperative mammograms, B-mode and Doppler sonograms, and dynamic breast MRIs of 72 patients with pathologically proven fibroadenomas and 70 patients with pathologically proven phyllodes tumor were evaluated in this retrospective study. Statistical significance was evaluated using chi-square and Fishers exact tests. Correlations in lesion size among radiological methods were examined by Pearsons correlation analysis. Results: The features that differed on mammogram were size, shape, and margin of the mass. Sonograms showed significant differences in size, shape, margin, echo pattern, and vascularization of the mass. Pearsons correlation analysis showed strong agreement among radiological methods in terms of assessment of size. Tumor size ≥ 3 cm, irregular shape, microlobulated margins, complex internal echo pattern, and hypervascularity were significant findings of phyllodes tumors. Internal cystic areas on MRI were frequently associated with phyllodes tumors. Conclusion: Mammographic, sonographic, and MRI findings of fibroadenomas and phyllodes tumors could help radiologists to ascertain imaging-histological concordance and guide clinicians in their decision making regarding adequate follow-up or the necessity of biopsy.

The incidence of 18F-FDG PET/CT thyroid incidentalomas andthe prevalence of malignancy: a prospective study.

BACKGROUND/AIM To determine the prevalence of malignancy in thyroid incidentalomas (TIs) detected by fluorine-18 fluorodeoxyglucose (18F-FDG) positron emission tomography/computed tomography (PET/CT). MATERIALS AND METHODS 18F-FDG PET/CT images were evaluated prospectively for the presence of thyroid uptake. The patients with a TI were evaluated by an endocrinologist according to the predefined diagnostic algorithm. The final diagnosis was obtained clinically and/or by pathology. RESULTS TI was detected in 4.2% of 4204 patients. A malignant thyroid nodule was diagnosed in 29% and 33% of the focal and diffuse-focal uptake groups, respectively. However, no malignancy was detected in the diffuse uptake group. The standardized maximum uptake values (SUVmax) of the nodules were significantly higher in patients with thyroid malignancy than in patients with benign nodules (P = 0.006). The calculated cut-off value of SUVmax for malignancy was 3.5. In 2 patients in whom the cytopathological diagnosis was benign, malignancy was diagnosed after total thyroidectomy. CONCLUSION A malignant nodule was present in one-third of the patients with focal or diffuse-focal uptake. A SUVmax value of 3.5 was considered as a cut-off value for the differentiation of a malignant lesion. Benign cytology in fine-needle aspiration biopsy for 2 patients underestimated a thyroid malignancy.

Cystic Solitary Fibrous Tumor of the Liver: A Case Report / Karaciğerin Kistik Soliter Fibröz Tümörü: Olgu Sunumu

Abstract Solitary fibrous tumors are unusual neoplasms that are rarely found in the liver parenchyma. They are usually described as hard, grayish white, well-defined lesions. Predominant cystic change in a solitary fibrous tumor is an unexpected finding, with only a few previous cases reported in the literature, two of which are localized in the head and neck region. Herein, we report a unique case of solitary fibrous tumor of the liver in a 38-year-old female with predominant multiloculated cystic appearance, and discuss the histopathologic differential diagnosis Öz Soliter fibröz tümörler, karaciğer parenkiminde de ender olarak bildirilen sıradışı neoplazmlardır. Genel olarak sert, gri-beyaz renkli, iyi sınırlı lezyonlar olarak tanımlanırlar. Soliter fibröz tümörler içerisinde belirgin kistik değişiklik bulunması pek beklenen bir bulgu değildir. Literatürde kistik değişiklik gösteren birkaç soliter fibröz tümör olgusu bildirilmiş olup, bunlardan ikisi baş boyun bölgesinde lokalizedir. Burada, 38 yaşında kadın hastada, karaciğerde yerleşim gösteren ve baskın olarak multiloküle kistik görünüm içeren bir soliter fibröz tümör olgusu, histopatolojik ayırıcı tanı özellikleri ile birlikte sunulmuştur

Factors predicting non-sentinel lymph node involvement in sentinel node positive breast carcinoma.

OBJECTIVE In routine practice, axillary lymph node dissection is performed in early invasive breast cancer patients with positive sentinel node biopsy. However, sentinel node is the only involved axillary node in 40-70% of patients, and determining factors that predict axillary non-sentinel node involvement will therefore prevent unnecessary axillary lymph node dissection and decrease morbidity. MATERIAL AND METHOD In this study, 119 invasive breast cancer patients with sentinel node metastasis who underwent axillary lymph node dissection between 1998-2009 at our institution were studied. Primary tumor characteristics and features of the metastatic tumors in sentinel nodes, such as microanatomic location, size of metastasis, and the ratio of metastatic tumor area to the total sentinel node area were evaluated. Students t-test and multivariate logistic regression were used for statistical analysis. RESULTS The mean age of the patients was 50.7 years (28-80). Forty-three patients (36%) had invasive ductal and 25 patients (21%) had invasive lobular carcinoma. Most of the patients had either pT1 (44%) or pT2 (54%) tumors. Fifty-four patients (45%) had no further positive nodes in the axilla. The metastatic deposits in the sentinel node were subcapsular in 16 patients (13%). The percent area of sentinel node occupied by tumor (p < 0.001), number of sentinel nodes (p=0.041), and microanatomic location of metastatic tumor (p=0.002) were significantly associated with non-sentinel node metastasis in univariate analysis. The percent area of sentinel node occupied by tumor (p < 0.001) and number of sentinel nodes (p=0.033) remained significantly associated with non-sentinel node involvement in multivariate analysis. CONCLUSION In patients with invasive breast cancer and positive sentinel node, area percent of sentinel node occupied by tumor, and the number of sentinel nodes removed are independently predictive of non-sentinel node involvement.

Hemoptysis caused by ectopic lingual thyroid

A 26-year-old man was referred to emergency department complaining of hemoptysis. Imaging studies showed ectopic lingual thyroid.

Is the extent of surgical resection important in patient outcome in benign and borderline phyllodes tumors of the breast

Background/aim: Phyllodes tumors (PTs) of the breast are rare, and their diagnosis and treatment remain controversial. This retrospective study aims to examine the clinical outcome of benign and borderline PTs, according to the surgical margins. Materials and methods: We examined the medical records of 122 patients in our clinic, who had histologically confirmed benign and borderline PTs between 1994 and 2017. Results: The mean age of the patients was 40.6 years (range 18.0-81.0, ±12.1 standard deviation [SD]) and the mean tumor size was 25.8 mm (range 9-65, ±10.3 SD). All patients underwent a breast-conserving procedure and the median follow-up was 51 months. Tumor margins were positive (tumor touching the ink) in 43 patients (35%). Only 16 patients (13%) had margins ≥10 mm. The margins were between 2 and 10 mm in most patients (40%) and ≤1 mm in 12% of the patients. Conclusion: Although no re-excision was performed to obtain grossly clear margins, local recurrence was not observed in any patients. Therefore, revision surgery for close or positive surgical margins for benign and borderline PTs should not be performed as a rule. As most tumors recur within 2 years of diagnosis, we propose a close clinical and imaging follow-up during this period.

Primary intracystic squamous cell carcinoma of breast

Primary squamous cell carcinoma (SCC) of the breast accounts for less than 0.04% of all breast carcinomas. Ultrasonographic imaging of a 41-year-old female showed a lesion compatible with complex cyst with a symmetric thick-walled septations in the right breast, with a dimension of 8x7.5 cm. Histopathologic examination showed nests of squamous neoplastic cells with occasional intercellular bridges and atypical mitotic figures infiltrating the breast parenchyma, as well as dysplastic squamous cells lining the cyst wall. Targeted treatment modalities need to be developed to achieve beter clinical outcome in these tumors, therefore more extensive series of studies are required.

Immunohistochemical HER2 Status Evaluation in Breast Cancer Pathology Samples: A Multicenter, Parallel-Design Concordance Study

Objective As patients with increased human epidermal growth factor receptor (HER2) overexpression are more likely to benefit from trastuzumab treatment, the accuracy of HER2 receptor status in breast cancer patients is significant for appropriate disease management. However, this assessment is not harmonized and results may be highly variable between centers. The aim of this study was to investigate the degree of interlaboratory variability in the results of HER2 expression reported by 5 participating centers and to assess the concordance between these centers and a reference laboratory.Materials and Methods: A total of 30 breast cancer samples were tested and scored for HER2 expression using immunohistochemical method in 5 centers from Turkey and in a reference laboratory from Netherlands (Academic Medical Center, Amsterdam). All the participating centers had an experience of more than 10 years regarding the HER2 testing. The results were compared both among the centers and with the reference laboratory. Results When the concordance of participating centers and the reference laboratory was evaluated regarding negative (0-1+), equivocal 2(+) and positive 3(+) classification of HER2 immunostaining, the highest concordance was found in Center-A, and the lowest in Center-C (Kendalls tau-b concordance coefficient 0.911 and 0.724, respectively). The concordance of the centers with reference laboratory was 80.0% both in equivocal and positive samples, while it increased up to 91.8% in negative samples. Conclusions This study showed that in general there is sufficiently good agreement between the reference laboratory and the participating centers for immunohistochemical HER2 assessment.