Murat Özgür Kılıç

Clinical, diagnostic and therapeutic management of patients with breast tuberculosis: Analysis of 46 Cases

Breast tuberculosis is a rare form of extrapulmonary tubercular infection. Our aim is to highlight the nonspecific clinical presentations, diagnostic difficulties and therapeutic approaches of mammarian tuberculosis. Forty‐six patients diagnosed with breast tuberculosis between 2005 and 2015 were reviewed retrospectively. Clinical features, all diagnostic methods, and the outcomes of treatment were analysed. All cases were female with a mean age of 36.4 years. Breast mass and pain were the most common complaints. While 34.8% of the cases had a physical examination with suspicions for malignancy, 43.5% of the patients had Breast Imaging Reporting and Data System (BI‐RADS) 4 or 5 lesions suggested malignancy radiologically. Definitive diagnosis was based on histopathologic examination through core needle biopsy (n = 29), excisional biopsy (n = 12), and open biopsy (n = 5) taken from the abscess wall during drainage. Standard antiTB therapy for 6 months was given to all cases. Thirty‐three patients recovered with standard 6‐month therapy while extended treatment for 9–12 months was needed in 13 (28.2%) cases. Surgery was carried out in 17 cases. Two patients developed recurrence. Breast tuberculosis can be easily confused with breast cancer, suppurative abscess, and other causes of granulomatous mastitis, both clinically and radiologically. A multidisciplinary approach is required to prevent diagnostic delays and unnecessary surgical interventions. Although antiTB therapy is the mainstay treatment of breast TB, surgery is usually indicated in patients refractory to medical treatment.

Four mucinous cystadenoma of the appendix treated by different approaches.

Appendiceal mucocele is a rare clinical entity characterized by dilatation of the appendiceal lumen due to abnormal mucinous secretion. It may be of inflammatory or tumoral origin. It may occur as a result of mucoceles, mucosal hyperplasia, mucinous cystadenoma or mucinous cystadenocarcinoma. Mucinous cystadenoma of the appendix is the most common form, although it manifests itself in many different clinical presentations. It is detected in 0.6% of appendectomy specimens. Preoperative diagnosis is difficult, and it is often detected at laparotomy. Despite existing reservations due to the risk of rupture, laparoscopic surgery is gaining acceptance. Although there is no consensus on the choice of surgery, either appendectomy or right hemicolectomy is applied. In this article, we discussed four patients with appendix mucinous cystadenoma where different surgical methods were applied in light of the literature.

A rare case of Spigelian hernia combined with direct and indirect inguinal hernias

Spigelian hernia is a rare type of ventral hernias with nonspecific symptoms and signs. Therefore, its diagnosis is often difficult and requires more clinical attention. Although intermittent abdominal swelling and pain are the main symptoms, Spigelian hernias can be sometimes asymptomatic and are discovered incidentally at the operation. In some cases, these hernias can be associated with other abdominal wall hernias, therefore a detailed physical examination of the patients is necessary to avoid mistakes in diagnosis. Herein, we report an interesting and educational case of Spigelian hernia with accompanying ipsilateral both direct and indirect inguinal hernias in a male patient treated by open surgical repair with use of polypropylene mesh.

Docetaxel-induced Scleroderma in A Breast Cancer Patient: A Case Report

Paclitaxel and docetaxel are antineoplastic drugs derived from the yew tree, Taxus brevifolia. They are the members of the taxane family and act by inhibiting mitotic activity due to the suppression of microtubule depolymerization. They are used in the treatment of ovarian cancer, breast cancer, gastric cancer, small cell lung cancer, and head and neck cancer. In addition to side effects such as cardiotoxicity, neutropenia, arthralgia, and myalgia, they may also cause alopecia, urticaria, mucositis, acral erythema, pustular dermatitis, erythema multiforme, and scleroderma-like mucocutaneous lesions. Scleroderma is among the uncommon side effects of taxane antineoplastic agents. As was the case in few cases in literature, it usually begins with edematous changes in the proximal aspect of the extremities, and subsequently, sclerosis is developed in the skin. Scleroderma, which usually regresses with the discontinuation of the drug and with steroid therapy, may lead to severe contractions that require physical therapy and rehabilitation in some patients. In this paper, we presented a 60-year-old female patient in whom scleroderma developed because docetaxel chemotherapy for breast cancer because it is encountered rarely.

Differentially regulated ADAMTS1, 8, 9, and 18 in pancreas adenocarcinoma

Introduction Despite recent diagnostic and therapeutic improvements, pancreas cancer remains one of the highly lethal cancers. The extracellular matrix (ECM) is a physiological barrier that limits the spread of cancer cells into surrounding tissues and distant organs. Disintegrin and metalloprotease with thrombospondin motifs (ADAMTS) is a family of 19 proteases, which is involved in various biological processes such as ECM remodelling and anti-angiogenesis. Aim To investigate the expression of ADAMTS1, 8, 9, and 18 proteinases in pancreas adenocarcinoma and its nodal metastasis. Material and methods The immunostaining status of ADAMTS1, 8, 9, and 18 were investigated in formalin-fixed paraffin-embedded samples of 25 patients who underwent pancreaticoduodenectomy for an adenocarcinoma located at the head of the pancreas. Results In semi-quantitive grading pathologically, ADAMTS1, 8, 9, and 18 were found to be highly stained in all cancerous pancreas samples compared with normal pancreas. In addition, the immune positivity of ADAMTS1, 9, and 18 was found to be higher in metastatic lymph nodes than in non-metastatic lymph tissue. Tumour size was correlated with ADAMTS9 and 18 expressions in cancerous pancreas. Conclusions According to the data obtained from the study, we suggest that these four ADAMTSs may have significant roles in the tumorigenesis and nodal spread of pancreas adenocarcinoma.

Phyllodes Tumor of the Breast: Analysis of 48 Patients

OBJECTIVE Phyllodes tumor (PT) is a rare biphasic breast neoplasm that accounts for less than 1% of all breast tumors. The aim of this study was to evaluate the clinicopathologic features, diagnostic difficulties, and therapeutic outcomes of patients with PT. MATERIALS AND METHODS A total of 48 female patients who underwent surgery for PT were included in the study. Patient characteristics, clinicopathologic features of tumors, diagnostic findings, surgical outcomes, adjuvant therapies, and follow-up findings were retrospectively evaluated. RESULTS The mean age of patients was 35 years. Painless breast mass was the most common (85.4%) presenting symptom. Total excision with at least 1 cm macroscopic clear margins was the most frequently performed (87.5%) surgery. Most patients (n=34, 70.8%) had benign PT; however, borderline and malignant tumors were found in 9 (18.8%) and 5 (10.4%) patients, respectively. During the mean follow-up period of approximately 30 months, local and distant recurrence was detected in three (6.3%) patients and one (2.1%) patient, respectively. Patients with malignant PT had larger tumors than those with benign and borderline PTs (p=0.010). No significant difference in other clinical, diagnostic, and pathologic characteristics was found between the groups. CONCLUSION PT can be easily confused with other breast masses such as fibroadenoma due to the non-specific clinical and radiologic findings. Surgical excision with at least 1 cm clear margins is of great importance to reduce the risk of local recurrence. However, recurrence can develop even after appropriate surgery, thus patients should be closely followed up after surgery.

Use of fibrin glue in preventing pseudorecurrence after laparoscopic total extraperitoneal repair of large indirect inguinal hernia

Purpose Seroma is among the most common complications of laparoscopic total extraperitoneal (TEP) for especially large indirect inguinal hernia, and may be regarded as a recurrence by some patients. A potential area localized behind the mesh and extending from the inguinal cord into the scrotum may be one of the major etiological factors of this complication. Our aim is to describe a novel technique in preventing pseudorecurrence by using fibrin sealant to close that potential dead space. Methods Forty male patients who underwent laparoscopic TEP for indirect inguinal hernia with at least 100-mL volume were included in this prospective clinical study. While fibrin sealant was used to close the potential dead space in the study group, nothing was used in the control group. The volume of postoperative fluid collection on ultrasound was compared between the groups. Results Patient characteristics and the volumes of hernia sac were similar between the 2 groups. The mean volume of postoperative fluid collection was found as 120.2 mL in the control group and 53.7 mL in the study group, indicating a statistical significance (P < 0.001). Conclusion Minimizing the potential dead space with a fibrin sealant can reduce the amount of postoperative fluid collection, namely the incidence of pseudorecurrence.

EFFECTIVENESS OF LIDOCAINE/PRILOCAINE CREAM ON PERCEIVED PAIN DURING MAMMOGRAPHY: A PILOT STUDY -

Background: Mammography (MG) is an important imaging method in the diagnosis of breast diseases. However, pain during MG is an uncomfortable factor for the majority of women. Aim: The aim of this study is to determine the effectiveness of lidocaine/prilocaine cream on reducing pain during mammography. Methods: This is a prospective clinical study. A total of 60 female patients who had mammographic examination were equally divided into three groups; patients receiving 10 g EMLA cream (EMLA group), patients receiving 10 g Bepanthen cream (placebo group), and patients not receiving any cream (control group). Pain levels were assessed by using visual analogue scale (VAS) before and after MG. RESULTS: Each group was statistically similar in terms of basic patient characteristics. There was also no significant difference between the pre-MG VAS scores of the three groups (p = 0.996). On the other hand, VAS scores during MG was found significantly different between the groups (p = 0.001). When the groups were compared in pairs, the patients in EMLA group had significantly less post-MG VAS score than the Bepanthen and control groups (p = 0.001). There was no significant difference between Bepanthen and control groups (p = 0.678). CONCLUSION: To our knowledge, this is the first study demonstrating that a topical anaesthetic, EMLA, provides an effective analgesia during MG. Reducing the pain can change women’s preconceptions regarding MG.

Acquired Lymphangiectasia of the Breast After Breast Conserving Surgery.

Lymphangiectasia is characterized by vesicular dilation of lymphatic vessels and is generally a complication of radiotherapy or surgery of various malignant tumors such as breast and cervical cancers. Although it is not a precancerous disease, correct diagnosis is important to rule out Stewart-Treves syndrome which is defined as lymphangiosarcoma that develops in long-standing chronic postmastectomy lymphedema. Observation alone or many therapeutic options including cryosurgery, electrocauterization, sclerotherapy, and excision have been widely used in the management. Herein, a case of breast lymphangiectasia was presented as a late and rare complication of breast cancer-related therapies.

Can mastalgia be another somatic symptom in fibromyalgia syndrome

OBJECTIVE: The purposes of this study were to determine the coexistence of mastalgia and fibromyalgia, to investigate the effects of this combination on pain patterns, and to discuss the status of breast pain in the diagnostic algorithm of fibromyalgia syndrome. METHODS: Sixty-one female patients reporting breast pain during the last three months and 53 female patients diagnosed with fibromyalgia syndrome were enrolled in this study. The Breast Pain Questionnaire was administered to all participants in the mastalgia group and to those in the fibromyalgia syndrome group who had experienced mastalgia during the past three months. The patients in the fibromyalgia syndrome group were evaluated using the 2010 preliminary American College of Rheumatology classification criteria. All of the patients in the mastalgia group were evaluated for the diagnosis of fibromyalgia syndrome by a single physiatrist. The coexistence and pain patterns of mastalgia and fibromyalgia were assessed statistically. RESULTS: Approximately half of the patients with fibromyalgia syndrome (47.2%) reported having mastalgia at the time of admission and 37.7% of the patients with mastalgia met the diagnostic criteria for fibromyalgia syndrome. The patients with mastalgia in the fibromyalgia syndrome group had significantly higher total breast pain scores compared with the women in the mastalgia group. In addition, the patients with fibromyalgia syndrome in the mastalgia group had significantly higher Widespread Pain Index and Symptom Severity Scale scores than the patients with fibromyalgia syndrome. CONCLUSIONS: We suggest that mastalgia can be an aspect of the central sensitivity syndrome and can be added to the somatic symptoms of fibromyalgia.