Mutlu Unver

Isolated metastasis of uterine leiomyosarcoma to the pancreas: Report of a case and review of the literature.

INTRODUCTION Metastatic tumors of the pancreas are uncommon and rarely detectable clinically. Metastases to the pancreas are rare. We present a patient with pancreatic metastases from a leiomyosarcoma of the uterus and review the literature about the clinical features of pancreatic metastasis and its surgical management. PRESENTATION OF CASE A 40-year-old woman, who underwent hysterectomy, left oophorectomy, omentectomy and lymp node dissection for leiomyosarcoma of the uterus. At the follow up, the patient complained of non-specific abdominal discomfort. Preoperative diagnosis were pancreatic pseudocyst, cystadenoma or cystadenocarcinoma. At laparotomy, a cystic mass was found in the tail of the pancreas which was invased to the transverse colon mesenterium and the spleen. Distal pancreatectomy with splenectomy and transverse colon resection was performed. Histologically, the tumor was evaluated as poorly differentiated leiomyosarcoma. DISCUSSION Metastatic lesions of the pancreas are uncommon and less than 2% of all pancreatic malignancies. However a few cases of leiomyosarcoma with metastases to the pancreas have been reported in the literature. Before deciding that the lesion in the pancreas was metastasis, primary leiomyosarcoma of the pancreas had to be ruled out. Histologically, leiomyosarcoma of the pancreas contains interlacing spindle cells with varying degrees of atypia and pleomorphism. The surgical approach to the pancreatic metastases must be aimed complete excision of the tumor with a wide negative margin of clear tissue and maximum preservation of pancreatic remnant if possible. CONCLUSION In the absence of widespread metastatic disease, aggressive surgical approach with negative margins must be aimed.

Predictive Value of Preoperative Neutrophil Lymphocyte Ratio in Determining the Stage of Gastric Tumor

Background Neutrophil-lymphocyte ratio (NLR) is an indicator of the inflammatory state, and its increase has been shown to be a negative prognostic factor for many malignancies. The aim of this study was to determine whether there was a relationship between NLR and tumor aggressiveness in gastric cancer patients and to investigate the prognostic significance of NLR. Material/Methods The medical records of 189 patients with gastric cancer between January 2009 and January 2014 were examined for the presence of metastasis, tumor staging, tumor differentiation grade, and preoperative NLR value. Results Of the 189 patients, 61 were female (32.2%) and 128 were male (67.7%). Eight-eight patients had NLR values of four or higher. A comparison of the high NLR value group and the low NLR value group found no statistically significant difference for clinicopathological features of age, gender, type of operation, of degree of differentiation; differences ranged from 20.7% to 46.2%, p<0.001. Conclusions Increase in NLR has been associated with poor prognosis in univariate analysis and variations of this parameter have also been shown to be correlated with tumor progression. NLR values should be considered as a useful follow-up parameter.

Prognostic Factors in Peptic Ulcer Perforations: A Retrospective 14-Year Study

Regarding the complications of peptic ulcer, a perforation remains the most important fatal complication. The aim of our retrospective study was to determine relations between postoperative morbidity and comorbid disease or perioperative risk factors in perforated peptic ulcer. In total, 239 patients who underwent emergency surgery for perforated peptic ulcer in Ege University General Surgery Department, between June 1999 and May 2013 were included in this study. The clinical data concerning the patient characteristics, operative methods, and complications were collected retrospectively. One hundred seventy-five of the 239 patients were male (73.2%) and 64 were female (26.8%). Mean American Society of Anesthesiologists (ASA) score was 1 in the patients without morbidity, but mean ASA score was 3 in the morbidity and mortality groups. Primary suture and omentoplasty was the selected procedure in 228 of the patients. Eleven patients underwent resection. In total, 105 patients (43.9%) had comorbidities. Thirty-seven patients (67.3%) in the morbidity group had comorbid diseases. Thirteen (92.9%) patients in the mortality group had comorbid diseases. Perforation as a complication of peptic ulcer disease still remains among the frequent indications of urgent abdominal surgery. Among the analyzed parameters, age, ASA score, and having comorbid disease were found to have an effect on both mortality and morbidity. The controversial subject in the present study is regarding the duration of symptoms. The duration of symptoms had no effect on mortality nor morbidity in our study.

Reliability of fine needle aspiration biopsy in large thyroid nodules

OBJECTIVE Fine needle aspiration biopsy provides one of the most important data that determines the treatment algorithm of thyroid nodules. Nevertheless, the reliability of fine needle aspiration biopsy is controversial in large nodules. The aim of this study was to evaluate the adequacy of fine needle aspiration biopsy in thyroid nodules that are four cm or greater. MATERIAL AND METHODS We retrospectively examined 219 patients files who underwent thyroidectomy for thyroid nodules that were greater than four centimeter between May 2007 and December 2012. Seventy-four patients with hyperthyroidism, and 18 patients without preoperative fine needle aspiration cytology were excluded from the study. Histopathologic results after thyroidectomy were compared with preoperative cytology results, and sensitivity and specificity rates were calculated. RESULTS False-negativity, sensitivity and specificity rates of fine needle aspiration biopsy of thyroid nodules were found to be 9.7%, 55.5%, and 85%, respectively. Within any nodule of the 127 patients, 28 (22.0%) had thyroid cancer. However, when only nodules of at least 4 cm were evaluated, thyroid cancer was detected in 22 (17.3%) patients. CONCLUSION In this study, fine needle aspiration biopsy of large thyroid nodules was found to have a high false-negativity rate. The limitations of fine-needle aspiration biopsy should be taken into consideration in treatment planning of thyroid nodules larger than four centimeters.

Isolated retroperitoneal hydatid cyst invading splenic hilum.

Introduction. Hydatid disease (HD) is an infestation that is caused by the larval stage of Echinococcus granulosus. The liver is affected in approximately two-thirds of patients, the lungs in 25%, and other organs in a small proportion. Primary retroperitoneal hydatid cyst is extremely rare. The most common complaint is abdominal pain; however, the clinical features of HD may be generally dependent on the location of the cyst. Case Presentation. A 43-year-old female was admitted with the complaint of abdominal pain. Her physical examination was normal. Computed tomography (CT) revealed a 17 × 11 cm cystic lesion, with a thick and smooth wall that is located among the left liver lobe, diaphragm, spleen, tail of the pancreas, and transverse colon and invading the splenic hilum. Total cystectomy and splenectomy were performed. Pathological examination was reported as cyst hydatid. Discussion. Cysts in the peritoneal cavity are mainly the result of the spontaneous or traumatic rupture of concomitant hepatic cysts or surgical inoculation of a hepatic cyst. Serological tests contribute to diagnosis. In symptomatic and large hydatid peritoneal cysts, surgical resection is the only curative treatment. Total cystectomy is the gold standard. Albendazole or praziquantel is indicated for inoperable and disseminated cases. Percutaneous aspiration, injection, and reaspiration (PAIR) technique is another nonsurgical option.

S-Shaped Wide Excision with Primary Closure for Extensive Chronic Pilonidal Sinus Disease

Background. The management of complex pilonidal sinus disease (PSD) with multiple pits on and beside the natal cleft is variable, contentious, and problematic. Wide excision of the sinus and reconstruction of the defect using different flap techniques have become more popular in recent years. Case Report. We report a case with a complex chronic PSD to which we applied primary closure after S-shaped wide excision. The patients postoperative course was uneventful, and at the end of one-year followup he is now disease-free and comes for routine checkups. Conclusion. The simplicity of the technique and the promising results support the applicability of the S-shaped wide excision in chronic bilaterally extended large PSDs. Further studies entailing large patient populations are needed to reach a definite conclusion.

Giant Extrarenal Retroperitoneal Angiomyolipoma: A Rare Case of a Large Size Tumor

Extrarenal retroperitoneal angiomyolipoma (ERAML) is a rare benign mixed mesenchymal tumor that can mimic other retroperitoneal tumors and cause a diagnostic problem. Angiomyolipomas are benign soft tissue tumors that generally occur in kidneys; extrarenal location is very rare. The definitive diagnosis for ERAML usually depends on histopathologic analysis. ERAML generally does not have tumoral progression to malign neoplasms, but there is an association between local recurrence and incomplete excision. The primary treatment for ERAML is to achieve complete surgery. This case is unique in that it is the largest case of ERAML in the literature, with a diameter of 55 cm and a weight of 18.490 kg.

Retroperitoneal paraganglioma presenting with pancytopenia: A rare case with rare manifestation

Highlights • Retroperitoneal paragangliomas are mostly benign with good prognosis.• Complete surgical excision is the treatment of choice for extra-adrenal paragangliomas.• Reactive thrombocytosis is a common cause of thrombocytosis after splenectomy.

A Rare Cause of Colonic Obstruction “Colonic Intussusception”: Report of Two Cases

Colocolic intussusceptions are rare clinical entities in adults and almost always caused by a leading lesion which often warrants resection. Mostly being malignant, the leading lesions are rarely benign lesions where intraluminal lipomas are the most frequent among them. Most adult intussusceptions require surgical resection owing to two major reasons: common presence of a leading lesion and significantly high risk of malignancy—reaching as high as 65% regardless of the anatomic site—of the leading lesion. Resection of the affected segment is usually the treatment of choice, since preoperative diagnosis of the lesion is usually ineffective and most leading lesions are malignant. This paper represents two cases of adult colocolic intussusception caused by intraluminal lipomas with a brief review of the literature.