AMAÇ: Erken taný hepatoselüler karsinom (HCC) tedavisindeki en kritik adýmdýr. Çalýþmada erken tanýda alfa-L- fukosidazýn (AFU) klasik belirteç olan alfa-fetoproteine (AFP) kýyasla güvenilirliði incelenmiþtir.
YÖNTEMLER: Teorimizi kanýtlamak için çalýþma hem insan hem de hayvan örneklemler kullanýlacak þekilde planlanmýþtýr. Çalýþmanýn hayvan deneyi ayaðýnda 60 Wistar faresi kontrol grubu ve 8, 16, 24 hafta dietilnitrozamine (DENA) verilen gruplar olmak üzere 4 gruba ayrýlmýþtýr. Ýnsan çalýþma grubu kontrol ve hafif, ileri ve metastatik olarak 4 gruba bölünen toplam 120 hastadan oluþmaktadýr. Histolojik ve biyokimyasal analizler (AFP, AFU, karaciðer fonksiyon testleri, total antioksidan serum seviyeleri) ve ROC eðrileri ile korelasyon analizleri insan ve hayvan gruplarýnda yapýlmýþtýr.
BULGULAR: DENA-tedavi grubu zamana baðlý olarak belirgin histopatolojik deðiþiklikler göstermiþtir. Kontrol grubu ile kýyaslandýðýnda 6 hafta sonra bilirubin ve total antioksidanlar dýþýndaki tüm biyokimyasal parametrelerde, 8 hafta sonra bilirubin, albumin, AFP ve total antioksidanlar dýþýndaki parametrelerde ve 24 hafta sonra ise tüm biyokimyasal parametrelerde (AFP, AFU, karaciðer fonksiyon testleri ve total antioksidan serum düzeylerinde) anlamlý deðiþiklikler saptanmýþtýr. Histolojik olarak sýnýflandýrýlmýþ tüm HCC gruplarýnýn tün incelenen parametrelerinde istatistiksel olarak anlamlý sonuçlar saptanmýþtýr. Sýnýr olarak 5 μmol/l/min kabul edildiðinde ROC analizi ile yapýlan incelemede AFU %90 sensitivite, %92 spesifite göstermiþtir ve %91 tanýsal doðruluk göstermiþtir. Sýnýr deðer 60 ng/ml olarak alýndýðýnda ise sensisivite, spesifite ve tanýsal doðruluk sýraýyla %60, %76 ve %68 olarak saptanmýþtýr. AFU ile ALT, AST ve AFP iliþki katsayýlarý istatistiksel olarak anlamlýdýr.
SONUÇ: HCC erken tanýsýnda erken tanýda AFU, AFP’den daha iyi bir belirteçtir. AFU sensitivite, spesivitesi daha yüksek olup diðer indekslerle AFP’ye kýyasla daha iyi korele olmuþtur. Ýnsandan elde edilen sonuçlar teorimizi doðrulamýþtýr.

OBJECTIVE: Early detection of hepatocellular carcinoma (HCC) is the most critical step in the management process. We try to provide new insights about the possible role of alpha-L- fucosidase (AFU) to achieve more reliable detection of HCC over a classical marker alpha fetoprotein (AFP).
METHODS: The study included both animal and human subjects, to legislate our theory. In animal study, 60 Male Wistar rats were classified to control, other 3 groups received di ethyl nitrosamine (DENA) for 8, 16, 24 weeks respectively. In human study: one hundred and twenty patients were assigned as: control group, 3 groups with histologically graded HCC, into mild, advanced and metastatic HCC. Histological and biochemical analysis (AFP, AFU, liver function tests, total antioxidant serum levels) in both animals and patients, as well as, receiver operating characteristic (ROC) curves and correlation analysis, were executed.
RESULTS: DENA-treated groups showed significant histopathological changes in a time dependant pattern. After 24 weeks, a significant variation in biochemical parameters (AFP,AFU, liver function tests and total anti-oxidant serum levels), after 6 weeks, a significant variations in all parameters except bilirubin and total antioxidants, after 8 weeks, a significant variations in all parameters except bilirubin, albumin, AFP and total antioxidants, compared to control group. All tested biochemical parameters showed non-significant correlation, compared to AFU.
All histologically-graded human HCC groups showed a highly statistically significant variations in all tested biochemical parameters. ROC analysis showed that at a cut-off value of 5 μmol/l/min, AFU yielded a sensitivity and specificity of 90% and 92%, respectively producing diagnostic accuracy of 91%. While At a cut-off value of 60 ng/ml, AFP yielded a sensitivity and specificity of 60% and 76%, respectively producing diagnostic accuracy of 68%. Correlation coefficients between AFU versus ALT, AST and AFP were statistically significant

CONCLUSION: AFU is a more accurate marker than AFP for early diagnosis of HCC. AFU showed higher sensitivity, specificity and correlated more to other indices than AFP. Human data confirmed our theory.

AMAÇ: Bu çalýþmada adjuvan kemoterapi olarak ardýþýk antrasiklin ve taksan içeren kombinasyonlarý alan meme kanserli hastalarda geliþen yan etkileri inceledik. Amacýmýz hasta yaþam kalitesini ve tedavi baþarýsýný etkileyen bu yan etkilerin ortaya konmasý ve hasta bilgilendirmesinin öneminin vurgulanmasýdýr.
YÖNTEMLER: Çalýþmamýzda tek merkezde takipli opere meme kanserli 100 hastanýn dosyalarý retrospektif olarak incelendi.
BULGULAR: Altmýþý (%60) premenopozal 100 hastanýn ortanca yaþý 47,6 (aralýk; 20-74) idi. Bir (%1) hasta evre I, 52 (%52) hasta evre II, 47 (%47) hasta evre III idi. Hastalarýn 31’i doz yoðun tedavi (DYT) [paklitaksel (n=26, %80.7), dosetaksel (n=5, %19.3)], 69’u 3 haftalýk tedavi [paklitaksel (n=10, %14.4), dosetaksel (n=59, %85.6)] almýþtý. DYT rejimleri ile daha sýk nöropati (%32.3, p<0,05), nötropeni (%67.7, p<0.05) ve týrnak deðiþikliði (%22.6, p<0.05) olduðu izlenirken 3 haftalýk tedavi ile daha sýk febril nötropeni izlendi. Anemi, trombositopeni, hepatotoksisite ve kardiyotoksisite geliþimi açýsýndan iki grup arasýnda anlamlý fark saptanmadý. Nöropati, kardiyotoksisite ve týrnak deðiþikliði geliþen hastalarýn tümü paklitaksel alan gruptaydý ve dosetaksel alan grupla arasýnda anlamlý fark saptandý (p<0,05). Hepatotoksisite geliþimi dosetaksel ve paklitaksel alan hastalar arasýnda karþýlaþtýrýldýðýnda da anlamlý fark saptanmadý.
SONUÇ: Sonuç olarak standart tedavi ile daha sýk febril nötropeni, doz yoðun rejimlerle nöropati ve paklitaksel kullanýlan rejimler ile nöropatinin daha sýk olduðu gözlendi. Ayrýca dosetaksel ile daha fazla görülen týrnak deðiþikliklerinin doz yoðunluðu arttýrýldýðýnda paklitakselle de görülebileceði gösterildi.

OBJECTIVE: We studied the side effects associated with the adjuvant therapy combinations containing anthracycline-taxane which is the most frequently used recently in the breast cancer. Our goal is to demonstrate these side effects affecting patient quality of life and treatment success and to emphasize the importance of patient awareness.
METHODS: In the study, the files of one hundred patients with diagnosis of breast cancer were investigated retrospectively.
RESULTS: Sixty of the patients (60%) were premenopausal and 40 of them (40%) were postmenopausal (40%). One (%1) patient was stage I, 52 (52%) patients were stage II, 47 (47%) patients were stage III. While 31 of the patients received intensive therapy [paclitaxel (n=26, 80.7%), docetaxel (n=5,19.3%)], 69 of them received 3 weekly therapy [paclitaxel (n=10, 14.4%), docetaxel (n=59, 85.6%)]. Neuropathy, neutropenia and nail changes were found to be more frequent (32.3%, p<0,05; 67.7%, p<0.05; 22.6%, p<0.05 respectively) with the dose dense regimens and febrile neutropenia was observed more often with the 3-weekly regimens. There was no significant differences in terms of anemia, thrombocytopenia, hapatotoxicity and cardiotoxicity between two groups. Neuropathy, cardiotoxicity and nail changes were detected in all patients paclitaxel group and a significant difference was found between the group receiving docetaxel (p<0,05). The difference was not significant in terms of hepatotoxicity among patients receiving docetaxel and paclitaxel.
CONCLUSION: Febrile neutropenia was more frequent in the three-weekly treatment group and neuropathy was more frequent in the dose dense group. Neuropathy was more frequent with paclitaxel receiving patients. Moreover, it was demonstrated that the nail changes seen with docetaxel in other studies can be also seen with paclitaxel when dose intensity is increased.

AMAÇ: mTOR ekspresyonu birçok solid tümörde klinik sonuçlarla iliþkilidir. Bununla birlikte
mide kanserindeki klinik önemi henüz netleþmemiþtir. Bu çalýþma bu biyobelirteçin Türk toplumundaki klinik önemini belirlemek için tasarlanmýþtýr.
YÖNTEMLER: 30 hastanýn mide kanser dokusu içeren parafin kaplý doku bloklarý hazýrlanmýþtýr. Ýmmünhistokimyasal olarak mTOR ekspresyonu incelenmiþtir.
BULGULAR: Bu biyobelirteçin mide kanserli hastalardaki klinikopatolojik özellikleri ve saðkalýmlarý ile olan korelasyonu çalýþýlmýþtýr. mTOR pozitiflik durumu genel olarak %36.7 idi.
SONUÇ: Saðkalým süresi ve mTOR ekspresyonu arasýnda iliþki bulunmamýþtýr.

OBJECTIVE: Expression of mTOR have been linked to clinical outcomes in several solid tumors. However clinical significance of this biomarker in gastric cancer remain unclear. This study was designed to detect the clinical implications of this biomarker in Turkish population.
METHODS: Paraffin -embedded tissue microarray blocks containing gastric cancer tissue obtained from 30 patients were constructed. Expression of mTOR, were detected by immunohistochemistry.
RESULTS: The correlation of this biomarker to clinicopathologic features and survival of patients with gastric cancer was studied. The overall rate of positive mTOR, status were 36.7%.
CONCLUSION: There was no association was noted between the expression of mTOR and survival time.

Bazoskuamoz karsinom, bazal hücreli karsinom-skuamoz hücreli karsinom spektrumunda yer alan nadir bir tümördür. Hem bazal hem de skuamoz hücreli karsinomun klinik, histopatolojik ve dermoskopik özelliklerini sergiler. Bazoskuamoz karsinomun dermoskopik özellikleri ile ilgili literatür bilgisi kýsýtlýdýr. Burada, yanaðýnda bazoskuamoz lezyonlarý olan bir olgu dermoskopik özellikleri ile birlikte sunulmuþtur.

Basosquamous carcinoma is a rare tumor in the spectrum between basal cell carcinoma and squamous cell carcinoma. It exhibits clinical, pathological and dermoscopic features of both basal cell carcinoma and squamous cell carcinoma. Literature data about dermoscopic features of BSC is limited. Herein we report a case with basosquamous carcinoma lesions on the cheek with dermoscopic features.

Dünyanýn birçok ülkesinde kronik hastalýðý olan çocuk ve yetiþkinlerin sayýsý gittikçe artmaktadýr. Dünya'da her yýl 6 milyondan daha fazla insana kanser tanýsý konulmakta ve bunlardan 4 milyondan fazlasý ölmektedir. Geliþen teknoloji ve tedavi yöntemlerine raðmen kanser hastalýðý olan çocuklarda hastalýðýn alevlenme evreleri sýklaþýp uzadýkça, hastalýk ilerledikçe, çocuklarýn ölümle ilgili korku ve kaygýlarý artmaktadýr. Çocuklar; ebeveyninin, kardeþinin ya da kendisinin ölümcül hastalýðý nedeniyle yas yaþayabilmektedir. Yasýn görünümü ve sonuçlarý, çocuðun ölümle ilgili kavramlarýnýn geliþimine baðlý olarak deðiþmektedir. Bu yazýda ölümcül hastalýðý olan çocuklarda ölüm kavramýnýn geliþimi, yas süreçleri ve ölüm sürecinde uygulanacak yaklaþýmlarýn gözden geçirilmesi amaçlanmýþtýr.

The number of children and adults with chronic diseases is increasing in many countries. Each year more than 6 million people in the world to be diagnosed with cancer and more than 4 million of them die. Despite advancing technology and methods of treatment of disease, exacerbations in children with cancer are more frequent and have more longer stages, the disease progresses, children are increasing fears and anxieties about death. Children; may live grief because of their parents’, brothers’ or their deadly disease. View of grief and the results varies depending on the development of related concepts of the child's death. Aim of this paper is to revise the development of concept of death, the process of greif and approaches to be applied in the process of death.

Tanýdan l0 yýl sonra geliþen lokal nüks ve uzak metastaz, renal hücreli kanserin (RCC) geç rekkürrensi olarak adlandýrýlýr. Geç rekürrens %4.7-11 oranýnda görülmektedir. Bu olgu sunumunda RCC nedeniyle nefrektomi yapýlan ve 16 yýl sonra soliter beyin metastazý geliþen 54 yaþýndaki kadýn hastayý tartýþmayý amaçladýk. Ýntrakranial tümör nedeni ile gross total eksizyon yapýldý. Patolojik tanýsý RCC metastazý olarak saptandý. Yapýlan immünohistokimyasal incelemede beyin metastazý ile 16 yýl once yapýlan nefrektomi patolojisinin ayný olduðu saptandý. Postoperatif hastaya gamma-knife uygulandý. Hastaya interferon baþlandý.
Erken evre RCC hastalarýnda da yýllýk kontrollerin >10 yýl sonra da devam edilmesi ile nüksün erken saptanmasý ile cerrahi rezeksiyon þansý saðlayabilir. Gelecekte yapýlan çalýþmalarla, geç rekkürens geliþiminde rol alan risk faktörlerinin belirlenmesi uzun takip süresi gereken hastalalarý belirleme de katký saðlayacaktýr.

Late recurrence of RCC was described as developing local recurrence or distant metastasis with a latency period of more than 10 years after nephrectomy. The rate of late recurrence after nephrectomy ranges from 4.7% to 11%. Here we report the case of a 54 year-old white female with RCC who developed brain metastasis 16 years after nephrectomy. Gross total resection of intracranial tumor was performed. Histologic examination and immunohistochemical profile of the primary renal tumor and metastatic cranial tumor showed identical morphology and immunophenotype. She was treated with gamma knife stereotactic radiosurgery. Postoperatively, the patient received interferon. Long term surveillance in RCC could be important for earlier detection of recurrence and provide chance for surgical resection. Future studies and long follow up are needed to identify risk factors for late recurrence in patients with RCC.

Amaç: Koryakarsinoma baðlý geliþen spontan uterus rüptürü vakasýný sunduk
Vaka: 28 yaþýnda miad gebeliði takiben geliþen koryakarsinom tanýlý hastaya multiajan kemoterapi (Ethoposite 100mgr/m2 + cisplatin20mgr/m2) baþlandý. Hastanýn tedavisi sýrasýnda spontan uterus rüptürü geliþti ve total abdominal histerektomi uygulandý.
Sonuç: Gestasyonel trofoblastik hastalýklar içinde en ciddi seyreden formlardan biri olan koryokasinom medikal tedaviye raðmen spontan uterus perforasyonu ile prezente olabilir.

Objective: We describe a rare case of choriocarcinoma with spontenous uterine perforation.
Case: A 28 year-old patient presented with uterine perforation and hypovolemic shock during chemotherapy treatment for choriocarcinoma following term pregnancy. Total abdominal hysterectomy was done.
Conclusion: Choriocarcinoma may be presented with spontenous uterine perforation in spite of chemotherapy regimen.

Memenin glikojenden zengin berrak hücreli karsinomu meme kanserinin nadir tipidir. Tümöral doku intrasitoplazmik glikojenden zengin þeffaf hücrelerden oluþmaktadýr. Biz burada glikojenden zengin berrak hücreli karsinom tanýsý ile izlenen 44 yaþýnda kadýn hastayý sunduk.

Glycogen-rich clear cell carcinoma of the breast is a rare type of breast carcinoma. Tumoral tissue is consist of intracytoplasmic glycogen-rich clear cells. We presented in here a 44-year old woman diagnosed with glycogen-rich clear cell carcinoma.

Birçok çalýþmada, kanser hastalarýnda depresyon sýklýðýnýn belirgin olarak yüksek olduðu belirtilmiþtir. Bir prototip olarak kanser ve majör depresyon iliþkisi en belirgin þekliyle pankreas kanserinde karþýmýza çýkar ve bu güçlü iliþki uzun yýllardýr bilinmektedir Ancak bu iliþki ve iliþkinin altýnda yatan patofizyolojik mekanizma hakkýnda yetersiz bilgi birikimi söz konusudur. Farklý kanser türlerinde de artmýþ majör depresyon sýklýðý mevcuttur. Bu yazýda taný öncesinde depresif bulgularý ortaya çýkan ve hastalýk progresyonu döneminde bu bulgularý belirgin þekilde artan pankreatik nöroendokrin karsinom tanýlý bir vaka sunulmuþtur. Depresif bulgularla; malignite tanýsý ve prognoz arasýndaki olasý iliþkinin tartýþýlmasý ve 'depresif semptomlar metastazý öngörebilir mi?' sorusunun gündeme getirilmesi amaçlanmýþtýr.

Various studies were reported remarkable higher rates of depression in cancer patients. As a prototype, close relationship between cancer and major depression was reported in pancreatic cancer patients markedly and this relationship has been known for long years. Higher incidence of major depression exists in various subtypes of cancer, too. However, there is an inadequate data about this relationship and its underlying pathophysiological mechanism. In this paper, we have reported a case of whom had depressive symptoms before the diagnosis of pancreatic neuroendocrine pancreatic carcinoma and became more prominent at the time of progression of the disease. We have aimed to discuss about the probable relationship between depressive symptoms with early cancer diagnosis and prognosis and come up with the question of 'may depressive symptoms predict metastasis? '.

Böbrek onkositomu ilk olarak 1942 de tarif edilmiþtir. Proksimal tüplerin epitelinden köken aldýðý düþünülen ve hipertrofiye mitokondriler tarafýndan oluþturulan ince granüler eozinofilik sitoplazmalarý olan büyük epitelial hücreler olan onkositlerleden oluþan tümörlerdir. Çoðunlukla benign ve 5-10 cm çapýnda kitlelerdir. Nekroz içermezler ancak santral fibrozis vardýr. 7. dekatta en sýk görülürler. Yaklaþýk olarak %70 i insidental olarak saptanýrken, %30 u flank aðrýsý, palpabl renal kitle ve gross yada makroskobik hematüri ile semptom verirler. Renal onkositomanýn klinik seyri benigndir. Klinik olarak renal hücreli kanserden ayýrt edilemeyen ancak kesin patolojide onkositom olduðu saptanan bir vakayý sunduk.
Altmýþbeþ yaþýnda erkek hasta 3 aydan uzun süren künt sað yan aðrýsý nedeniyle kliniðimize baþvurdu. Renal ultrasonografide sað renal kitle saptandý. Bilgisayarlý tomografi (BT) incelemeside sað böbrek yerleþimli 10x8x6 cm lik solid kitle saptayarak Ultrasonografiyi doðruladý. Sað radikal nefrektomi yapýldý. Kesin patoloji raporu onkositom olarak geldi. Hasta sorunsuz olarak taburcu edildi.
Onkositomayý renal malign kitlelerden ayýracak güvenilir bir metod günümüzde yoktur.BT de kitle santralinde satelit skar görülmesi veya renal arteriografide at arabasý tekeri görüntüsü renal onkositomadan þüphelendirebilmekle birlikte ayný bulgular renal hücreli kanserlerde de görülebilmektedirler.Sonuç olarak insidental saptanan bir renal kitlenin taný ve tedavisi sýrasýnda onkositom olasýlýðý daima akýlda tutulmalý ve hastalar bu olasýlýk hakkýnda bilgilendirilmelidir.

Oncocytoma of the kidney was first described in 1942. The tumours are probably of proximal tubular epithelial origin and composed of oncocytes which are large epithelial cells with finely granular eosinophilic cytoplasm resulting from hypertrophied mitochondria.Most were being and 5–10 cm in diameter. They lack necrosis but may have central fibrosis.Peak incidence is in the seventh decade. Approximately 70% of oncocytomas are discovered as incidental findings,while 30% of patients may present flank pain, palpable renal mass, and gross or microscopic haematuria. Renal oncocytoma follows a benign clinical course.We report a right renal mass which was undistinguishable from renal cancer clinically but diagnosed as oncocytoma at the definitive pathological diagnosis.
65 yrs old man investigated for dull right flank pain lasting for more than 3 months.Renal ultrasonography revealed a right renal mass and CT examination confirms ultrasound by reporting a 10x8x6 cm solid mass located at the right kidney.Right radical nephrectomy was performed.Definitive pathology reported oncocytoma.Patient was discharged uneventfully.
There is no reliable preoperative diagnostic procedure distinguishing oncocytoma from renal carcinoma. The presence of a central stellate scar on CT or spoke wheel vascular pattern on renal arteriography may be suggestive of renal oncocytoma but these findings are also seen in some cases of renal carcinoma.We conclude that in the evaluation of an incidental renal mass the possibility of an oncocytoma should always be kept in mind and patients should be informed properly.

Sentinel lenf nodu biyopsisi (SLNB), malign melanomalý hastalarýn lenf nodlarýnýn durumunu belirlemek için kullanýlan bir evreleme prosedürüdür. Elektif lenf nodu diseksiyonuna göre çok daha az komplikasyon riski bulunmaktadýr. SLNB, Breslow kalýnlýðý <0.75 mm. olan hastalara önerilmemektedir. Teknesyum sülfür kolloid ve vital mavi boyanýn birlikte kullanýlmasý ile yapýlan lenfatik haritalama sonucu sentinel lenf nodu %99 oranýnda tespit edilebilir. SLNB, klinik olarak lenf nodu metastazý olmayan malign melanomalý hastalarda en önemli prognostik faktördür. SLNB'de mikrometastaz tespit edilmesi, tamamlayýcý lenf nodu diseksiyonu endikasyonudur. Bu derlemede SLNB hakkýnda hem güncel literatür bilgisi hem de süregelen tartýþmalar ele alýnmýþtýr.

Sentinel lymph node biopsy (SLNB) is a staging procedure used to determine the nodal status of patients with melanoma. It has a significantly lower complication rate compared with elective lymph node dissection. SLNB is not recommended for very thin lesions (Breslow thickness ≤ 0.75 mm). The combined lymphatic mapping technique of technetium sulfur colloid with vital blue dye would result in identification of the sentinel node in 99% of patients when performed correctly. SLNB is the single most important prognostic factor in melanoma patients without clinical evidence of nodal metastasis Currently, micrometastatic disease found on SLNB is an indication for completion lymph node dissection. In this review, both current literature and ongoing debates considering SLNB are discussed.