GÝRÝÞ ve AMAÇ: Akut Myeloid Lösemi (AML) kemik iliðinde myeloid öncü hücrelerin diferansiyasyon ve apoptozis kontrolünden korunup proliferasyon hýzýnýn artmasý sonucu kemik iliði yetmezliði ile giden bir hastalýktýr. Nükleofosmin (NPM1) ve FMS like tirozin kinaz (FLT3), heterojen bir genetiðe sahip olan AML’de sýk görülen mutasyonlardýr. Bu çalýþmamýzda AML’de NPM1 ve FLT3 tespit edilen hastalarýn klinik özelikleri ve yaþam sürelerini deðerlendirmeyi amaçladýk.
YÖNTEM ve GEREÇLER: Çalýþmaya 01 Ocak 2012-31 Haziran 2019 tarihleri arasýnda Dicle Üniversitesi hematoloji kliniðinde WHO 2016 kriterlerine göre AML teþhisi konan hastalarýn klinik, immünofenotipik ve genetik parametreleri retrospektif olarak incelendi. Hastalarýn tedaviye cevaplarý, yaþam süreleri, genetik özelikleri ve NPM1 ve FLT3 mutasyonlarýnýn yaþam süresi ile iliþkisi incelenmiþtir.
BULGULAR: Çalýþmamýzda 269 AML tanýsý alan hastalardan 'sitogenetik olarak normal 107 hasta RT-PCR (Gerçek Zamanlý Polimeraz Zincir Reaksiyonu) kullanýlarak NMP1 ve FLT3 mutasyonlarýnda araþtýrýldý.. NPM1 pozitif hasta grubunda ortanca saðkalým 12,3 ay (% 95 confidence interval(C.I.): 0,1-32 ay) tespit edildi, NPM1 negatif hasta grubunda ise 10,6 ay(% 95 C.I: 4,9-16,3 ay) olarak tespit edildi. FLT3 pozitif hasta grubunda ortanca saðkalým süresi 8,4 ay (% 95 C.I: 1,2-15,6 ay) olup FLT3 negatif grupta ise 12,3 ay(% 95 C.I: 3,8-20,8 ay) olarak tespit edildi. NPM1 pozitif hasta sayýsý 31 (%29), FLT 3 pozitif hasta sayýsý19( % 17,8) izlendi.

TARTIÞMA ve SONUÇ: Ülkemizin ilk verisi olarak AML sitogenetik normal hastalarda NPM1 pozitiflik oraný %29, FLT3 pozitiflik oraný %17,8 bulundu. NPM1 ile genel saðkalým daha iyi, FLT3 ile genel saðkalým daha kötü olarak izlendi.

INTRODUCTION: Acute Myeloid Leukaemia (AML) is a disease characterized by bone marrow failure due to increased proliferation resulting from the protection of myeloid precursor cells from differentiation and apoptosis control in the bone marrow. Nucleophosmin (NPM1) and FMS-like tyrosine kinase (FLT3) are mutations frequently seen in AML, which has heterogeneous genetics. The present study aimed to evaluate the clinical characteristics and lifespan of the patients with NPM1 and FLT3 in AML.
METHODS: The study retrospectively investigated the clinical, immunophenotypical, and genetic parameters of the patients diagnosed with AML between 1 January 2012 and 31 June 2019 in the haematology clinic of Dicle University following WHO 2016 criteria. The study primarily focused on the patients' response to the disease, genetic characteristics, and the relationship of NPM1 and FLT3 mutations with their lifespan.
RESULTS: The study was performed 107 cytogenetically normal patients were investigated using RT-PCR (Real-Time Polymerase Chain Reaction) in NMP1 and FLT3 mutations in 269 AML patients. While the median survival time in the NPM1-positive patient group was 12.3 months (95% confidence interval (C.I.): 0.1-32 months), it was 10.6 months (9%5 C.I: 4,9-16,3 months) in the NPM1-negative group. On the other hand, the median survival time in the FLT3-positive patient group was 8,4 months (95% C.I: 1,2-15,6 months), and it was 12,3 months ( 95% C.I: 3,8-20,8 months) in the FLT3-negative group. While the number of NPM1-positive patients was 31 (29%), one of the FLT3-positive patients was 19 (17.8%)
DISCUSSION AND CONCLUSION: The study found that while the NPM1 positivity rate in AML cytogenetically normal patients was 29%, the FLT3 positivity rate was 17.8%, representing the first-ever data in this respect in our country. The results indicate that overall survival was better in cases with NPM1 and worse in those with FLT3.

GÝRÝÞ ve AMAÇ: Tamoksifen, meme kanserli kadýnlarda kullanýlan bir selektif östrojen modülatör ajandýr. Memede antiöstrojenik etkiye sahipken, genital sistemde östrojenik ve antiöstrojenik etkileri vardýr. Uterus ve overlerde; endometrial polip, hiperplazi, kanser, over kistleri gibi yan etkileri vardýr. Çalýþmamýzda tamoksifen kullanan hastalarýn jinekolojik açýdan klinik ve patolojik özelliklerini inceledik.
YÖNTEM ve GEREÇLER: Bu retrospektif çalýþmada, meme kanseri için tamoksifen kullanan 183 kadýnýn demografik verileri, komorbiditeleri, menopoz durumu, baþvuru semptomlarý, ultrason bulgularý, endometriyal örnekleme sonuçlarý, tamoksifen kullaným süreleri hasta dosyalarýndan elde edilerek deðerlendirildi.
BULGULAR: Çalýþmamýza dâhil edilen 183 hastanýn yaþ ortalamasý 53,86±10,04 idi. Toplam 22 (%12) hastada over kisti saptandý. Premenopozal hastalarýn %15,6'sýnda ve postmenopozal hastalarýn %8,6'sýnda kist tespit edildi. Tüm hastalarýn %13,7'sinde, premenopozal hastalarýn %17,8'inde ve postmenopozal hastalarýn %9,7'sinde anormal uterin kanama görüldü. Hastalarýn %54,1'inde endometriyal örnekleme yapýldý. Hastalarýn %18,6'sýnda endometriyal biyopsi sonuçlarý yetersiz, %15,3'ünde benign bulgular, %6,6'sýnda atrofi, %9,3'ünde polip, %2,2'sinde atipisiz hiperplazi, %1,1'inde atipili hiperplazi ve %1,1'inde kanser saptandý. Anormal uterin kanama oranlarý, 60 ay veya üzerinde tedavi görenlerde, 60 ayýn altýnda tedavi görenlere göre istatistiksel olarak daha yüksekti.
TARTIÞMA ve SONUÇ: Tamoksifen, polip, hiperplazi, kanser ve over kisti gibi patolojilerle iliþkilidir. Uterus patolojileri genellikle anormal uterin kanama ile kendini gösterir. Tamoksifen kullaným süresi arttýkça anormal uterin kanama oraný da artmaktadýr.

INTRODUCTION: Tamoxifen is a selective estrogen modulator agent used in breast cancer women. While it has an antiestrogenic effect in the breast, it has estrogenic and antiestrogenic effects in the genital system. It has side effects such as endometrial polyps, hyperplasia, cancer, and ovarian cysts in the uterus and ovaries. In our study, we examined the gynecological clinical and pathological features of patients using tamoxifen.
METHODS: In this retrospective study, 183 women’s, using tamoxifen for breast cancer, demographic data, comorbidities, menopausal status, admission symptoms, ultrasound findings, endometrial sampling results, tamoxifen duration of use were obtained from patient files and evaluated.
RESULTS: The mean age of 183 patients included in our study was 53.86±10.04. Ovarian cysts were detected in 22 (12%) patients, 15.6% of premenopausal and 8.6% of postmenopausal patients. 13.7% of all patients, 17.8% of premenopausal, and 9.7% of postmenopausal patients had abnormal uterine bleeding. Endometrial sampling was performed in 54.1% of the patients. Endometrial biopsy results were unsatisfactory in 18.6% of the patients, benign findings in 15.3%, atrophy in 6.6%, polyps in 9.3%, hyperplasia without atypia in 2.2%, hyperplasia with atypia in 1.1%, and cancer in 1.1%. Abnormal uterine bleeding rates were statistically higher in those who received treatment at 60 months or more than under 60 months.
DISCUSSION AND CONCLUSION: Tamoxifen is associated with pathologies such as polyps, hyperplasia, cancer, and ovarian cyst. Uterine pathologies usually present with abnormal uterine bleeding. As the duration of tamoxifen use increases, the rate of abnormal uterine bleeding also increases.

GÝRÝÞ ve AMAÇ: Çalýþmamýzda kliniðimizde takipli olan transforme lenfoma hastalarýnýn prognozunda etkili olan faktörleri deðerlendirmeyi amaçladýk.

YÖNTEM ve GEREÇLER: Çalýþmamýza uygun olan 45 transforme lenfoma hastasý retrospektif olarak incelendi. Hastalarýn preparatlarý deneyimli patologlar tarafýndan yeniden deðerlendirilerek doðrulandý.

BULGULAR: Hastalarýn primer tanýsýnýn büyük çoðunluðunu folliküler lenfoma oluþturmaktaydý. En sýk transforme lenfoma çeþidi diffüz büyük B hücreli lenfoma (DBBHL) olarak gözlendi. Transformasyona kadar geçen süre 31 ay (2-312) olarak ölçüldü. Hastalarda transformasyon sonrasý ilk kurtarma tedavisine yanýt veren kiþi sayýsý 32 (%71), refrakter hasta sayýsý ise 9 (%20)’du. Transforme hastalarda median sað kalým 4,5 ay (1-102) olarak ölçüldü.

TARTIÞMA ve SONUÇ: Transformasyona kadar geçen süre 31 ay olarak ölçüldü. Primer hastalýklarýn tanýlarýndaki heterojenlik ve alýnan tedavilerdeki farklýlýklar çalýþmalar arasý transformasyon sürelerinin farklýlýðýný açýklayabilecek nedenlerden olabilir. Daha saðlýklý prognostik deðerlendirme için daha fazla çalýþmaya ihtiyaç duyulmaktadýr.

INTRODUCTION: In our study, we aimed to evaluate the factors that affect the prognosis of patients with transformed lymphoma who are followed up in our clinic.
METHODS: Forty-five patients with transformed lymphoma who were eligible for our study were retrospectively analyzed. The preparations of the patients were confirmed by experienced pathologists with second look.
RESULTS: The majority of the primary diagnosis of the patients was follicular lymphoma. The most common type of transformed lymphoma was diffuse large B-cell lymphoma (DLBCL). The time to transformation was measured as 31 months (2-312). The number of patients who responded to the first rescue treatment after transformation was 32 (71%), and the number of refractory patients was 9 (20%). Median survival in transformed patients was 4.5 months (1-102).
DISCUSSION AND CONCLUSION: The time to transformation was measured as 31 months. The fact that this period is shorter compared to some studies in the literature may be due to close follow-up of the patients and diagnosis in a short time. In addition, heterogeneity in the diagnosis type of primary diseases and the treatments received are another reason that may explain the difference in transformation times between studies. More studies are needed for more accurate prognostic assessment.

GÝRÝÞ ve AMAÇ: Bu çalýþmada, pür uterin papiller seröz karsinomda preoperatif kanser antijeni(CA)-125 düzeylerinin çeþitli klinikopatolojik deðiþkenlerle iliþkisinin ve metastaz bölgesini öngörmede optimal cut-off deðerlerinin belirlenmesi amaçlanmýþtýr
YÖNTEM ve GEREÇLER: Çalýþma verileri, kurumumuzda 2005-2020 yýllarý arasýnda pür uterin papiller seröz karsinom tanýsý alan hastalarýn belgelerinden ve elektronik týbbi kayýtlarýndan toplandý. Klinikopatolojik deðiþkenler ile CA-125 arasýndaki iliþki analiz edildi. Preoperatif serum CA-125 deðerinin metastaz bölgelerini tahmin etmedeki doðruluðu, ROC(receiving operating characteristic) eðrisi analizi ile deðerlendirildi ve mevcut en uygun cut-off deðerleri seçildi.
BULGULAR: Yetmiþ sekiz hasta çalýþma kriterlerini karþýladý. Ameliyat öncesi serum CA-125 düzeyi ortanca deðeri omental (P<0,001), over (P<0,001), servikal tutulum (P=0,017) ve derin miyometriyal invazyon (≥%50) (P = 0,001) olan hastalarda daha yüksekti. ROC eðrisine göre, omental tutulumu öngörmek için preoperatif CA-125 seviyesinin optimal cut-off deðeri 35.5 U/mL (duyarlýlýk: %93,8, özgüllük: %79,3), servikal tutulum için 15.0 U/mL ( duyarlýlýk: %86,8, özgüllük: %44,7) ve over tutulumu için 32,5 U/mL (duyarlýlýk: %77,3, özgüllük: %72,2) idi.
TARTIÞMA ve SONUÇ: Preoperatif serum CA-125'in yüksek seviyesi omental, over, servikal tutulum ve derin myometrial invazyon için bir belirteçtir. Servikal tutulum için cut-off deðeri, cerrahi uygulanacak hastalarda radikal histerektominin ön planda düþünülmesi gerektiðine dair bir rehber olabilir. Uterus papiller seröz karsinomunda CA-125'in nüks ve saðkalýmý öngörmedeki rolünü deðerlendirecek ileri çalýþmalara ihtiyaç vardýr.

INTRODUCTION: This study aimed to determine the relationship between preoperative cancer antigen(CA)-125 levels and clinicopathologic prognostic factors as well as appropriate cut-off levels for pure uterine papillary serous carcinoma.
METHODS: Study data were collected from the documents and electronic medical records of patients who were diagnosed with pure uterine papillary serous carcinoma between 2005 and 2020 in our institution. The association between clinicopathological variables and CA-125 were analyzed. The accuracy of the preoperative serum CA-125 value in predicting metastasis sites was evaluated by the receiving operating characteristic curve analysis and the most appropriate cut-off values available were selected.
RESULTS: Seventy-eight patients met the study criteria. Median value of preoperative serum CA-125 level was higher in patients with omental (P <0.001), ovarian (P <0.001), cervical involvement (P = 0.017) and deep myometrial invasion (≥50%) (P = 0.001). According to the receiving operating characteristic curve, the optimal cut-off value of preoperative CA-125 level for predicting omental involvement was 35.5 U/mL (sensitivity: 93.8%, specificity: 79.3%), cervical involvement was 15.0 U/mL (sensivity: 86.8%, specificity: 44.7%) and ovarian involvement was 32.5 U/mL (sensivity: 77.3%, specificity: 72.2%).
DISCUSSION AND CONCLUSION: An elevated level of preoperative serum CA-125 is a marker for omental, ovarian, cervical involvement and deep myometrial invasion. The value for cervical involvement may be a guide that radical hysterectomy should be considered in the foreground in patients undergoing surgery. There is a need for future studies to evaluate the role of CA-125 in predicting recurrence and survival in uterine papillary serous carcinoma.

GÝRÝÞ ve AMAÇ: Lokal ileri larinks kanserinin tedavisi çok zordur. Son birkaç on yýlda total larenjektomiden organ koruyucu yaklaþýmlara, yani kemoradyoterapiye doðru bir kayma olmuþtur. Bu çalýþmanýn amacý, cerrahi (total larenjektomi) ardýndan radyoterapi ve kemoradyoterapi ile larinksin korunmasý arasýndaki onkolojik sonuçlarý karþýlaþtýrmaktýr.
YÖNTEM ve GEREÇLER: 2009-2018 yýllarý arasýnda evre III-IVa-b larinks kanserli 114 hasta çalýþmaya dahil edildi. 36 hastaya (%31,6) radyoterapi ve 78 hastaya (%68,4) larinks koruyucu yaklaþým uygulandý. Larinks koruma yaklaþýmlarý, indüksiyon kemoterapisi sonrasý kemoradyoterapi veya eþ zamanlý kemoradyoterapi idi. Gruplar arasýndaki saðkalým farklýlýklarý Kaplan-Meier testi ve saðkalýma etki eden faktörler cox-regresyon testi ile deðerlendirildi.
BULGULAR: 5 yýllýk genel saðkalým larinks koruma ve cerrahi gruplarda sýrasýyla 66,3 ay ve 74,1 ay olarak bulundu (p=0.29). Evre III hastalarda 5 yýllýk hastalýk spesifik saðkalým (HSS) oraný cerrahi grupta %63,3 iken kemoradyoterapi grubunda %66,2 idi (p=0,83). Evre IV hastalarda 5 yýllýk HSS oranlarý cerrahide %68,6, kemoradyoterapi grubunda %46,2 bulundu (p=0,22). Ýleri N kategorisi (N2-N3), çok deðiþkenli analizde kötü progresyonsuz saðkalým ile iliþkili faktör olarak bulundu (p<0.01). Yaþ (≥65) 2,1 kat (p=0,01), ileri T kategorisi (T4) 2 kat artmýþ ölüm riski (p=0,03) ile iliþkili bulundu. Trans-glottik tümörler 3.6 kat artmýþ trakeostomi riski ile iliþkili bulundu (p<0.01).
TARTIÞMA ve SONUÇ: T3/N0-N1 ve T3/N2-N3 alt gruplarý ayrý ayrý deðerlendirildiðinde, T3/N0-N1 hastalarda, kemoradyoterapi yüksek düzeyde larinks korumasý saðlayan bir tedavi seçeneðidir.

INTRODUCTION: The treatment of locally advanced laryngeal cancer (LALC) is very challenging. In the last few decades there has been a shift from total laryngectomy towards organ-sparing approaches. The aim of the current study is to compare oncological outcomes between surgery (total laryngectomy) followed by radiotherapy and larynx preservation with chemoradiotherapy (CRT).
METHODS: 114 patients with stage III-Iva-b laryngeal cancer were included in the study, between 2009 and 2018. Thirty-six patients (31.6%) were performed total laryngectomy followed by radiotherapy and 78 (68.4%) underwent the larynx preservation approach. Survival differences between the groups were examined with the Kaplan-Meier test and cox-regression tests for factors affecting survival.
RESULTS: 5-year overall survival (OS) was found 66.3 months and 74.1 months, in the larynx preservation and the surgical groups, respectively (p=0.29). There was no statistically difference between groups for OS in the patients with T3/N0-N1 (p=0.76), but surgical groups had longer OS in the patients with T3/N2-N3 (p=0.04). There was no statistically difference between groups for OS in the patients with T4/N0-N1 (p=0.47), however CRT groups had longer OS in the patients with T4/N2-N3 (p=0.02). The N2-N3 was the factor associated with poor progression-free survival and distant metastasis free survival in multivariate analysis (p<0.01). Age (≥65) was found to be associated with 2.1 times increased risk of death (p=0.01). The trans-glottis tumors were associated with a 3.6-fold increased risk of tracheostomy (p<0.01).
DISCUSSION AND CONCLUSION: The N0-N1 and N2-N3 should also be considered as well as advanced T-category for the treatment of LALC.

GÝRÝÞ ve AMAÇ: Pazopanib, birden çok hedefli bir tirozin kinaz inhibitörü olarak çalýþýr. Ýleri evre Yumuþak Doku Sarkomlu (YDS) hastalarda etkinliði gösterilmiþtir. Gerçek yaþam verilerinin retrospektif bir deðerlendirmesini yaparak saðkalým sürelerini ve önemli yan etkilerini deðerlendirmeyi amaçladýk.
YÖNTEM ve GEREÇLER: Bu çalýþma retrospektif yöntemle gerçekleþtirilmiþtir. Pazopanib ile tedavi edilen ileri ever YDS'li yetiþkin hastalarýn klinik özellikleri hasta kayýt veritabanýndan kaydedilmiþtir. Týbbi kaydý olmayan hastalar çalýþma dýþý býrakýlmýþtýr. Objektif yanýt oraný (ORR), Progresyonsuz saðkalým (PFS), genel saðkalým (OS), tedaviye baðlý pnömotoraks ve hipertansiyon yan etkiler deðerlendirilmiþtir.
BULGULAR: Kýrk yetiþkin hasta dahil edildi (erkekler: %55). Ortanca yaþ 44,5 (aralýk: 20-88) olarak saptandý. Histopatolojik olarak malign mezenkimal tümör örneklemin %32,5'inde tespit edildi. Yüzde seksen sekiz hasta ilk taný anýnda Evre 3 veya daha yüksek bir hastalýða sahipti. Hastalarýn yüzde yetmiþinde akciðer metastazý vardý. Hastalarýn yüzde yetmiþi pazopanib öncesinde iki veya daha fazla sýra sistemik kemoterapi almýþtýr. Pazopanib için ORR tüm hastalar için %45 olarak saptandý. PFS (IQR) 5,73 (2,67) ay olarak belirlendi. OS (IQR) 8,54 (17,81) aydý. Pazopanib sýrasýnda hastalarýn %12’sinde pnömotoraks tespit edildi. Pazopanib sýrasýnda hastalarýn %15'inde hipertansiyon saptandý.
TARTIÞMA ve SONUÇ: Pazopanib, gerçek yaþam verilerine dayalý olarak önceden tedavi edilmiþ bu hasta popülasyonunda anlamlý saðkalýma yol açmýþtýr. Ayrýca yönetilebilir bir yan etki profiline sahiptir.

INTRODUCTION: Pazopanib acts as a multitargeted tyrosine kinase inhibitor. It has been shown to be effective in patients with advanced stage Soft Tissue Sarcomas (STSs). We aimed to evaluate survival times and significant side effects by making a retrospective evaluation of real-life data.
METHODS: This study was carried out with a retrospective method. Clinical characteristics of adult patients with advanced STSs treated with the pazopanib were recorded in the hospital's patient registry database. Patients without medical records were excluded from the study. Objective response rate (ORR), Progression-free survival (PFS), overall survival (OS), and treatment-related pneumothorax and hypertension side effects were determined.
RESULTS: Forty adult patients were included (males: 55%). The median age was 44.5 years (range: 20-88). Malignant mesenchymal tumor by histopathology was found in 32.5% of the sample. Eighty-eight percent of the sample had a Stage 3 or higher disease at the time of initial diagnosis. Seventy percent of the patients had lung metastases. Seventy percent of the patients received two or more lines of systemic chemotherapy prior to pazopanib. The ORR to the pazopanib was 45% for whole patients. PFS (IQR) was determined as 5.73 (2.67) months. OS (IQR) was 8.54 (17.81) months. Pneumothorax was detected during pazopanib in twelve and a half percent of patients. Hypertension was detected during pazopanib in fifteen percent of patients.
DISCUSSION AND CONCLUSION: Pazopanib led to significant survival in this pretreated population of patients based on real-life data. It also has a manageable side-effect profile.

GÝRÝÞ ve AMAÇ: Nüfus yaþlandýkça, yaþlý kanser hastalarýnýn sayýsý çarpýcý biçimde artmakta ve bu hastalar artan bir oranda acil servislere (AS) baþvurmaktadýr. Bu çalýþmada AS’e baþvuran yaþlý kanser hastalarýnda demografik bulgularý, klinik özellikleri, mortalite ve mortaliteye etkileyen faktörleri deðerlendirmeyi amaçladýk.
YÖNTEM ve GEREÇLER: Hastalar yaþ gruplarýna göre 65-74 yaþ, 75-84 yaþ ve 85 yaþ ve üstü olmak üzere üç gruba ayrýldý. Gruplar arasýnda demografik bulgular (yaþ, cinsiyet), lomorbidite, AS’e geliþ sayýsý, baþ þikayetleri, tümör lokalizasyonu, kanser evresi, metastaz durumu, tedavi durumu, hastanaye yatýþ, mortalite ve mortaliteyi etkileyen faktörler retrospektif olarak deðerlendirildi.
BULGULAR: Çalýþmaya alýnan 273 hastanýn 142 (%52) 65-74 yaþ grubunda, 77 (%28,2) 75-84 yaþ grubunda, 54 (%19,8) 85 ve üzeri yaþ grubunda idi. AS’te metastatik hastalýðý olan 60 (%33) hasta öldü. 85 ve üzeri yaþ grubu hastalarda mortalite, diðer gruplara göre daha yükek idi (p<0.001). Tümör lokalizasyon ile mortalite açýsýndan fark bulunmadý (p>0.05). Baþ þikayeti nörolojik ve kardiyovasküler sistem sorunlarý olan hastalarda mortalite daha yüksekti (sýrasýyla p<0.001, p<0.001). Metastatik hastalýðý olan hastalarda mortalite erken evre ve lokal hastalýðý olanlara göre daha yüksek idi (sýrasýyla p<0.01, p<0.001). Tedavi edilmeyen hastalarda mortalite daha yüksek idi (p<0,001).
TARTIÞMA ve SONUÇ: AS’e baþvuran yaþlý kanser hastalarýnýn yaþ gruplarýnda farklý özelliklere sahip olduðu gözlendi. Bu hastalarda mortalite yüksekti ve mortaliteyi etkileyen faktörler belirlendi.

INTRODUCTION: As the population ages, the number of elderly cancer patients is increasing dramatically, and these patients are visiting emergency departments (ED) at an increasing rate. We aim to evaluate the demographic findings, clinical features, mortality, and factors affecting mortality in old age cancer patients who visit ED.
METHODS: The patients were divided into three groups according to age groups: 65-74 years old, 75-84 years old, and 85 years and older. A retrospective analysis and evaluation of demographic findings (age, gender), comorbidity, number of ED visits, chief complaints, tumor localization, stage of cancer, metastasis status, treatment status, hospitalization, morbidity, and factors affecting mortality were evaluated across the groups.
RESULTS: 142 (52%) of 273 patients were in the 65-74 age group, 77 (28.2%) were in the 75-84 age group, and 54 (19.8%) were in the 85 and over age group. 60 (33%) patients died in the ED. Patients aged 85 and over had a higher mortality (p<0.001). The tumor location had no impact on mortality (p>0.05). Patients with neurologic and cardiovascular system problems as a chief complaint had a higher mortality (p<0.001, p<0.001, respectively). Patients with metastatic disease had higher mortality than patients with early-stage and locoregional disease (p<0.01, p<0.001, respectively). Untreated patients had higher mortality (p<0.001).
DISCUSSION AND CONCLUSION: Old age cancer patients who visited the ED had different characteristics in the age groups were observed. These patients had a high mortality and factors affecting mortality have been identified.

GÝRÝÞ ve AMAÇ: Ýmmün trombositopeni (ITP) izole trombositopeni (<100x109) ile karakterize otoimmün bir hastalýktýr. ITP teþhisi için altýn standart bir test yoktur. Tüm ITP hastalarý için tedavi endike deðildir. Kortikosteroidler tedavinin ilk basamaðýdýr. Rituksimab, splenektomi, eltrombopag, azatioprin, siklosporin, siklofosfamid, dapson, mikofenolat mofetil ve vinka alkaloid diðer tedavi seçeneklerinden bazýlarýdýr. Burada ITP hastalarý ve tedavi sonuçlarý ile ilgili deneyimlerimizi sunmayý amaçladýk.
YÖNTEM ve GEREÇLER: Hastalarýn verileri 2015-2021 yýllarý arasýnda geriye dönük kayýtlardan toplandý. Çalýþmaya, düzenli takibine devam eden 18 yaþ üstü ITP hastalarý dahil edildi. Primer hematolojik malignitesi olan hastalar ve verisi olmayan veya takipten çýkan hastalar çalýþma dýþý býrakýldý.
BULGULAR: Çalýþmaya ITP tanýlý 62 hasta alýndý. 51 (%82,3) hastada tedavi endikeydi. Tedaviye alýnan hastalarýn tamamýna ilk basamakta steroid verildi. Steroid tedavisine yanýt vermeyen on hastada tedaviye direnci öngören faktörler araþtýrýldý. Analiz için yaþ, ortalama trombosit hacmi (MPV), C reaktif protein (CRP), ferritin, B12 ve folik asit deðerleri alýndý, Prediktif faktör saptanmadý.
TARTIÞMA ve SONUÇ: Steroid tedavisi ilk aþamada etkili olmakla birlikte nüksler sýk görülmektedir. Steroid refrakterliðini öngören faktörlerin saptanmasý için daha büyük çalýþmalar gerekmektedir. Diðer tedavi seçenekleri, nüks anýnda vaka bazýnda deðerlendirilmelidir. Hastalar ayrýca klinik araþtýrmalara katýlmaya teþvik edilmelidir.

INTRODUCTION: Immune thrombocytopenia (ITP) is an autoimmune disease and characterized with isolated low platelet count (<100x109). There is no single golden standard test for ITP diagnosis. Treatment is not indicated for all ITP patients. Corticosteroids are the first line of treatment. Rituximab, splenectomy, eltrombopag, azathioprine, cyclosporin, cyclophosphamide, dapsone, mycophenolate mofetil, and vinca alkaloid are some of the other therapeutic options. Here, we aimed to present our experience on ITP patients and treatment outcomes.
METHODS: The data of the patients were retrieved from retrospective records between 2015-2021.The study included patients over the age of 18 who had a regular follow-up diagnosis of ITP. Patients with primary hematological malignancy and patients with unavailable data or lost follow-up were excluded from the study.
RESULTS: A total of 62 patients with a diagnosis of ITP were included in the study. Treatment was indicated in 51 (82.3%) patients. All of the patients with treatment inclusion were given steroids in the first step. In ten patients who didn't respond to steroid treatment, the factors that predicted resistant treatment were explored. Age, Mean platelet volume (MPV), C-reactive protein (CRP), ferritin, B12 and folic acid values were taken for analysis, no predictive factor was detected.
DISCUSSION AND CONCLUSION: While steroid treatment is effective in the initial step, recurrences are common. Factors that predict steroid refractoriness seems to require larger studies. Other step treatments should be evaluated on a case-by-case basis at the time of recurrence. Patients should also be encouraged to participate in clinical trials.

GÝRÝÞ ve AMAÇ: Meme kanseri evrelemesinde primer tümor ve aksiller lenf nodu SUVmax parametrelerinin uzak metastaz varlýðý ile iliþkisini araþtýrmak amaçlanmýþtýr.
YÖNTEM ve GEREÇLER: Çalýþmaya kliniðimize meme kanseri tanýsý ile evreleme amaçlý positron emisyon tomografi /bilgisayarlý tomografi (PET/BT) incelemesi için refere edilen 57 kadýn hasta dahil edildi. Hastalarýn immünohistokimyasal özellikleri [hormonreseptörü (HR), human epidermal büyüme factor reseptörü tip-2 (HER2), Ki67 indeksi] geriye dönük olarak tarandý. Hastalarýn tümü HR-pozitif,HER2-negatif idi. PET/BT’de primer tümör SUVmax(Tmax), aksiller lenf nodu SUVmax (Nmax) deðerleri ve tümör/aksiller lenf nodu SUVmax (T/N) oranlarý hesaplandý. Hastalar PET/BT bulgularýna göre metastatik ve non-metastatik olarak iki gruba ayrýldý. Gruplar arasý yaþ, Ki67 indeksi ve SUV deðerleri açýsýndan farklýlýk istatistiksel analizi yapýldý.
BULGULAR: Hastalarýn yaþ ortalamasý 52 ± 14.4 (aralýk 25-79) idi. PET/BT bulgularýna göre hastalar %57’si metastatik (n=33), %43’ü non-metastatik (n=24) olmak üzere iki grupta izlendi. Ýki grup arasýnda yaþ, Ki67 indeksi ve Tmax ortalamalarý açýsýndan istatistiksel olarak anlamlý fark izlenmezken ortalama Nmax deðerleri ve T/N oranlarý arasýnda istatistiksel olarak anlamlý fark bulundu (sýrasýyla p<0.001, p=0.001). Uzak metastaz varlýðý açýsýndan ROC analizde Nmax için kesme deðeri 7.8,T/N oraný için 8.5 olarak bulundu.
TARTIÞMA ve SONUÇ: Meme kanserinde tedavi planý, hastalýk prognozu açýsýndan evrelemenin doðru þekilde yapýlmasý önem arzetmektedir. Çalýþmamýzda Nmax deðerinin ve T/N oranýnýn, Tmax deðerlerinden baðýmsýz olarak farklýlýk göstermesi, uzak metastaz saptanamayan hasta grubunda gözden kaçan ve olasý erken metastatik hastalýk göstergesi açýsýndan belirleyici olabileceði düþünülmüþtür.

INTRODUCTION: We aimed to investigate the relationship between primary tumor and axillary lymph node maximum standardized uptake values (SUVmax) with the presence of distant metastases at initial staging of breast cancer.
METHODS: Fifty-seven women who were referred to our clinic for staging positron emission tomography/computed tomography (PET/CT) with diagnosis of breast cancer were included in the study. Immunohistochemical (IHC) features of the primary tumor [hormone receptor (HR), human epidermal growth factor receptor type-2 (HER2), Ki67 index] were reviewed retrospectively. All patients’ HR status was positive and HER2 status was negative. Primary tumor SUVmax (Tmax) and axillary lymph node SUVmax (Nmax) values and primary tumor-to-axillary lymph node (T/N) ratios were calculated in PET/CT. Patients were divided into two groups as metastatic and non-metastatic according to PET/CT findings. The differences between groups in terms of age, Ki67 index and SUV values were statistically analyzed.
RESULTS: The mean age of the patients was 52±14.4 (range 25-79 years). According to PET/CT findings, the patients were divided in two groups, 57% metastatic (n = 33) and 43% non-metastatic (n = 24). While no statistically significant difference was observed between the two groups in terms of age, Ki67 index and Tmax averages, statistically significant differences were found between Nmax values (p <0.001) and T/N ratios (p=0.001). Cut-off value in association with distant metastasis was 7,8 for Nmax value and 8,5 for T/N ratio on ROC curve analysis.
DISCUSSION AND CONCLUSION: Accurate staging is important in terms of treatment plan and prediction of disease prognosis in breast cancer. In our study, it was thought that the difference in Nmax values and T/N ratios, independent of Tmax values, could be a determinant in terms of the overlooked and possible early metastatic disease indicator in the patient group without known distant metastasis.

GÝRÝÞ ve AMAÇ: Çalýþmanýn amacý, hematolojik ve solid organ maligniteli hastalarda COVID-19 enfeksiyonundaki klinik farklarýn deðerlendirilmesidir.
YÖNTEM ve GEREÇLER: Çalýþmada 01.09.2020-01.01.2021tarihleri arasýnda Necmettin Erbakan Üniversitesi Meram Týp Fakültesi COVID-19 kliniðinde yatarak takip edilen malignite tanýlý hastalar epidemiyolojik ve klinik özellikleri açýsýndan karþýlaþtýrýldý
BULGULAR: Çalýþmaya 134 dahil edildi. Hematolojik maligniteli hastalarda hastanede yatýþ günü, yoðun bakým ihtiyacý, konvelesan plazma ihtiyacý, sedimentasyon ve ferritin düzeyleri daha yüksek (sýrasýyla; p: 0.001, 0.008, 0.001, 0.001, <0.001); nötrofil, lenfosit, trombosit ve nötrofil/lenfosit oraný daha düþük bulundu. COVID-19 enfeksiyonundan iyileþme oraný, ilave enfeksiyonun olduðu hematolojik maligniteli hastalarda, daha düþüktü (OR: 3.1, 95%; CI: 1.4-6.9; p: 0.004). Çok deðiþkenli analizde, COVID-19 dýþýnda bir enfeksiyon varlýðýnýn ölüm riskini 2,8 kat arttýrdýðý tespit edildi (%95 GA; 1.3-6.5, p: 0.010).
TARTIÞMA ve SONUÇ: COVID-19 enfeksiyonu hematolojik maligniteli hastalarda solid organ maligniteli hastalara göre daha þiddetli seyretmektedir. COVID-19 pandemisinde COVID-19 dýþý enfeksiyonlar, hematolojik parametreler, yaþ ve ko-morbiditeden oluþan bir modelin kullanýlmasý, yüksek mortalite riski olan malign hastalarýn yönetiminde yardýmcý olabilir.

INTRODUCTION: The aim of this study is to evaluate the clinical differences of COVID-19 infection in hematological and solid organ malignancy patients.
METHODS: In the study, patients who have followed up in the Necmettin Erbakan University Meram Medical Faculty Clinic of COVID-19 with a diagnosis of malignancy between 01 September 2020 and 01 January 2021 were compared in terms of epidemiological and clinical characteristics.
RESULTS: The study included 134 patients. Hospitalization day, intensive care need, convalescent plasma need, sedimentation and ferritin levels of patients diagnosed with hematological malignancies were significantly higher (p: 0.001, 0.008, 0.001, 0.001, <0.001 respectively), and the neutrophil, lymphocyte, platelet, and neutrophil-lymphocyte ratio was found to be low, according to the findings of the study. The cure rate of COVID infection was significantly lower with additionally infection in hematological malignancies (OR: 3.1, 95%; CI: 1.4-6.9; p: 0.004). In multivariate analysis, it was determined that an presence of non-COVID-19 infection increased the risk of death 2.8 times (95% CI; 1.3-6.5, p: 0.010).
DISCUSSION AND CONCLUSION: Patients with hematological malignancy have experienced a more severe clinical course of COVID-19 and higher mortality than those with solid tumors. The use of a model in the COVID-19 pandemic that summarizes these non-COVID-19 infections, hematological parameters, age, and comorbidities can help in the method of malignant patients with high mortality risk.

Fascioliasis zoonotik bir enfeksiyondur ve ateþ, eozinofili, bulantý ve hatta görüntülemede malignite olarak yorumlanan bir kitleye neden olur. Klinik özelliklerinin geniþ bir yelpazeye sahip olmasý nedeni ile hastalýðý teþhis etmek zordur. Bu trematod enfeksiyonu daha çok geliþmekte olan ülkelerde görülmektedir Burada fasciola hepatica'nýn neden olduðu yanlýþlýkla kolanjiokarsinom olarak bildirilen bir karaciðer kitlesi vakasýný sunuyoruz.

Fascioliasis is a zoonotic infection and causes fever, eosinophilia, nausea, and even a mass interpreted as malignancy on imaging. Cause of the wide spectrum of clinical features, diagnosing the disease is difficult. This trematode infection is mostly observed in developing countries Here we report a case of hepatic mass, mistakenly reported as cholangiocarcinoma, caused by fasciola hepatica.

Paraneoplastik hiperkalsemi, özellikle ileri evre solid organ malignitelerinde (meme kanseri, böbrek kanseri, akciðer kanseri) ve multipl miyelomda yaygýndýr ve kötü prognoz ile iliþkilidir. Kronik lenfositik lösemide paraneoplastik hiperkalsemi nadiren görülür. Düþük insidansý nedeniyle literatürde hiperkalseminin prognoza ve tedavisine etkisi hakkýnda yeterli veri bulunmamaktadýr. Kronik lenfositik lösemi tanýsý ile takip edilen ve semptomatik malign hiperkalsemi geliþen 68 yaþýndaki erkek hastada nadir görülen bu durumu bildirdik. Ýbrutinibin kronik lenfositik lösemiye baðlý hiperkalsemi kontrolünde etkili olduðu sonucuna vardýk.

Paraneoplastic hypercalcemia is common, especially in advanced stage solid organ malignancies (breast cancer, renal cancer, lung cancer) and multiple myeloma, and is associated with poor prognosis. Paraneoplastic hypercalcemia is rarely observed in chronic lymphocytic leukemia. Due to its low incidence, there is not enough data in the literature about the effect of hypercalcemia on prognosis and its treatment. We reported this rare condition that a 68-year-old male who was followed up with a diagnosis of chronic lymphocytic leukemia and developed symptomatic malignant hypercalcemia. We concluded that ibrutinib was effective in the control of hypercalcemia due to chronic lymphocytic leukemia.

Solid organ transplantasyonundan sonra malignite riski artar. Akut miyeloid lösemi bu malignitelerden biridir. Translokasyon (8;21), akut miyeloid lösemide en sýk görülen karyotipik anormalliklerden biridir. JAK2 V617F mutasyonu, de novo akut miyeloid lösemi vakalarýnda nadiren görülür. Literatürde böbrek nakli sonrasý translokasyon (8;21) ve JAK2 V617F mutasyon pozitif akut miyeloid lösemi geliþen bir olgu yoktur. 10 yýl önce kardeþinden böbrek nakli olan 43 yaþýnda halsizlik þikayeti ile kliniðimize baþvuran kadýn hastayý sunduk. Bu hastada JAK2 V617 mutasyonu ve translokasyon t(8;21) pozitif akut miyeloid lösemi tespit edildi. Hasta 3+7 remisyon indüksiyon tedavisi aldý. Kemoterapi sonrasý translokasyon (8,21) ve JAK2 V617F mutasyonu negatifti. Böbrek nakli sonrasý geliþen akut miyeloid lösemi olgularý JAK2V617F mutasyon pozitifliði açýsýndan deðerlendirilmelidir.

There is an increased risk of malignancy after solid organ transplantation. Acute myeloid leukemia is one of these malignancies. The translocation (8;21) is one of the most frequent karyotypic abnormalities in acute myeloid leukemia. The JAK2 V617F mutation is rarely seen in cases of de novo acute myeloid leukemia. There is no case with translocation (8;21) and JAK2 V617F mutation-positive acute myeloid leukemia after kidney transplantation in the literature. We report a 43 years old female patient who had a kidney transplant from her brother 10 years ago applied to our clinic with the complaint of fatigue. The JAK2 V617 mutation and translocation t(8;21) positive acute myeloid leukemia was detected in this patient. The patient received 3+7 remission induction treatments. After chemotherapy, translocation (8,21) and JAK2 V617F mutation were negative. Acute myeloid leukemia cases developing after kidney transplantation should be evaluated in terms of JAK2V617F mutation positivity.