GÝRÝÞ ve AMAÇ: Bir çok meme kanseri hastasýnda sentinel lenf nodundan baþka metastatik lenf nodu olmadýðý halde gereksiz yere aksiller diseksiyon uygulanmaktadýr. Bu çalýþmanýn amacý Memorial Sloan-Kettering Cancer Center (MSKCC) nomogramýnýn Anadolu’da yaþayan meme kanseri hastalarýndaki doðruluðunu araþtýrmaktýr.
YÖNTEM ve GEREÇLER: Sentinel lenf nodu (SLN) biyopsisi pozitif olduðu için aksiller lenf nodu diseksiyonu yapýlan 120 meme kanserli hastanýn hasta ve tümör özellikleri irdelendi. Bu hastalarýn her birisinin non-SLN tutulum riski MSKCC nomogramý kullanýlarak hesaplandý.
BULGULAR: Negatif SLN sayýsý, pozitif SLN sayýsý, SLN ekstrakapsüler yayýlýmý, pozitif SLN sayýsýnýn toplam SLN sayýsýna oraný (pozitif SLN oraný), lenfovasküler invazyon varlýðý, tumor çapý, human epidermal growth factor receptor-2 durumu tek deðiþkenli analizde non-SLN metastazý ile istatistiksel olarak iliþkili bulunan faktörlerdi. Çok deðiþkenli analizde ise tümör çapý ≥ 5cm (p<0.036) ve pozitif SLN oraný (p<0.005) non-SLN metastazý ile iliþkili bulunan parametrelerdi. Nomogramýn sonucuna göre ROC eðrisi çizildi ve eðri altý alan 0,779 (p<0.001) olarak bulundu.
TARTIÞMA ve SONUÇ: SLN pozitif meme kanserli hastalarda non-SLN metastaz riskini belirlemede MSKCC nomogramý bizim hasta populasyonumuz için iyi bir ayýraç olmuþtur.

INTRODUCTION: Many breast cancer patients undergo to unnecessary axillary dissection as additional nodal metastasis is not detected other than sentinel lymph node in most of the patients. This study is conducted to establish the accuracy of Memorial Sloan-Kettering Cancer Center (MSKCC) nomogram in Anatolian patients.
METHODS: One hundred and twenty sentinel lymph node (SLN) biopsy positive breast cancer patients who received completion axillary lymph node dissection were reviewed according to patient and tumour characteristics. The likelihood of having positive non-SLN metastasis based on the factors and the performance of the diagnostic value of MSKCC nomogram were evaluated.
RESULTS: The number of negative SLNs, the number of positive SLNs, SLN extracapsular extention, proportion of positive SLNs to total SLNs (positive SLN ratio), lymphovascular invasion, tumor size, human epidermal growth factor receptor-2 status were found statistically significant on non-SLN metastasis in univariate analysis. Tumor size ≥ 5cm (p<0.036) and positive SLN ratio (p<0.005) were found to be correlated with non-SLN metastasis in multivariate analysis. Receiver operating characteristic (ROC) curve was formed according to the nomogram and areas under curve (AUC) was found as 0,779 (p<0.001).
DISCUSSION AND CONCLUSION: The MSKCC nomogram was good discriminator of non-SLN metastasis in SLN positive breast cancer patients for our patient population.

GÝRÝÞ ve AMAÇ: Tiroid nodüllerinin prevelansý yüksek olmasýna raðmen, bu nodüller için malignite oranlarý düþüktür. Bu nedenle, cerrahi yaklaþým gerektiren malign nodülleri, benign nodüllerden ayýrmak çok önemlidir. Ultrasonografi, ultrasonografi eþliðinde ince iðne aspirasyonu ve ayrýca Tiroid Sitopatolojisi için Bethesda Raporlama Sistemi tiroid nodüllerinin deðerlendirilmesinde fayda saðlamaktadýr. Ancak, bu sistem ‘Önemi Belirsiz Atipi/ Önemi Belirsiz Foliküler Lezyon (ÖBA/ÖBFL)’ olarak adlandýrýlan problemli bir kategori içermektedir. Bu kategori için son zamanlarda bildirilen malignite yüzdeleri %5 ile %96,7 arasýnda deðiþmektedir. Bu çalýþmada merkezimizde incelenen ilk ince iðne aspirasyon tanýsý ÖBA/ÖBFL olan tiroid nodüllerindeki malignite oranlarýnýn sunulmasý amaçlanmaktadýr.
YÖNTEM ve GEREÇLER: Yedi yýl süresince, Trakya Üniversitesi Týp Fakültesi Patoloji Anabilimdalý’nda (Edirne, Türkiye) incelenen hastalarýn tanýlarý (ince iðne aspirasyon ve tiroidektomi) geriye dönük olarak deðerlendirildi.
BULGULAR: Ýnce iðne aspirasyon sitolojisinde ÖBA/ÖBFL tanýsý alan 153 hastadan 68’inde (%44,4) histopatolojik taný papiller tiroid karsinomu, 1’inde (%7) foliküler karsinom ve 1’inde (%7) de medüller karsinom idi.
TARTIÞMA ve SONUÇ: Tiroid Sitopatolojisi için Bethesda Raporlama Sistemi bazý taný kategorilerinde standardizasyon saðlamýþsa da, ÖBA/ÖBFL kategorisi hala subjektif sitolojik kriterleri barýndýrmakta ve farklý çalýþmalarda oldukça deðiþken histolojik malignite oranlarý bildirilmektedir. Bu nedenle, immünositokimya ve özellikle moleküler testler gibi yardýmcý yöntemlerin kullanýlmasý tiroid nodüllerinin preoperatif tanýsýnda faydalý olabilir.

INTRODUCTION: Although the prevelance of thyroid nodules is high, the rate of malignancy in these nodules is low. Thus, the distinction between the malignant nodules requiring surgical approach and the benign ones is very important. Ultrasound, ultrasound guided fine needle aspiration and also The Bethesda Reporting System for Thyroid Cytopathology are useful tools for interpretation of thyroid nodules. However, this system includes a problematic category titled as ‘Atypia of Undetermined Significance/ Follicular Lesion of Undetermined Significance (AUS/FLUS)’. The reported percentages of malignancy in these nodules range between 5-96,7%, recently. We aimed to present the rate of malignancy in thyroid nodules with initial fine needle aspiration diagnosis as AUS/FLUS.
METHODS: The final diagnosis (fine needle aspiration and thyroidectomy) of patients who presented at the Department of Pathology of the Trakya University Medical Faculty (Edirne, Turkey) were reviewed for seven years.
RESULTS: Histological diagnosis was papillary thyroid carcinoma in 68 (44,4%), follicular carcinoma in 1 (0.7%) and medullary carcinoma in 1 (0.7%) of the 153 patients with prior fine needle aspiration diagnosis as AUS/FLUS.
DISCUSSION AND CONCLUSION: Although, The Bethesda Reporting System for Thyroid Cytopathology have provided standardisation in some of categories, the category of AUS/FLUS remains to be including subjective cytological criteria and subsequent malignancy rates are highly variable in different reports. So, ancillary tools such as immunocytochemistry and particularly molecular tests may be appropriate in preoperative diagnosis of thyroid nodules.

GÝRÝÞ ve AMAÇ: Bu çalýþmada, radikal nefrektomi (RN) ile nefron koruyucu cerrahinin (NKC) uzun dönem böbrek fonksiyonlarý üzerine etkisini ortaya koymak amaçlanmýþtýr.
YÖNTEM ve GEREÇLER: Hacettepe Üniversitesi Týp Fakültesi Üroloji Anabilim Dalý’nda Ocak 1990 - Nisan 2011 tarihleri arasýnda renal kitle nedeniyle ameliyat edilen 1016 hastaya ait veriler, retrospektif olarak incelenmiþtir. Taný anýnda metastatik olduðu bilinen 78 olgu çalýþma dýþý tutulmuþtur.
BULGULAR: Çalýþmaya alýnan olgularýn 579'u (%61,7) erkek ve 359'u (%38,3) kadýndýr. 624 olguya RN, 314 olguya NKC yapýlmýþtýr. Hastalarýn ortalama takip süresi RN yapýlan grupta 46.7 ay iken, NKC uygulanan grupta 39.9 aydýr. Ortalama radyolojik tümör boyutu sýrasýyla 75±33,5 mm ve 37,8±26 mm’dir (p<0.001). Ortalama ameliyat süresi RN ve NKC gruplarý için sýrasýyla 137.6 ve 139.5 dakikadýr. NKC uygulanan grupta ortalama sýcak iskemi süresi 18,9±6,8 (3-36) dakikadýr. Uzun dönem takip sonunda RN yapýlan gruptaki kreatinin deðerindeki ortalama 0,51 mg/dl artýþ, NKC uygulanan gruptaki 0,39 mg/dl artýþtan anlamlý þekilde daha fazladýr (p<0.001). Uzun dönem takipte preoperatif GFR’ý ≥60 olan hastalarýn halen GFR deðerinin ≥60 olarak devam etme oranlarý, RN ve NKC yapýlan gruplarda sýrasýyla %47.6 ve %74.8 olarak tespit edilmiþtir (p<0.001).
TARTIÞMA ve SONUÇ: Çalýþmamýzda GFR’de azalma oranýnýn uzun dönemde RN yapýlan hastalarda NKC yapýlanlara göre daha fazla olduðu bulunmuþtur. T1 renal tümörü olan birçok olguda RN ile bütün böbreði çýkarmak fazladan tedavidir. T1 renal tümörü olan hastalarda teknik olarak mümkün oldukça parsiyel nefrektomi tercih edilmelidir.

INTRODUCTION: The goal of this study was to demonstrate the long-term effects of radical nephrectomy (RN) and nephron sparing surgery (NSS) on kidney functions.
METHODS: The medical records of 1016 patients who underwent kidney surgery from January 1990 to April 2011 at Hacettepe University School of Medicine, Department of Urology were retrospectively collected and analyzed. Metastatic 78 patients at presentation were excluded.
RESULTS: Radical nephrectomy and nephron sparing surgery was performed in 624 and 314 cases, respectively. Male to female ratio was 579/314. The mean follow up was 46.7 and 39.9 months for RN and NSS, respectively. The mean radiological tumor size was 75±33,5 mm for RN and 37,8±26 mm for NSS (p<0.001). The mean duration of surgery for RN and NSS was 137 and 139 minutes, respectively. The mean warm ischemia time for NSS was 18.9 minutes. Serum creatinin level was increased 0.51mg/dl and 0.39mg/dl for RN and NSS after long-term follow up, respectively (p<0.001). Glomerular filtration rate (GFR) was ≥ 60 ml/min/m2 in 47.6% and 74.8% of RN and NSS patients in long-term follow up, respectively (p<0.001).
DISCUSSION AND CONCLUSION: Decrease in GFR was more prominent in RN compared to NSS patients in long term. Therefore, removing the whole kidney for especially T1 renal tumours is over treatment in most cases. Partial nephrectomy should be preferred for all T1 renal tumours whenever technically feasible.

GÝRÝÞ ve AMAÇ: Fibula kaynaklý tümörler daha az sýklýkla görülmekle birlikte çoðunun lokal agresif ve malign olmasýndan dolayý önem arz etmektedir. Fibula kaynaklý tümör nedeniyle tedavi edilen hastalar incelenerek, taný ve tedavideki tuzak noktalara dikkat çekilmesi amaçlandý.
YÖNTEM ve GEREÇLER: Mayýs 2007 ile Haziran 2015 tarihleri arasýnda fibula yerleþimli tümör nedeniyle taný ve tedavi edilmiþ 36 hasta retrospektif olarak incelendi. Hastalarýn yaþý, cinsiyeti ve lezyonlarýn lokalizasyonu belirlendi. Tümörün radyolojik özellikleri, histolojik tipi, uygulanan rezeksiyon tipi ve komplikasyonlar incelendi.
BULGULAR: Hastalarýn 20’ si kadýn, 16’ sý erkek olup yaþ ortalamasý 31.5 (6-74) yýl bulundu. Fibula 1/3 proksimal bölge 26, 1/3 orta bölge 6, 1/3 distal bölge 4 hastada tespit edildi. Histolojik olarak tümörlerin 23’ ü bening, 9’ u malign ve 4’ ü metastatik tümördü. Hastalarýn 19’una intralezyonel küretaj, 15’ ine geniþ rezeksiyon ve 2’ sine amputasyon uygulandý.
TARTIÞMA ve SONUÇ: Fibula diz eklemi ve ayak bileði stabilitesine katkýsý ve proksimalde nörovasküler yapýlara yakýn komþuluðu nedeniyle birtakým cerrahi zorluklar içermektedir. Radyolojik olarak tümörün sýnýrlarý ve ne kadar kemiðin feda edilebileceði iyi planlanmalýdýr. Ýyi bir planlama ve dikkatli bir cerrahi tedavi ile tümörün komplikasyonsuz bir þekilde uzaklaþtýrýlabileceði kanaatindeyiz.

INTRODUCTION: Although fibula based tumors are less common, they are important since a great number of them are local aggressive and malign. The purpose of this study is to evaluate the patients with fibula based tumors and to focus on pitfalls in diagnosis and treatment.
METHODS: 36 patients who had been diagnosed with and treated for tumor involving fibula between May 2007 and June 2015 were examined retrospectively. The patients’ ages, genders and localizations were specified. Tumor’s radiologic features and histological type, type of resection and complications were analyzed.
RESULTS: 20 of the patients were women, while 16 were men and the average age of the patients was 31.5 (6-74) years of age. Tumor was found in fibula 1/3 proximal zone of 26 patients, in fibula 1/3 middle zone of 6 patients and in fibula 1/3 distal zone of 4 patients. Histological, 23 were benign, 9 were malign and 4 were metastatic tumors. Intralesional curettage was performed on 19 patients, wide resection was performed on 15 patients and amputation was performed on 2.
DISCUSSION AND CONCLUSION: Fibula involves some surgical difficulties because of its contribution to knee joint and ankle stability and its close adjacency to neurovascular structures in proximal. Radiologically, tumor borders and how much bone can be sacrificed should be planned well. With a good planning and a careful surgical treatment, tumor can be removed without complications.

GÝRÝÞ ve AMAÇ: Günümüzde osteoid osteoma olgularýnda bilgisayarlý tomografi (BT) rehberliðinde perkütan radyofrekans (RF) ablasyon tedavisi popular bir yöntem olarak uygulanmaktadýr. Bu çalýþmanýn amacý iþlemin komplikasyonlarýný ve etkinliðini deðerlendirmektir.
YÖNTEM ve GEREÇLER: Aðustos 2012 ile Kasým 2015 tarihleri arasýnda iþlem yapýlan ardýþýk 35 hasta çalýþmaya dâhil edildi. Hastalara BT ünitesinde, sedasyon anestezisi altýnda RF jeneratörüne baðlanan elektrot ile ablasyon uygulamasý yapýldý. Arþiv görüntüler ve dosya kaydý retrospektif olarak incelendi. Lezyonlarýn yerleþim yeri, nidus geniþliði ve etkilenen bölge (kortikal, kortikal-intramedüller, medüller) not edildi. Ýþlem sonrasý aðrýnýn kaybolmasý baþarý kriteri olarak kabul edildi. Hastalar rutin olarak iþlem sonrasý bir gün yatýrýlarak takip edildi.
BULGULAR: Çalýþma dâhilinde 25 erkek, 10 kýz hasta mevcuttu. Hastalarýn yaþ ortalamasý ve nidus ortalama çapý sýrasýyla 16±5.59 ve 5.64±2.5 mm idi. Niduslarýn 24’ü kortikal, 7’si kortikal-intramedüller, 4’ü medüller bölgede idi. Lezyonlar femur (n=19), tibia (n=9), asetabulum (n=3), fibula (n=1), kalkaneus (n=1), skapula (n=1) ve iliak kemik (n=1) yerleþimli idi. Ýþlemi takiben bir hasta hariç tüm hastalarda aðrýnýn kaybolduðu gözlendi. Bu hastaya 3 hafta sonra re-ablasyon yapýldý. Bir hastada iþlem sonrasý 1 saat süren peroneal nöropraksi, bir hastada 5-6 gün süren karýncalanma hissi geliþti. Bir hastada 15. ayda yeniden baþlayan aðrý (rekürrens) saptandý ve RF ablasyon önerildi. Üç hastada iþleme baðlý yanýk (üçüncü derece) geliþti.
TARTIÞMA ve SONUÇ: Osteoid osteomaya yönelik RF ablasyon uygulamalarýnýn tedavi baþarýsý yüksektir. Ýþlem baþarýsýzlýðý ve rekürrens oraný düþüktür. Tedavi sonrasý aðrýda dramatik düzelme, erken taburculuk ve gündelik yaþama kýsa sürede dönüþ beklenir. Uygun lokalizasyonlardaki lezyonlarda RF ablasyon cerrahi tedavinin önüne geçmiþtir. Ýþleme baðlý komplikasyon oraný düþüktür. Ancak iþlem sýrasýnda geliþebilen yanýk ciddi bir sorun teþkil etmektedir.

INTRODUCTION: Percutaneous radiofrequency (RF) ablation via computed tomography (CT) guidance has been currently performed in treatment of osteoid osteoma as a popular method. The purpose of this study was to evaluate the complications and efficacy of the procedure.
METHODS: A total of thirty-five consecutive patients from August 2012 to November 2015, were included in the study. The ablation procedure was performed under conscious sedation with a RF electrode in tomography unit. Archive images and file records were retrospectively evaluated. Lesions’ locations, nidus diameters, and affected areas (cortical, cortical-intramedullary, medullary) were noted. Relief of pain after the procedure was accepted as success criteria. The patients were routinely hospitalized a day after the procedure.
RESULTS: Twenty-five male and ten female patients were included. The mean age and nidus size were 16±5.59 and 5.64±2.5 mm, respectively. Niduses were located in cortical (n=24), cortical-intramedullary (n=7), and medullary (n=4) regions. Lesions were located in femur (n=19), tibia (n=9), acetabulum (n=3), fibula (n=1), calcaneus (n=1), scapula (n=1) and iliac bone (n=1). All of the patients except one achieved pain relief after the procedure. The patient, who had pain after ablation, had been re-ablated 3 weeks later. Two patients had peroneal neuropraxia lasting in an hour (n=1) and tingling sensation lasting in 5-6 days (n=1) after ablation. Recurrence was recorded in one patient 15 months after the procedure, and re-ablation was offered. Third degree burn associated with ablation procedure was observed in three patients.
DISCUSSION AND CONCLUSION: RF ablation technique in the treatment of osteoid osteoma has a high success rate. Procedure failure and recurrence rates are lower. Dramatic pain relief, early discharge and return to daily life in a short time are expected. RF ablation is the first-line therapy in appropriate lesion locations. Complication rate is low. However, burn complication, which can occur during the procedure, seems to be a serious problem.

GÝRÝÞ ve AMAÇ: Akciðer kanseri kýsa yaþam beklentisi ve agresif tedavi seçenekleri nedeniyle hastalarýn hem yaþam kalitesini hem de psikoseksüel durumlarýný etkilemektedir. Bu çalýþmanýn amacý akciðer kanseri hastalarýnda anksiyete, depresyon, cinsel doyum durumu ve yaþam kalitesinin deðerlendirilmesidir.
YÖNTEM ve GEREÇLER: Birinci veya ikinci sýra kemoterapi alan metastatik akciðer kanseri hastalarýyla yüz yüze anketler yapýlarak bilgiler toplanmýþtýr. Kullanýlan anketler sosyodemografik karakteristikleri, Beck Depresyon Anketini (BDI), Golombok-Rust Cinsel Doyum Anketini (GRISS) and European Organization for Research on Treatment of Cancer Questionnaires-C30 Yaþam Kalitesi Anketini (EORTC-QoL-C30) içermektedir.
BULGULAR: Bu çalýþma 44 hastanýn anket verilerini içermektedir. Hastalarýn anksiyete ve depresyon durumu için toplam Beck skoru çok yüksek çýkmýþtýr (sýrasýyla; 15.60 ± 12.30 ve 16.02 ± 11.39). Metastatik akciðer kanseri hastalarýmýzýn GRISS skorlarý anksiyete ve depresyon durumlarýna göre deðerlendirildiðinde herhangi bir istatistiksel anlamlýlýk bulunamamýþtýr. Hastalarýmýzdan anksiyete ve depresyon skorlarý yüksek olanlarda EORTC-QLQ-C30’un fiziksel, biliþsel, duygusal ve sosyal fonksiyonlarý istatistiksel olarak anlamlý þekilde düþük bulunmuþtur. Rol fonksiyonu açýsýndan sadece yüksek anksiyete skorlu hastalarda istatistiksel anlamlýlýk saptanmýþtýr.
TARTIÞMA ve SONUÇ: Metastatik akciðer kanserli hastalarda yüksek anksiyete ve depresyon durumu, azalmýþ cinsel doyum ve bozulmuþ yaþam kalitesi izlenmiþtir.

INTRODUCTION: Lung cancer (LC) affects psychosexual outcome and quality of life (QoL) of the patients because of short survival period and aggressive treatment modalities. The aim of our study was to investigate anxiety, depression, QoL and sexual satisfaction levels of LC patients.
METHODS: The data for metastatic LC patients treated with first or second-line chemotherapy were collected by using four forms completed during face-to-face interviews. The forms consist of socio-demographic characteristics, the Beck Depression Inventory (BDI), Golombok-Rust Inventory of Sexual Satisfaction (GRISS) and European Organization for Research on Treatment of Cancer Questionnaires Quality of Life-C30 (EORTC-QoL-C30).
RESULTS: Forty-four LC patients were participated in this study. The total Beck scores of patients for anxiety and depression were very high (15.60 ± 12.30 and 16.02 ± 11.39; respectively). When we evaluated GRISS scores of our metastatic LC patients with respect to their anxiety or depression levels, we could not find any statistical significance. In the metastatic LC patients whose anxiety and depression scores were high, physical, cognitive, emotional and social functioning of EORTC-QLQ-C30 was found statistically significantly low. Statistical significance in terms of role functioning was only found in the patients with high anxiety scores.
DISCUSSION AND CONCLUSION: Metastatic LC patients had high anxiety and depression levels, decreased sexual satisfaction and impaired QoL.

GÝRÝÞ ve AMAÇ: Lipomlar en sýk görülen yumuþak doku tümörleri olup özellikle omuz, sýrt ve alt ekstremitede görülmektedir. Nadir görülmekle birlikte 5 cm’ in üzerinde olanlar ise dev lipom þeklinde tanýmlanmaktadýr. Yazýmýzda tanýda ve tedavide sýkýntýlara yol açabilecek üst ekstremite yerleþimli dev lipom nedeniyle cerrahi tedavi edilen olgular literatür eþliðinde sunulmuþtur.
YÖNTEM ve GEREÇLER: Mart 2009 ile Aralýk 2014 tarihleri arasýnda üst ekstremite yerleþimli dev lipom nedeniyle cerrahi total eksizyon uygulanmýþ ve son kontrolleri yapýlan 17 olgu çalýþmaya dahil edildi. Hastalar yaþ, cinsiyet, lokalizasyon, cerrahi yaklaþým, histopatolojik özellik ve nüks açýsýndan deðerlendirildi. Veriler SPSS sistemine yüklendikten sonra normal daðýlýma uyup uymadýðý Shapiro-Wilk testi ile deðerlendirildi.
BULGULAR: Olgularýn 7’si kadýn, 10’u erkek ve ortalama yaþý 44 (8-81) idi. Lezyon olgularýn 4'ünde el, 4'ünde önkol, 3'ünde kol ve 6'sýnda omuz bölgesinde, sað/sol yerleþimi ise 12/5 þeklinde idi. Olgularýn ortalama takip süresi 42 ay (9-84) idi. Takiplerinde el yerleþimli bir olgumuzda 22. ayda nüks geliþtiði gözlendi ve kitleye cerrahi olarak re-eksizyon uygulandý.
TARTIÞMA ve SONUÇ: Sonuç: Lipomlarýn kesin tedavisi cerrahi olarak total eksizyondur. Bunun için özellikle üst ekstremite yerleþimli lipomlarda tüm sýnýrlara ulaþmak ve komþu nörovasküler yapýlarý korumak için yeterince geniþ insizyon kullanýlmalýdýr.

INTRODUCTION: Lipomas are the most frequently seen soft tissue tumors and are seen particularly in the shoulder, back and lower extremity. Although rarely seen, lipomas of >5 cm are known as giant lipomas. In this paper, cases treated surgically due to giant lipoma located in the upper extremity, which can lead to problems in diagnosis and treatment, are presented in the light of current literature.
METHODS: The study included 17 cases that underwent surgical total excision for giant lipoma located in the upper extremity and underwent final follow-up examination between March 2009 and December 2014. Patients were evaluated in point of age, gender, localization, surgical approach, histopathological characteristics and recurrence. Data were evaluated to confirm normal distribution using the Shapiro-Wilk test.
RESULTS: The patients were 7 females and 10 males with a mean age of 44 years (ranging from 8 to 81 years). The lesions were in the hand in 4 cases, in the arm in 3 cases and the shoulder region in 6 cases, with right/left location in 12/5 cases. The mean follow-up period was 42 months (ranging from 9 to 84 months). In one case, recurrence was seen at 22nd month and surgical re-excision of the mass was applied.
DISCUSSION AND CONCLUSION: The definitive treatment for lipomas is surgical total excision. To achieve this, particularly in lipomas located in the upper extremity, a sufficient wide incision must be used to reach all the nerves and protect the neurovascular structures.

GÝRÝÞ ve AMAÇ: Kolorektal kanserli hastalarýn yaklaþýk olarak %50-60'ýnda senkron veya metakron uzak metastazlar izlenmektedir. Kolorektal kanserlerin hepatik ve pulmoner metastazlarýnýn cerrahi rezeksiyonu hastalýksýz saðkalým (DFS) ve genel saðkalýmý (OS) anlamlý düzeyde uzatmakta ve böylece son yýllarda yaygýn olarak uygulanmaktadýr.
YÖNTEM ve GEREÇLER: Bu araþtýrmada, Dokuz Eylül Üniversitesi Týp Fakültesi Hastanesi'nde tedavi gören ve kolorektal kanserlere baðlý akciðer metastazlarý nedeniyle metastazektomi uygulanan 29 hasta deðerlendirildi. Hastalara ait bilgiler retrospektif olarak elde edildi.
BULGULAR: Hastalarýn 24'ü (%82.8) izole akciðer metastazý, gerikalan 5’i (%17.2) ise hem akciðer hem karaciðer metastazýna sahipti. Çalýþmaya alýnan hastalarýn tümüne akciðer metastazýna yönelik rezeksiyon uygulanýrken, 5 (%17.2) hastaya ise akciðer+karaciðer metastazektomisi uygulanmýþtý. Tüm hasta grubunda ortanca OSx 57 ay (SD± 4 ay), 1, 3 ve 5 yýllýk saðkalým oranlarý sýrasýyla %96, %92 ve %49 olarak tespit edildi. Metastazektomi operasyonu sonrasý izlenen lezyonu olmayan hastalarda ortanca DFS 31 ay (SD± 3 ay), 1, 3 ve 5 yýllýk DFS oranlarý sýrasýyla %86, %42 ve %1 olarak saptandý. Metastazektominin þekline göre OS deðerlendirildiðinde wedge rezeksiyon yapýlanlarda ortanca OS 58 ay (SD± 5 ay), lobektomi yapýlanlarda ise 50 ay (SD± 2 ay) olarak bulundu. Rezeksiyon türüne göre OS deðerlendirildiðinde R0 rezeksiyon yapýlanlarda ortanca OS 66 ay (SD± 5 ay), R1 rezeksiyon yapýlanlarda ise ortanca OS 47 (SD± 7 ay) ay olarak bulundu.
TARTIÞMA ve SONUÇ: Sonuçlarýmýz kolorektal kanser akciðer metastazlarýnýn cerrahi rezeksiyonunun, özellikle R0 rezeksiyonun OS süresinin uzamasýna katký saðladýðýný göstermektedir.

INTRODUCTION: Synchronous or metachoronous distant metastasis develops in approximately 50-60% of patients with colorectal cancer during the clinical course. Surgical resection of the hepatic and/or pulmonary metastasis of colorectal cancers significantly extends disease-free survival (DFS) and overall survival (OS) rates, and thus has been applied more broadly in recent years.
METHODS: In this study, 29 patients who were treated at the Dokuz Eylül University Medical Faculty Hospital and who had received a metastasectomy due to a lung metastasis related to colorectal cancer were evaluated. Information on the patients was obtained retrospectively.
RESULTS: Twenty-four (82.8%) patients had an isolated lung metastasis and 5 (17.2%) had both lung and liver metastasis. Resection was performed on all patients for lung metastasis, and a lung+liver metastasectomy was performed on 5 (17.2%). For the entire patient group, the median OS was 57 months (SD± 4 months), and 1, 3, and 5 year survival rates were 96%, 92% and 49%, respectively. In patients who received follow-up treatment after undergoing the metastasectomy operation and who did not have lesions, the median DFS was 31 months (SD± 3 months), and 1, 3, and 5 year DFS rates were 86.3%, 42% and 1%, respectively. In patients who received wedge resection treatment, the median OS was 58 months (SD± 5 months), and for the patients who received lobectomy treatment, the median OS was 50 months (SD± 2 months). In the evaluations made according to the resection type, median OS was 66 months (SD± 5 months) in patients who had R0 resection and 47 months (SD± 7 months) in patients who had R1 resection.
DISCUSSION AND CONCLUSION: Our results show that surgical resection, particularly an R0 resection of lung metastasis in colorectal cancer patients contributes to extended patient OS time.

Bazal hücreli karsinom, derinin en sýk görülen malign tümörü olup insidansý giderek artmaktadýr. Predispozan faktörler arasýnda en önemlisi güneþ ýþýnlarýna maruz kalmaktýr. Bununla birlikte genetik hastalýklar, organ nakilleri ve immünsupresyon da bazal hücreli karsinom geliþimini tetiklemektedir. Oldukça nadir metastaz yapmasýna raðmen lokal agresif seyreder. Ana tedavi þekli cerrahi olup cerrahiye aday olmayan hastalarda radyoterapi, kriyoterapi, kemoterapi ve hedgehog yolak inhibitörleri kullanýlabilir. Bu derlemede bazal hücreli karsinomun tedavisi konusunda güncel geliþmeler tartýþýlmýþtýr.

Basal cell carcinoma is the most commonly seen malignant tumor of the skin and its incidence is gradually increasing. Sun exposure is the single most important predisposing factor. In addition, genetic disorders, organ transplantations and immunesupression may trigger the development of basal cell carcinoma. Although it metastasizes rarely, its clinical course is local aggressive. The main treatment modality is surgery. In patients who are not candidates for surgery; radiotherapy, cryotherapy, chemotherapy and hedgehog pathway modulators can be used. In this review, current advances in the treatment of basal cell carcinoma is discussed.

Giriþ: Kronik hepatit B tedavisinde pegile interferon grubu ilaçlar, HBs Ag kaybýnýn oral antivirallerden daha sýk geliþmesi, direnç olmamasý ve tedavi süresinin sýnýrlý olmasý nedeniyle özellikle genç hastalarda tercih edilmektedir. Grip benzeri sendrom, asteni, nöropati, anksiyete, depresyon, hepatotoksisite, nötropeni, trombositopeni ve tiroid fonksiyon bozukluðu gibi yan etkiler tedaviye uyumu zorlaþtýrmaktadýr. Bu yazýda pegile interferon alfa (Peg-IFNα) tedavisi sýrasýnda tiroidit geliþen bir kronik hepatit B hastasý sunuldu.
Olgu: Yirmidokuz yaþýndaki kadýn hasta, tedavi öncesi bakýlan tiroid fonksiyon testleri normalken, tedavinin 4. ayýnda saç dökülmesi ve kilo kaybý þikayetleri ile baþvurdu. Yapýlan tetkiklerde HBV DNA düzeyi negatif, karaciðer fonksiyon testleri normal, tiroid stimülan hormon (TSH) düzeyi düþük ve serbest T3 ve T4 deðerleri yüksekti. Hastaya yapýlan ileri tetkiklerde Anti tiroid peroksidaz (TPO) antikoru, Anti tiroglobulin (TG) antikoru ve TSH reseptör antikoru pozitif bulundu. Tiroid USG ve radyoaktif iyot uptake testi troidit ile uyumlu idi. Hipertiroidi için tedavi verilmeyen hastanýn Peg-IFNα tedavisine devam edildi. Tedavinin 8. ayýnda TSH yükselince subklinik hipotiroidi nedeniyle levotiroksin sodyum baþlandý. PegIFN-α tedavisi 48 haftaya tamamlanan hastanýn tedavi sonunda ve daha sonraki takiplerinde tiroid fonksiyonlarý normal devam etti. Takibin 4. yýlýnda HBs Ag’nin negatifleþtiði, anti HBs düzeyinin 250mU/mL olduðu görüldü.
Sonuç: Peg-IFNα tedavisi alan hastalar klinik ve laboratuar olarak tiroid fonksiyonlarý açýsýndan takip edilmeli ve tiroidit geliþme ihtimali akýlda tutulmalýdýr. Yan etki yönetiminde bu tedavinin uygun sürede verilmesinin kronik hepatit B tedavisinde Hbs Ag serokonversiyonu ihtimalini arttýracaðý unutulmamalýdýr.

Introduction: Interferon alfa is preferred in treatment of hepatitis B, especially for young patients, because of the greater chance of HBs Ag loss, the absence of resistance and the finite duration of treatment. But its side effects like flu like symptoms, asthenia, neuropathy, anxiety, depression, hepatotoxicity, neutropenia, thrombositopenia and throid disfunction causes poor tolerance to treatment. We described a chronic hepatitis B patient who had thyroid dysfunction during Peg-IFNα therapy.
Case: A twenty-nine year old woman admitted to hospital with hair and weight loss on fourth month of Peg-IFNα therapy while her TSH level was normal at the beginning of the treatment. AST and ALT levels were within normal limits and HBV DNA was negative, TSH was low and T3 and T4 levels were high. Anti thyroid peroxidase antibody, anti thyroglobulin antibody and TSH receptor antibody were positive. Tiroid US and radioactive iodine uptake tests were compatible with troiditis. Peg-INFα was continued and the patient was not treated for hyperthyroidism. At the eight month of Peg-INFα therapy, levothyroxine was initiated for subclinical hypothyroidism. Hepatitis B treatment ended in the 48th week. Thyroid functions were normal at the end of HBV treatment and follow-up. At the fourth year of the therapy the patient had HBs Ag seroconvertion, with Anti HBs level of 250mU/mL.
Conclusion: The patients who have Peg-IFNα treatment should be evaluated for thyroid dysfunction and probability of thyroiditis should be kept in mind. As optimal treatment duration is important for achievement of Hbs Ag seroconvertion, appropriate management of side effects is essential in these patients.

Multipl miyelom (MM) ve myelodisplasik sendrom (MDS) birlikteliðine nadir rastlanmaktadýr. MM tedavisinde kullanýlan alkilleyici ajanlarýn bir komplikasyonu olarak MDS geliþimi olabileceði bilinmektedir. Bu yazýmýzda öncesinde herhangi bir alkilleyici ajan tedavisi ve radyoterapi maruziyeti olmaksýzýn eþzamanlý MDS ve MM geliþen bir olgumuzu tartýþtýk. 63 yaþýnda kadýn hasta, ateþ ve halsizlik þikâyeti ile kliniðimize baþvurdu. Laboratuvar incelemelerinde lökosit: 1.51x 109 / L, hemoglobin: 8 g/l, MCV 85.4 fl., trombosit: 71,000/mm3,total protein: 10.2 g/dl (normal deðerler: 6-8,5), albumin: 4 g/dl (normal deðerler: 3,5-5)saptandý. Periferik yaymada makrositer- normokrom eritrositler, anizopoikilositoz ve target hücreler izlendi. Hastanýn yapýlan serum immünfiksasyonunda IG G Lambda monoklonal protein saptandý. Kemik iliði aspirasyon ve biyopsisinde;% 70 atipik plazma hücre infiltrasyonu ve immünhistokimyasal incelemede bu plazma hücrelerinde IG G ve lambda ile pozitif boyanma saptandý.Kemik iliði aspirasyonunda her üç seriye ait öncül hücrelerde displastik deðiþiklikler ve 14% miyeloblast izlendi. Bu bulgularla hastamýza MM IG G Lambda ve MDS RAEB II tanýsý koyduk. Hastaya VCD (Bortezomib, Siklofosfamid ve Deksametazon) kemoterapisi baþlandý.
MDS ve MM gibi farklý hücrelerden köken aldýðý bilinen hastalýklarýn birlikteliði literatürde de görüldüðü üzere nadir deðildir ve pluripotent kök hücre kökenli olduðu fikrini desteklemektedir. Bu olguyu paylaþmamýzýn nedeni hem literatürün bu görüþünü desteklemek hem de yeni taný multipl myelom hastalarýnda görülen sitopenilerde eþlik edebilecek diðer myeloid neoplazilerinde akla getirilmesine dikkat çekmektir.

Coexistence of multiple myeloma (MM) and myelodysplastic syndrome (MDS) are rare. It has been known that coexistence of MM and MDS may occur as a complication of treatment. Due to treatment with alkylating agents myelodysplastic syndrome (MDS) may occur in multiple myeloma patients. Here we report a case of coexistent MM and MDS in a patient without history of treatment with any cytotoxic drugs or radiation therapy.
A 63-years-old female was presented to our clinic with fever and weakness. Her blood counts were- WBC: 1.51x 109/l – HGB: 8g/dL– MCV 85.4 fl. - PLT: 71,000/mm3. Her serum total protein elevated at 10.2 g/dl albumin 4 g/dl. The peripheral blood smear showed macrocytic and normochromic cells, anisopoikilocytosis and target cells. Bone marrow biopsy specimen showed 70 % monoclonal growth of lambda-positive plasma cells infiltration and was tri-lineage cellular dysplastic features, which included multinucleated erythroblasts and dysplastic megakaryocytes with hypolobulated nucleus. 14 % myeloblasts were seen. Serum immunofixation studies showed a monoclonal IgG lambda. These findings were characteristic for Primary MDS RAEB II and MM. We started treatment for her multiple myeloma with VCD (bortezomib, cyclophosphamide and dexamethasone). Presence the coexistence of both diseases originating from different cell lines may not be rare as they known. There have been some reports of coexistence of MDS and myeloma; supporting the idea of pluripotent stem cell origin of the disease. We suggest that MM patients administrating with cytopenie should be evaluated for coexistent myeloid neoplasms.

Langerhans hücreli histiositozis (LHH) etyolojisi tam bilinmeyen, myeloid dentritik hücrelerin nadir bir bozukluðudur. Lokalize kemik ve cilt lezyonlarý yapabileceði gibi multi organ yetmezliðine neden olabilecek kadar yaygýn tutulum da yapabilir. Yenidoðan döneminde LHH’li hastalar sýklýkla cilt bulgusu ile taný almaktadýr. Hastalarýn ilk baþvuru da lenfadenopati ile baþvurmasý sýk görülmemektedir.
Boyunda kitle? lenadenopati(LAP)? ön tanýlarý ile 35 günlük erkek hasta hastanemize baþvurdu. Hastanýn þikâyetleri 10 günlükken baþlamýþtý ve almýþ olduðu tedavilere raðmen boyundaki þiþlik geçmemiþti. Boyun ultrasonografisinde lenfadenit?, lenfoma? olarak deðerlendirildi. Hastanýn LAP’den alýnan biyopsi sonucu LHH olarak raporlandý.
Bu yaþ grubunda deri bulgusu eþlik etmeden, ilk baþvuru þikâyeti LAP olup LHH tanýsý koyulan literatürdeki nadir vakalardandýr. Yenidoðan dönemindeki LAP’lerin çok iyi deðerlendirilmesi, klinik ve ultrason görüntüsü ile LHH’un enfeksiyon ve malignite ile karýþabileceði akýlda tutulmalýdýr.

Langerhans cell histiocytosis (LCH) is a rare disorder of myeloid dendritic cells with an unknown etiology. It may cause localized bone and skin lesions also may be so widespread that the involvement can lead to multiple organ failure. In the neonatal period, patients with LCH is often diagnosed by skin lesions. In the first application of the patient, lymphadenopathy is not an expected finding.
A 35 day old male patient was admitted to our hospital with a presumptive diagnosis of mass in the neck? lymphadenopathy (LAP). His complaints had begun when he was 10 days old and despite the taken treatment, swelling in the neck was ongoing. It was evaluated as lymphadenitis? lymphoma? with cervical ultrasonography. LCH was reported as a result of the biopsy taken from LAP.
In this age group without accompanying cutaneous manifestations, the first complaint as LAP in patients diagnosed with LCH is rare in the literature. During the neonatal period, a good evaluation of the LAP must be done and it should be kept in mind that clinical and ultrasound images of LCH may interfere with infection and malignancy.

Ýntrakranial Kondrosarkomlar çok nadir görülen malign tümörlerdir, intrakranial tümörlerin sadece %15’ini oluþtururlar. Bu tümörlerin tedavisinde, cerrahi rezeksiyon ve adjuvan radyoterapi temel yaklaþýmlardýr. Kemoterapinin rolü iyi tanýmlanmamýþtýr. Biz burada intrakranial mezenkimal kondrosarkom tanýlý 26 yaþýnda erkek hastayý sunduk.

Intracranial chondrosarcomas are very rare malignant tumors, account for only 0.15% of all intracranial tumors. Surgical resection and adjuvant radiotherapy are main approaches of treatment in the treatment of these tumors. The role of chemotherapy is not well defined. We presented a 26 year-old- man diagnosed with intracranial mesenchymal chondrosarcoma.

Giriþ: Brenner tümörü nadir olarak görülen bir yumurtalýk kanseridir ve tüm kanserlerin %1’ni oluþturur. Bu tümörler genelde iyi huyludur ve Brenner tümörlerinin sadece %1’i kötü (malign) karakterdedir. Nadir olarak görülen bilateral malign brenner tümörlü bir olguyu sunacaðýz.
Olgu: 55 yaþýnda hasta son bir aydýr olan karýnda þiþlik ve aðrý þikâyeti ile baþvurdu. Hastanýn fizik muayenesinde pelvik kitle ve asit sývýsý mevcuttu. Ultrasonografik incelemede yumurtalýktan kaynaklanan kitlesi mevcuttu. Ameliyat öncesi serum CA-125: 64 IU/ml’idi. Laparotomi yapýlan hastanýn bilateral yumurtalýk kitleleri mevcuttu, frozen section incelemesi malign olan hastaya geride tümör kalmayacak þekilde evreleme cerrahisi yapýldý. FIGO 2009 evrelemesine göre evre IIIC olarak kabul edilen hasta adjuvan 6 kür platin bazlý kemoterapi aldý. On üç ay sonra bilateral ve çok sayýda akciðer metastazý geliþen hasta kurtarma kemoterapisi aldý. Sonrasýnda çok defa kemoterapi rejimleri almasýna raðmen hastalýðýn ilerlemesi nedeniyle tanýdan 53 ay sonra hastalýðýndan dolayý eksitus oldu.
Tartýþma: Ýyi huylu lezyonlar basit eksizyonla tedavi edilebilir. Çok nadir görülmesinden dolayý malign brenner tümörünün cerrahi sonrasý adjuvan tedavisi konusunda fikir birliði yoktur. Buna benzer yumurtalýk patolojilerini içeren çok merkezli çalýþmalar, bu hastalýk ile olan bilgimizi artýracaktýr.

Background: Brenner tumor of ovary is a rare neoplasm which constitutes almost 1 percent of all ovarian tumors. These tumors are usually benign, with only 1% being malignant. Here, we report a very rare case of bilateral malignant Brenner tumor.
Case: A 55 year-old woman admitted to our center with complaints of abdominal distention and pain. Her physical examination was remarkable for pelvic mass and ascites. Sonographic examination showed a complicated pelvic mass of ovarian origin. Her preoperative serum CA-125 level was 64 IU/ml. An exploratory laparotomy revealed bilateral ovarian masses and frozen section of the ovarian tumors was reported to be malignant. There was no peritoneal disease and she underwent a standard staging procedure. Final pathology revealed FIGO 2009 stage IIIC bilateral malignant Brenner tumor of the ovary. Patient received 6 cycles of platinum based chemotherapy. After 13 months of diagnosis multiple metastatic lesions in lungs were found and she underwent salvage chemotherapy. She received multiple chemotherapy regimens however disease progressed gradually and she succumbed to disease 53 months after initial diagnosis.
Discussion: In the vast majority of ovarian Brenner tumors, surgical resection provides a cure for benign disease. Owing to its low incidence there is not established adjuvant treatment algorithm for malignant ovarian Brenner tumors. Multicenter trials of ovarian cancer should aim to include this rare pathology to increase our knowledge.

Meme kanseri kadýnlarda en sýk görülen kanserdir. Tüm meme kanserlerinin %0,5-3’ü bilateral olarak görülmektedir. Meme kanserli hastalar genellikle erken evrede taný almaktadýr, yalnýz metastatik dönemde de karþýmýza çýkabilmektedir. Metastaz alanlarý genellikle kemik, akciðer ve karaciðerdir. Gastrointestinal sistemde metastaz nadir görülmekle birlikte sýklýkla kolon, rektum, mide ve özefagusa metastaz yapmaktadýr. Kliniðimizde bilateral meme kanseri tanýsýyla takip ettiðimiz ve taný esnasýnda mide metastazý saptadýðýmýz olguyu sizlere sunmayý amaçladýk.

Breast cancer is the most commonly seen cancer in women. 0.5-3% of the all breast cancer cases occur bilaterally. Breast cancer is generally diagnosed in early stages, but it can be recognised in metastatic period. Most commonly seen metastasis sites are bone, lung and liver. Although metastasis in gastrointestinal system is rare; it may be seen in colon, rectum, stomach and esophagus. We aimed to present a woman who has the diagnosis of bilateral breast cancer and stomach metastasis at diagnosis.

GÝRÝÞ ve AMAÇ: Romatoid Artrit (RA) eklemleri etkileyen ve görece sýk rastlanýlan inflamatuar bir hastalýktýr. Bu çalýþmada RA tanýlý hastalarda serum tümör belirteçleri olan karsinoembriyonik antijeni (CEA),CA 125, CA 19.9 ve CA15.3 düzeylerinin belirlenmesi amaçlanmýþtýr
YÖNTEM ve GEREÇLER: Bir üniversite hastanesinin romatoloji kliniðinde RA tanýsý ile takip edilmekte olan toplam 148 hasta çalýþma grubuna ve osteoartrit tanýlý 36 hasta ise kontrol grubuna dâhil edilmiþtir. Çalýþmaya katýlan bireylerden alýnan kan örneklerinden romatoid faktör (RF), eritrosit sedimantasyon hýzý (ESR), anti siklik sitrilünepeptid (anti CCP) ve serum tümör belirteçleri olan CEA,CA19.9,CA 125 ve CA 15.3 düzeyleri ölçülmüþtür. Hastalýk aktivite skoru çalýþmaya dâhil edilme sýrasýnda ilgili romatoloji uzmaný tarafýndan deðerlendirilmiþtir.
BULGULAR: Serum CEA,CA19.9,CA 125 ve CA15.3 düzeyleri RA tanýlý hastalarda kontrollere göre anlamlý olarak daha yüksek saptanmýþtýr. Hem aktif hem de inaktif hasta grubunda tümör belirteç düzeyleri kontrol grubuna göre anlamlý olarak yüksek ölçülmüþtür ancak tümör belirteçleri ile hastalýk aktivite skoru arasýnda bir korelasyon saptanamamýþtýr. Tümör belirteçleri arasýnda yalnýzca CEA ile RF arasýnda bir korelasyon saptanmýþtýr(r 0.165, p >0.049).
TARTIÞMA ve SONUÇ: Serum tümör belirteçleri RA tanýlý hastalarda sýklýkla yüksek seviyelerde saptanabilir. Hastalarýn takibinden sorumlu olan hekimlerin bu durumdan haberdar olmalarý, bu hasta grubunda malignite varlýðý araþtýrma amacý ile yapýlabilecek olan gereksiz iþlemlerin önüne geçilmesine yardýmcý olacaktýr.

INTRODUCTION: Rheumatoid arthritis (RA) is a relatively common inflammatory disease generally affecting the joints. This study aimed to assess the levels of various serum tumors markers; carcinoembryonic antigen (CEA), CA 125, CA 19.9 and CA15.3 in patients with a known diagnosis of RA.
METHODS: A total of 148 patients who were being followed in the rheumatology clinic of a tertiary academic center with a diagnosis of RA and 36 controls were included in the study group. Measurement of rheumatoid factor (RF), erythrocyte sedimentation rate (ESR), anti CCP and serum tumor markers including CEA, CA 19.9, CA 125, CA 15.3 were made from the blood samples obtained from the participants. Disease activity score at the time of study entry was also evaluated by the attending rheumatologist.
RESULTS: Serum levels of CEA, CA19.9, CA 125 and CA 15.3 were found to be significantly higher in RA patients compared to controls. This difference was statistically significant in both patient groups with active and inactive disease compared to the control group. However a correlation between tumor markers and disease activity score was not found. Among tumor markers only serum CEA levels were found to be associated with RF levels (r 0.165, p >0.049)
DISCUSSION AND CONCLUSION: Serum tumor markers are frequently elevated in patients with RA and caring physicians should be aware of this phenomenon to avoid the use of unnecessary evaluative procedures for searching presence of malignancy in these group of patients.

Diyabetik mastopati; lenfositik lobulit, duktit ve stromal fibrozisli perivaskülit tablosuyla karakterize nadir görülen bir fibroinflamatuar meme hastalýðýdýr. Bu meme lezyonu uzun süreli tip 1 diyabet ve diðer otoimmün hastalýklarý olanlarda, genellikle unilateral veya bilateral palpe edilebilir. Memede kitle ile baþvuran ve kliniði malign olan diyabetik mastopatili hastayý raporluyoruz. Bu tip 2 diyabetli hastamýz 74 yaþýndadýr. Mamografisi ve ultrasonografisi malignite þüphesi uyandýrdýðýndan bu hastaya tel yardýmýyla eksizyonel biyopsi uygulandý. Biyopsi sonucu invaziv karsinom olarak raporlandý. Bu biyopsi sonucuyla yapýlan operasyon sonrasý patoloji raporunda ise yoðun keloid benzeri stromal fibrozisin eþlik ettiði lenfoid deðiþimlerin diyabetik mastopati ile uyumlu olduðu bildirildi.

Diabetic mastopathy is a rare inflammatory breast disease demonstrated with ductitis, lymphocytic lobulitis and perivasculitis with stromal fibrosis. This lesion often presents as a discretely palpable uni- or bilateral mass in traditional type I diabetes and other autoimmune diseases. We report a case of diabetic mastopathy, which presented clinically as an indeterminate breast lump suspicious for malignancy. The patient is a 74-year-old woman who had type 2 diabetes mellitus. Mammography and ultrasonography raised a suspicion of malignancy, and a wire-guided excisional biopsy was performed. The biopsy was reported as invasive carcinoma. Histopathological examination now showed dense keloid-like stromal fibrosis with lymphoid features consistent with diabetic mastopathy.

GÝRÝÞ ve AMAÇ: Göz kapak tümörlerinin eksizyonu sonrasý oluþan kapak defektlerinin rekonstrüksiyonunda uygulanan yöntemlerin deðerlendirilmesi.
YÖNTEM ve GEREÇLER: Kapak tümörü nedeniyle 2010-2016 yýllarý arasýnda, total eksizyonel biyopsi uygulanan hastalarýn kayýtlarý retrospektif olarak deðerlendirildi. Hastalarýn yaþý, cinsiyeti, kapak tümörü eksizyonu sonrasý oluþan defektin büyüklüðü, defekti kapatmak için kullanýlan yöntem ve oluþan komplikasyonlar deðerlendirildi.
BULGULAR: Çalýþmaya 50 erkek 14 kadýn hasta çalýþmaya dâhil edildi. Hastalarýn yaþ ortalamasý 51,54 (5-84) idi. Ameliyat sonrasý takipleri 35 ay (6-56 ay) olan hastalarýn büyük çoðunluðunda rekonstriksiyonda göz kapaðýnýn çevresindeki dokular kullanýlarak primer olarak kapama metodu kullanýldýðý saptandý.
TARTIÞMA ve SONUÇ: Küçük kapak tümörlerinin cerrahisi sonrasý oluþan defektlerin kapatýlmasýnda herhangi bir greftyada flep dokusuna ihtiyaç olmadan primer kapamanýn yeterli olduðu gösterildi. Kapak tümörlerinde uygun cerrahi teknik ile uygun bir anatomik sonuç elde edilebilmektedir.

INTRODUCTION: Evaluation of the methods applied in there construction of eyelid defects following eyelid tumor excision.
METHODS: The medical records of patients who had undergone total excional biopsy between 2010-2016 were retrospectively reviewed. The age and sex, of the patients, the size of the defect after eyelid tumor excision, the method used to close the defect and the complications were evaluated.
RESULTS: Fifty male and fourteen female patients were included in the study. The mean age of the patients was 51.54 (5-84). In the majority of patients with post-operative follow-up of 35 months (6-56 months), it was found that the method of closure as a primary using tissues around the eyelid was used in reconstruction.
DISCUSSION AND CONCLUSION: It has been shown that primer closure without the need for any graft flap tissue is sufficient in the closure of defects after surgery of small eyelid tumors. An appropriate anatomical result can be obtained with appropriate surgical technique in the eyelid tumors.

Onkoloji pratiðinde nörolojik semptomlar genellikle direkt tümör etkisi veya paraneoplastik sendrom olarak karþýmýza çýkmaktadýr. Nörolojik semptomlara neden olan nadir hastalýklarýn tanýsý özellikle metastatik kanser hastasýnda zordur. Burada kýrmýzý idrar ve nörolojik semptomlarla deðerlendirilen bir metastatik akciðer kanseri olgusu sunulmuþtur. Metastaz ve paraneoplastik patolojilerin ekartasyonu sonrasýnda bulgular porfiri tanýsý ile iliþkilendirilmiþtir. Tecrübemiz porfiri taný ve tedavi hakkýnda klinik ipuçlarý verirken, onkoloji hastasýnda nörolojik semptomlarýn ayýrýcý tanýsýnda tanýsal yaklaþýmýn önemini vurgulamaktadýr.

In cancer patient neurological symptoms are mostly due to direct tumor effect or paraneoplastic syndromes. The diagnosis of rare diseases causing neurological symptoms is challenging, especially in a metastatic cancer patient. Here we discussed a metastatic lung cancer patient who presented with red urine and neurological symptoms. After exclusion of metastasis and paraneoplastic pathologies, the findings were associated with the diagnosis of porphyria. While our experience is giving clinical clues about a rare pathology, it also reminds us the importance of work up in the face of neurological symptoms in oncology patients.