GÝRÝÞ ve AMAÇ: Kolorektal kanserler dünya genelinde en sýk görülen kanserlerden biridir. Karaciðer metastazý tanýdan kýsa bir süre sonra geliþebilir. Daha önce tedavi almýþ kolorektal kanserli hastalarda karaciðer metastazektomi yapýlmasý 5 yýllýk saðkalýmý %20-40 oranýnda arttýrabilir. Bu çalýþmada erken evre kolorektal karsinomlu hastalarýn karaciðer nüksünü erken dönemde predikte edebilecek faktörleri araþtýrmayý amaçladýk.
YÖNTEM ve GEREÇLER: Çalýþmamýza Ankara Numune Eðitim ve Araþtýrma Hastanesi Týbbi Onkoloji Kliniðinde 2009 Ocak- 2014 Aðustos aylarýnda takibe alýnarak tedavi planý yapýlan non-metastatik 517 hasta dahil edilmek üzere deðerlendirildi. Birinci grupta karaciðer dýþý nüksü olan hastalarla beraber nüks olmadan takibe devam edilen hastalar varken 2.grupta ise karaciðer metastazý geliþen hastalar mevcuttu. Hastalarýn taný anýndaki laboratuar sonuçlarý receiver operating characteristic (ROC) curve analizi uygulanarak laktat dehidrogenaz (LDH), karsinoembriyonik antijen (CEA) ve gama glutamil transferaz (GGT) için cut off deðerleri belirlendi (sýrasýyla, 400 U/L, 50 ng/ml ve 90 U/L).
BULGULAR: Univariate analizde CEA deðeri yüksek olan 20 hastanýn 7’sinde (%35), düþük olan 206 hastanýn 28’inde (%8,7) kc metastazý geliþmiþti (p<0,001). LDH deðerine göre karaciðer nüksüne bakýldýðýnda ise yüksek olan 15 hastanýn 5’inde (%33,3), düþük olan hasta grubunda 189 hastadan 17’sinde (%9) takipte karaciðer metastazý geliþti (p=0,003). GGT deðerine göre ise yüksek olan 15 hastanýn 5’inde (%33,3), düþük olan 244 hastanýn 24’ünde (%9,8) karaciðer nüksü geliþmiþti (p=0,005). Multiple lojistik regresyon analizi ile deðerlendirildiðinde LDH anlamlýlýðýný korumaktaydý (p=0,047, OR 7,8: 1,02-59,3).
TARTIÞMA ve SONUÇ: Karaciðer metastazý kolorektal kanser tanýsý alan hastalarda surveyi etkileyen önemli bir faktördür. Bizim çalýþmamýzda LDH yükseliðinin karaciðer nüksünü predikte etmede kullanýlabilecek uygun bir fakör olduðu görüldü fakat bu sonucun prospektif randomize çalýþmalarla desteklenmesi gerekmektedir.

INTRODUCTION: Colorectal cancer (CRC) is one of the most commonly detected cancers worldwide. Liver metastasis might develop shortly after the diagnosis of colorectal cancer. Liver metastasectomy might improve the five year survival rate to 20-40% in patient with previously treated CRC. We aimed in this study to evaluate the predictive factors to liver metastases in patients with newly diagnosed non metastatic CRC.
METHODS: Five hundred and seventeen non-metastatic colorectal patients followed at Medical Oncology Department of Ankara Numune Training and Research Hospital between January 2009 and August 2014 were evaluated retrospectively. Patients were divided in to the two subgroups. Group 1 consisted of non-metastatic and metastatic patients except liver metastases. Group 2 consisted of patients with liver metastases. Laboratuary results at the time of diagnosis were evaluated with receiver operating characteristic (ROC) Curve analysis and cut-off values were determined for lactate dehydrogenase (LDH), carcinoembryonic antigen (CEA) and gama glutamil transferase (GGT) with (400 U/L, 50 ng/ml and 90 U/L, respectively).
RESULTS: There were 7 cases (%35) with high CEA levels in Group 2 and 28 (%8,7) cases in Group 1. There was a significant difference between this subgroups in univariate analysis (p<0,001). According to LDH levels, there were 5 (%33,3) liver metastases in high LDH group and 17 (%9) liver metastases in low LDH group (p=0,003). There were 5 cases (%33,3) of liver metastases in patients with high GGT and 24 cases(%9,8) in patients with low GGT (p=0,005). LDH was remained only significant factor after multiple logistic regression analysis (OR 7,8: 1,02-59,3).
DISCUSSION AND CONCLUSION: Hepatic metastases from colorectal cancer were an important predictive factor of overall survival. In our study we showed that high LDH levels at the time of diagnosis might be useful predictive factor of liver metastases. We need prospective randomized studies to determine effect of high LDH levels in colorectal cancer.

GÝRÝÞ ve AMAÇ: Tromboembolizm kanser hastalarýnda yaygýn olarak görülmektedir. Kolorektal kanser geliþimi ve progresyonu sýrasýnda koagülasyon ve fibrinolitik sistemdeki pek çok molekül aktive olmaktadýr.Trombinle aktive fibrinolizis inhibitörü (TAFI), doku faktör yolak inhibitörü (TFPI) ve protrombin fragmant 1+2 koagülasyon ve fibrinoliziste yeni tanýmlanan moleküllerdir.Bu çalýþmanýn amacý ileri evre kolorektal kanser hastalarýnda klinikopatolojik özelliklerle TAFI, TFPI ve protrombin fragment 1+2 düzeyleri arasýndaki iliþkinin araþtýrýlmasýdýr.
YÖNTEM ve GEREÇLER: Seksen iki ileri evre kolorektal kanser hastasý (32 metastatik,50 lokal ileri hasta) çalýþmaya alýndý.Serum TAFI, TFPI, and prothrombin F1+2 düzeyleri enzim baðlý immünosorbent yöntemi (ELISA) ile saptandý. Hastalarýn klinikopatolojik özellikleri týbbi kayýtlardan retrospektif olarak deðerlendirildi.
BULGULAR: 28 (%34) kadýn ve 54 erkek (%66) olgu çalýþmaya alýndý. Olgularýn ortalama yaþý 56 idi. Hastalarda plasma TAFI, TFPI ve protrombin F1+2 düzeyleri sýrasýyla %70, %71 ve %96 oranýnda yüksek olarak saptandý. Protrombin F1+2 düzeyleri düþük performans skoru olan hastalarda yüksek bulundu. TFPI düzeyleri tümör grade 2 ve 3 olan hastalarda yüksek bulunurken TAFI düzeyleri rektal kanser hastalarýnda daha yüksek bulundu.Yaþ, cins, beden kitle endeksi, metastatik ve lokal ileri hastalýk, tümör çapý, vasküler invazyon, perinoral invazyon karsinoembriyonik antijen, hemoglobin ve trombosit sayýsý ile TAFI, TFPI ve prothrombin F 1+2 düzeyleri arasýnda anlamlý iliþki bulunmadý.
TARTIÞMA ve SONUÇ: Yüksek grade’li tümörlerde TFPI düzeylerinin yüksek bulunmasý tümör grade’i ile koagülasyon sistemi arasýndaki iliþkinin bir belirtisi olarak düþünülmüþtür. Düþük performanslý hastalarda protrombin fragmant 1+2 düzey yüksekliði bu hastalarda daha aktif bir koagülasyon kaskadýný göstermektedir. Rektal kanser hastalarýndaki TAFI yüksekliði bu hastalarýn daha kötü giden seyri ile iliþkili olabilir.

INTRODUCTION: Thromboembolism is common in cancer patients. During colorectal cancer development and progression, many molecules located in coagulation and fibrinolytic systems are activated. Thrombin activatable fibrinolysis inhibitor (TAFI), tissue factor pathway inhibitor (TFPI) and prothrombin fragment 1+2 (F1+2) are newly identified molecules involved in coagulation and fibrinolysis. The aim of this study was to investigate the relationship between clinicopathologic characteristics and TAFI, TFPI and F1+2 levels in patients with advanced colorectal.
METHODS: Eighty-two patients (32 metastatic, 50 locally advanced disease) diagnosed with colorectal cancer in the medical oncology clinic. Serum TAFI, TFPI, and prothrombin F1+2 levels were evaluated via enzyme-linked immunosorbent assay. Clinicopathologic characteristics of the patients were investigated retrospectively from the medical records of the patients.
RESULTS: There were 28 (34%) females and 54 males (66%) included in the study. The mean age of the participants was 56 years. The plasma TAFI, TFPI, and prothrombin F1+2 levels were high in 70, 71, and 96% of the patients, respectively. Prothrombin F1+2 levels were higher among patients with lower performance scores. TFPI levels were higher among patients with tumor grades of 2 and 3. TAFI levels were higher among rectal cancer cases. Age, gender, BMI, metastatic or locally advanced disease, size of tumor, vascular invasion, perineural invasion, carcinoembryonic antigen, hemoglobin and thrombocyte levels were not associated with TAFI, TFPI, and prothrombin F 1+2 levels
DISCUSSION AND CONCLUSION: Higher TFPI levels in case of tumors at higher stages can indicate that there is an association between tumor grade and coagulation cascade. The higher prothrombin F1+2 levels, an indicator of active coagulation cascade, among patients with low performance scores may indicate that the coagulation cascade of these patients is more active. Higher TAFI levels among rectal cancer patients may be related to the natural course of the disease.

GÝRÝÞ ve AMAÇ: Bu çalýþmanýn amacý; alt ekstremite uzun kemiklerinde malign patolojik kýrýklarýn cerrahi ve fonksiyonel sonuçlarýný deðerlendirmek ve bu sonucu etkileyebilecek faktörleri ortaya koyabilmektir.
YÖNTEM ve GEREÇLER: Çalýþmaya alt ekstremite uzun kemiklerindeki malign patolojik kýrýk nedeniyle tedavi edilen 24‘ü erkek 21‘i kadýn 45 hasta dahil edildi. Olgularýn yaþlarý 14-80 arasýnda ve ortalama yaþ 59.8 idi. Hastalar ortalama 10.3 (1-60) ay süreyle takip edildi. Patolojik kýrýk lokalizasyonlarý 32 hastada femur proksimal, 7 hastada femur diafiz, 6 hastada ise femur distal yerleþimli idi.
BULGULAR: Fonksiyonel deðerlendirmede Enneking’in MSTS skorlamasý kullanýldý. Hastalarýmýzýn tüm serilerdeki ortalama postoperatif MSTS skoru % 57.6 (% 26- % 93) idi. Bu oran Femur proksimali için ortalama % 57.3, Femur diafiz için ortalama % 61.7, Femur distal için ortalama % 54.6 olarak bulunmuþtur. Tüm seride: Mükemmel: 3 (% 6), iyi: 12 (% 27), Orta: 16 (% 36), kötü 14 (% 31) sonuç elde edilmiþtir. Sonuçlarýmýz litaratürle benzerdir.
TARTIÞMA ve SONUÇ: Uzun kemik metastazlarýnýn tedavi algoritmasýnýn düzenlenmesi ve uygun cerrahi tedavinin planlanmasý halen günümüzde önemli bir problemdir. Tedaviye karar vermede ve hastalarýn evrelendirilmesinde onkolojinin temel prensipleri uygulanmalý ve multidisipliner bir yaklaþým sergilenmelidir. Cerrahi tedavide amaç aðrýyý azaltmak ve sonrasýnda hastaya yük verebileceði bir ekstremite kazandýrmaktýr.

INTRODUCTION: The aim of this study is to analyze the surgical and functional results of malign pathologic fractures of long bones of lower ekstremity and the factors releated with this results.
METHODS: 45 patients (24 male and 21 female) were included in the study who were treated with the diagnosis of pathologic fractures in the lower extremities. Mean age of the patients were between 14-80 years and average 59.8 years. Patients were followed up with a mean period of 10.3(1-60) months. 32 patients had proximal femur, 7 patients had femoral diaphysis and 6 patients had distal femoral fractures.
RESULTS: Enneking’s MSTS classification system was used for functional assesment. The average postoperative score was 57.6(% 26- % 93) in all series. This average score was % 57.3 for proximal femur, % 61.7 for distal femoral diaphysis and % 54.6 for distal femur. Excellent results were recorded for 3(% 6), good results for 12(% 27), average results for 16 (% 36)and poor results for 14 (% 31) patients. The results were similar with literature.
DISCUSSION AND CONCLUSION: The treatment algorithm and proper surgical technique is still a major problem in long bone metastases. While deciding the treatment method, we should use the basic oncologic rules and perform mutidisciplinar approach. The aim is to decrease pain and to provide a weight bearing extremity.

GÝRÝÞ ve AMAÇ: Bu çalýþmayý, prostat kanserinde, tümör dokusunda ve tümör çevresinde CD105 ve CD31 ile araþtýrýlan mikrovasküler yoðunluðun (MVY) histopatolojik ve klinik bulgularla iliþkisini araþtýrmak amacýyla planladýk.
YÖNTEM ve GEREÇLER: Çalýþmamýzda, Patoloji Bölümünde incelenmiþ 100 radikal prostatektomi materyali klinik ve histopatolojik bulgularý açýsýndan retrospektif olarak deðerlendirildi. Her bir materyaldeki tümör dokusuna ve tümör çevresine CD105 ve CD31 immünohistokimyasal belirteçleri uygulandý. Tümoral ve peritümöral CD105 ve CD31 ile MVY ekspresyonu, klinik ve histopatolojik bulgularla karþýlaþtýrýldý.
BULGULAR: Tümör dokusunda CD105 ve CD31 ile MVY, tümör çevresindekinden anlamlý olarak fazla bulundu (p<0.001). Tümör çevresindeki CD105 ile boyanan damar sayýsý, tümör çevresindeki CD31 ile boyanan damar sayýsýndan anlamlý derecede düþük bulundu (p<0.001). Tümör dokusundaki CD105 MVY ile preoperatif serum total PSA düzeyi, tümör hacmi, perinöral invazyon, lenf düðümü metastazý ve lokal invazyon arasýnda anlamlý iliþki bulundu (sýrasýyla r=0,338 ve p<0,001, p= 0,003, p= 0,009, p= 0,044). Tümör dokusundaki CD31 MVY ekspresyonu ile patolojik evre, cerrahi sýnýrda tümör bulunmasý ve veziküloseminalis invazyonu arasýnda anlamlý iliþki bulundu (sýrasýyla r=0,228 ve p= 0,022, p=0,034).Tümör çevresindeki CD105 ve CD31 MVY ekspresyonu ile klinik ve histopatolojik bulgular arasýnda anlamlý iliþki görülmedi (p > 0,05).
TARTIÞMA ve SONUÇ: Tümör dokusundaki CD105 ve CD31 MVY’nun, prognostik açýdan önemli klinik bulgularla iliþkili olmasý, tümör pogresyonunda anjiogenezin önemini vurgulamaktadýr. Bu bulgu anti-anjiojenik ajanlarý içeren yeni tedavi modalitelerinin geliþmesini saðlayacaktýr.

INTRODUCTION: We designed this study in order to investigate the relation between histopathological and clinical properties in prostatic carcinoma patients and microvessel density (MVD) of tumoral and peritumoral tissue, assessed by CD105 and CD31 expression.
METHODS: A total of 100 radical prostatectomy samples, have been evaluated retrospectively with clinical and histopathological findings. Immunohistochemical markers of CD105 and CD31 were applied to the tumoral tissue and surroundings of tumor. Relation between tumoral and peritumoral CD105, CD31 and clinical or histopathological findings was evaluated.
RESULTS: CD105 and CD31 together with MVD have been found more significant in the tumoral tissue than the periphery (p<0,001). CD105 expression in the peritumoral tissue was significantly lower than the CD31 expression. A significant correlation has been found between CD105 MVD in the tumoral tissue and the preoperative serum total PSA levels and tumor volume (r=0.259, p=0.009, r=0.198, p=0.049, respectively). Tumoral CD105 expression was significantly higher in cases with perineural invasion, lymph node metastasis and local invasion (p=0.003, p=0.009, p=0.044). CD31 expression was significantly correlated with pathological stage (r=0.228, p= 0.022, p=0,034, respectively). Cases with seminal vesicle invasion and extracapsular extension had with significantly higher CD31 MVD. No significant correlation was found between peritumoral tissue MVD and clinical or histopathological findings.
DISCUSSION AND CONCLUSION: Finding of association between CD105 and CD31 in the tumoral tissue and prognostic clinical findings, supports the importance of angiogenesis in tumoral progression. This may reveal new treatment modalities for research involving anti-angiogenic agents.

GÝRÝÞ ve AMAÇ: Ýnvaziv araç iliþkili hastane enfeksiyonlarý sürveyansýnýn enfeksiyon kontrol önlemlerinin planlanmasýnda önemli rolü vardýr. Bu çalýþmada amacýmýz, 2009-2013 yýllarý arasýnda yoðun bakým ünitesinde yatan hastalarda invaziv araç iliþkili hastane enfeksiyonlarýnýn deðerlendirmesi ve malignite varlýðýnýn mortalite oranlarý üzerindeki etkisini araþtýrmaktýr.
YÖNTEM ve GEREÇLER: Hastanemiz yoðun bakým ünitesinde hastane enfeksiyonlarýna yönelik aktif sürveyans yapýlmaktadýr. Hastalara ait veriler Ulusal Hastane Enfeksiyonlarý Sürveyansý Aðý kayýtlarýndan alýnmýþtýr. Mikroorganizma tanýmlamasý klasik yöntemlerle yapýlmýþ, VITEK 2 otomatize sistem ile teyit edilmiþtir. Hastane enfeksiyonu tanýsý “Centers for Diseases Control and Prevention” kriterlerine göre konulmuþtur.
BULGULAR: Yoðun bakým ünitesinde hastane enfeksiyonu insidansý bu dönem içinde ortalama 40,75/1000 hasta günü olup, %85-100’ünü invaziv araç iliþkili hastane enfeksiyonlarý oluþturmuþtur. Santral venöz kateter kullaným oraný ile santral venöz kateter iliþkili kan dolaþýmý enfeksiyonu hýzlarýnda beþ yýlda anlamlý azalma saptanmýþtýr (p= 0,0005). Santral venöz kateter iliþkili kan dolaþýmý enfeksiyonlarý ve ventilatör iliþkili pnömonilerde Gram negatif basiller daha fazla izole edilmiþ ve özellikte Acinetobacter spp’ nin önemli sorun teþkil ettiði gözlemlenmiþtir. Kateter iliþkili üriner sistem enfeksiyonlarýnda Gram negatif basiller ve kandidalar en çok izole edilen mikroorganizmalar olmuþtur. Ýnvaziv araç iliþkili hastane enfeksiyonu geliþen maligniteli hastalarda yoðun bakým mortalite oraný 2013 yýlýnda, diðer hastalara göre anlamlý olarak daha yüksek bulunmuþtur (p= 0,010).
TARTIÞMA ve SONUÇ: Hastanemizde santral venöz kateter iliþkili kan dolaþýmý enfeksiyonu hýzlarýnda bir miktar gerileme varken diðer invaziv araç iliþkili enfeksiyonlarýn yüksek seyrettiði gözlemlenmiþtir. Yoðun bakým ünitemizde Acinetobacter spp enfeksiyonlarýnýn ciddi bir problem oluþturduðu ortaya çýkmýþtýr. Ayrýca invaziv araç iliþkili hastane enfeksiyonu olan hastalarda malignite varlýðýnýn yoðun bakým mortalite oranlarýný artýrdýðý gözlemlenmiþtir.

INTRODUCTION: Surveillance of invasive device related nosocomial infections is important for planning infection control procedures. We aimed to evaluate these infections in intensive care unit patients during the period between 2009 and 2013 and the effect of malignancy on mortality rates in this group.
METHODS: Surveillance of nosocomial infections is done prospectively in our intensive care unit. The data of patients were recorded from our national surveillance system. The causative microorganisms of nosocomial infections were classified by conventional methods and verified by VITEK 2 automated system. “Centers for Diseases Control and Prevention” criteria were used to diagnose nosocomial infections.
RESULTS: Mean nosocomial infection incidence in this period was 40,75/1000 patient days and 85-100% of them were invasive device related nosocomial infections. We found that the usage of central venous catheter and catheter related bloodstream infection rates were declined significantly during this period (p: 0,0005). Gram negative bacilli, especially Acinetobacter spp were the most common microorganisms that caused catheter related blood stream infections and ventilator associated pneumoniae. Gram negative bacilli and Candida spp. were the most common microorganisms causing catheter related urinary tract infections. Intensive care unit mortality rates were statistically higher in patients with malignancy than the others in 2013 (p: 0,010).
DISCUSSION AND CONCLUSION: We observed that catheter related blood stream infection rates were decreased during the study period while catheter related urinary tract infections and ventilator associated pneumoniae rates did not change during the study period. Acinetobacter baumannii is a serious problem in our intensive care unit. We observed that intensive care unit mortality rate is higher in patients with invasive device related nosocomial infections in the presence of malignancy.

Prostat kanseri erkeklerde çok sýk görülen bir kanserdir. En sýk metastaz yerleri lenf nodu ve kemiklerdir. Ancak uzun sað kalým süresi olan hastalarda nadir olarak hipofiz, larinks ve cilt tutulumu da olabilmektedir. Gastrointestinal sistem tutulumlarý da ancak vaka sunumu þeklinde literatürde bildirilmiþtir. Duodenum metastazý, 2014 yýlýna kadar 3 vakada bildirilmiþtir. Biz de yaygýn kemik metastatik olan bir hastada geliþen izole duodenum metastazlý hastayý sunmayý amaçladýk.

Prostate cancer is the most common cancer in males. The most common metastatic regions for prostate cancer are the lymph nodes and bone. Unexpected metastasis sites, such as the pituitary gland, larynx, and skin, have been reported which is associated with long survival. Gastrointestinal system involvement has been also reported as case presentations. Until 2014, duodenum metastasis was reported in three patients. Herein, we aimed to present a patient who had widespread bone metastasis, as well as isolated duodenum metastasis at diagnosis.

Tiroid bezinde papiller tiroid karsinomu ve medüller tiroid karsinomunun birlikte oluþumu nadir bir durumdur. Papiller tiroid karsinomu folliküler hücrelerden kaynaklanýrken medüller tiroid karsinomu parafolliküler hücrelerden kaynaklanýr. Bu olgu sunumunda tiroiddeki nodülden ince iðne aspirasyon biopsisi sonucu folliküler neoplazi olmasý nedeniyle total tiroidektomi yapýlan ve operasyon sonrasý patolojik incelemesi papiller karsinom ve ayný lobda medüller karsinom olarak raporlanan 65 yaþýnda erkek hasta sunuldu.

Papillary thyroid carcinoma and medullary thyroid carcinoma in the thyroid gland is a rare condition. Papillary thyroid carcinoma originates from follicular cells, medullary thyroid carcinoma originates from parafollicular cells. We report the case of a 65 years old man who developed a thyroid follicular neoplasia. The patient was operated to our department with total thyroidectomy. In the pathological examination of the specimen showed papillary carcinoma and medullary carcinoma in the right lobe.

Akustik nörinom, vestibulokohlear sinirin vestibüler kýsmýndan köken alan serebellopontin açýda en sýk rastlanan iyi huylu bir tümördür. Kýrk altý yaþýnda kadýn hasta sað göz kapaðýný kapatamama, dýþa bakamama þikayetleriyle kliniðimize baþvurdu. Beþ yýl önce akustik nörinom nedeniyle ameliyat geçirdiði öðrenilen hastanýn yapýlan muayenesinde sað periferik fasiyal paralizisi, ezotropya, sað dýþa bakýþ kýsýtlýlýðý ve korneada his kaybý tespit edildi. Hastaya fasiyal sinir felci bulgularýný düzeltmek için orta yüz kaldýrma ve levator menteþe yöntemi ile levator geriletme ameliyatý yapýldý. Abdusens felci için ise Foster sütür ile Hummelsheim split tendon transpozisyonu uygulandý. Ameliyat sonrasý bulgularýnda belirgin düzelme izlendi. Bu olguda akustik nörinom cerrahisi sonrasý ortaya çýkan göz þikayetlerine yaklaþým tartýþýldý.

Acustic neuroma is the most common bening tumor of cerebellopontine angle which is originated from vestibular portion of the vestibulocochlear nerve. Fourty-Six year-old female patient was admitted to our clinic with complaints of inability to close her right eye. She had history of a acustic neuroma operation 5 years ago. Her ophthalmic examination revealed right peripheral facial paralysis, right esotropia, underactivity of the left lateral rectus muscle and impaired corneal sensation. Therefore, mid-face lift combined with levator hinge procedure was performed for facial nerve paralysis. Hummelsheim split tendon transfer with Foster modification was performed for abducens paralysis. After these procedures, a satisfactory result was achieved. In this report, acoustic neuroma related eye involvement and its treatment was discussed.

Sphingomonas paucimobilis genellikle altta yatan bir komorbit hastalýk ile beraber patojenite gösteren fýrsatçý bir enfeksiyon ajanýdýr. Sphingomonas paucimobilis bakteriyemi, ventilatör iliþkili pnömoni, intravasküler kateter iliþkili enfeksiyonlar, menenjit, peritonit, osteomyelit, septik artrit, postoperatif endoftalmit, plevral ampiyem, splenik apse, üriner trakt enfeksiyonlarý ve bilier trakt enfeksiyonlarý da dahil olmak üzere çok çeþitli enfeksiyonlarla iliþkilendirilmiþtir. Bu vaka takdiminde osteosarkoma nedeni ile endoprostetik tümör rekonstrüksiyonu yapýlan bir olguda, Sphingomonas paucimobilis'in neden olduðu prostetik eklem enfeksiyonu bildirilmiþtir. Bu olgu S. paucimobilis'in neden olduðu, tümör rezeksiyon protezi eklem enfeksiyonu raporudur.

Sphingomonas paucimobilis is an opportunistic infectious agent that generally shows its pathogenicity by accompanying an underlying comorbid disease. It is recognized that Sphingomonas paucimobilisis associated with many infections, including: bacteremia, ventilator related pneumonia, intravascular related catheter infections, meningitis, peritonitis, osteomyelitis, septic arthritis, postoperative endophthalmitis, pleural empyema, splenic abscess, urinary tract infections and biliary tract infections.
The present report described a prosthetic joint infection, caused by Sphingomonas paucimobilis, in a patient who had endoprosthetic tumor reconstruction due to osteosarcoma. It chronicles the prosthetic joint infection with endoprosthetic tumor reconstruction in the literature caused by S. paucimobilis.

Akral lentiginöz malign melanom (ALMM) nadir görülen ve kötü prognozlu bir malign melanom alt tipidir. Sýklýkla ileri evrede taný alýr. Karakteristik dermatoskopik bulgularý olan bir ALMM vakasý sunmaktayýz.

Acral lentiginous malignant melanoma (ALMM) a rare subtype of malignant melanoma with poor prognosis. It is often diagnosed at advanced stage. We present a ALMM case with characteristic dermoscopy findings.

Meme kanserinin kranial metastazlarý; kemik, dura veya beyin parankimine olmaktadýr. Semptomlar metastazýn lokalizasyonuna göre deðiþir. Kitleler; solid, kistik veya parsiyel kistik þekilde olabilirler. Meme kanserinin kistik intrakranial metastazlarý oldukça nadirdir. Cerrahi sonrasý radyoterapi ve/veya kemoterapi uygulanýr. Kýrksekiz yaþýnda bayan olgu, baþ aðrýsý ve generalize tonik-klonik nöbet þikayetleri ile baþvurdu. Sekiz yýl önce sol meme kanseri nedeniyle sol total mastektomi ve sol koltukaltý lenfadenektomi ameliyatý yapýlmýþ. Patolojisi adenoid kistik karsinom olarak gelmiþ. Lenf nodlarýnda metastaz tespit edilen olguya adjuvan kemoterapi uygulanmýþ. Meme ameliyatýndan sekiz yýl sonra yapýlan kranial MRG’sinde (Manyetik Rezonans Görüntüleme) sol frontalde ve serebellar orta hatta büyük kistik kitle lezyonlarý tespit edildi. Yapýlan PET-CT (Pozitron Emisyon Tomografi) incelemesinde, baþka herhangi bir organýnda metastaz tespit edilmedi. Meme açýsýndan yapýlan genel cerrahi konsültasyonunda herhangi bir patoloji bulunmadý. Her iki kranial lezyon nedeniyle bir hafta arayla iki kez ameliyat edilen olgunun yapýlan patolojik incelemesinde, kistik meme kanseri metastazý tespit edildi. Ameliyat sonrasýnda olguya tüm beyin radyoterapi uygulandý. Kemoterapi uygulanmadý. Bu olgu dolayýsýyla kranial kistik metastazlarda, ender de rastlansa meme kanseri metastazlarýný ayýrýcý tanýda düþünmemiz gerektiðini vurgulamak istedik.

Breast cancer is most frequently metastasize dura, bone and parenchyma in cranial tissue. Symptoms vary according to the location of the metastasis. Masses may be solid, cystic and partial cystic form. Cystic intracranial metastases of breast cancer is very rare. Radiotherapy and/or chemotherapy could be performed after surgery. Forty-eight-year-old female patient was admitted with complaints of headache and generalized tonic-clonic seizure. Patient underwent surgery for cancer of the left breast for eight years ago. Left total mastectomy and left axillary lymphadenectomy was performed. Pathology was determined as adenoid cystic carcinoma. Adjuvant chemotherapy was applied to patients with lymph nodes metastasis detected. Cranial MRI (Magnetic Resonance Imagination) was performed after eight years after breast surgery. In the left frontal and cerebellar midline, large cystic mass lesions were detected in cranial MRI. PET–CT (Positron Emission Tomography) examination was not detected in any other organ metastases. There was no pathology in terms of breast surgery consultation. Both cranial lesions were underwent surgery twice in one week. In the pathological examination of the patient, cystic breast cancer metastasis was detected. Whole brain radiotherapy was performed to the patient after surgery. We want to emphasize that in cranial cystic metastasis, rarely come across if breast cancer metastasis should be considered in differential diagnosis.