GÝRÝÞ ve AMAÇ: Önceden kolorektal kanser(KRK) genel saðkalým ve rekürrense etki edebilecek çeþitli faktörler tanýmlanmýþtýr. Ancak bunlarýn birkaçý prognostic marker olarak kabul edilir. Mevcut çalýþmamýzda nötrofil/lenfosit oraný(NLO), trombosit/lenfosit oraný(TLO) ve ortalama trombosit hacminin(OTH) KRK li hastalarada bir biobelirteç olarak potansiyelini araþtýrmayý amaçladýk.
YÖNTEM ve GEREÇLER: Retrospektif olarak taný anýnda metastaik olmayan ve en az 12 aylýk takip periyodu sonrasýnda rekürrens geliþen, 2008-2014 yýllarý arasýnda taný almýþ 336 KRK tanýlý hastanýn klinik ve demografik verilerini incelendik. NLO, TLO ve OTH deðerlerini belirlemek içi ROC eðrisi analizi kullanýldýk.
BULGULAR: Hastalar nüks eden ve etmeyen olarak 2 gruba kategorize edildi. 89 hastada (%26,5) da takip periyodunda nüks geliþti. NLO≤3.39 olan grupta hastalýksýz saðklaým 55.5 bulunurken NLO>3.39 olan grupta hastalýksýz saðkalým 82.8 ay bulundu(p<0.0001). TLO≤183 olan grupta hastalýksýz saðklaým 57.8 ay bulunurken TLO>183 olan grupta ise hastalýksýz saðkalým 78.7 ay bulundu(p: 0.016). OTH≤8.3 olan grupta hastalýksýz saðkalým 59.7 ay bulunurken OTH>8.3 olan grupta ise hastalýksýz saðklaým 59.7 ay oarak bulundu(p: 0.057)
TARTIÞMA ve SONUÇ: Bizim çalýþmamýz NLO,TLO ve OTH seviyelerinin KRK tanýlý hastalarda güvenilebilecek prognostic biyobelirteçler olabileceðini göstermiþtir. Yeni taný almýþ KRK Tanýlý hastalardaki NLO,TLO ve OTH deðerlerinin artan sitokin seviyesini ve buna baðlý olarak deðiþimleri yansýmasý olabilir.

INTRODUCTION: There are various factors that have been determined to affect recurrence and survival in colorectal cancer (CRC). However, few of them exhibit so high a prognostic marker. The present study aimed to investigate the potential of neutrophil/lymphocyte ratio (NLR), platelet/lymphocyte ratio (PLR) and mean platelet volume (MPV) as prognostic markers in patients with CRC.
METHODS: We retrospectively examined the demographic and clinical data of 336 patients with colorectal adenocarcinoma in 2008-2014, which recurred after a 12-month follow-up period; the patients had non-metastatic cancer at the time of diagnosis. In order to find out NLR, PLR, and MPV cut-off values, ROC curve analysis was used.
RESULTS: Patients were categorized into two groups according to positive relapse and negative relapse. 89 patients (26.5%) experienced a relapse in the follow-up period. The group NLR≤3.39 had 55.5 months of disease-free survival (p<0.0001) while the group NLR>3.39 had 82.8 months (p<0.0001). The group PLR≤183 had 57.8 months, the group PLR>183 had 78.7 months (p=0.016); the group MPV≤8.3 had 59.7 months, the group MPV>8.3 had 87.2 months; the group MPV>8.3 had 87.2 months and the group MPV<8.3 had 59.7 months (p=0.057).
DISCUSSION AND CONCLUSION: Our study demonstrated that NLR, PLR and MPV levels can actually be relied on as a prognostic factor in patients with CRC. MPV, NLR and PLR values displayed by recently diagnosed patients with CRC may be a reflection of an increased cytokine level and thereby change depending on it.

GÝRÝÞ ve AMAÇ: Birçok sindirim sistemi ve jinekolojik kansere baðlý olarak peritoneal yayýlým geliþebilir. Görüntüleme yöntemlerindeki geliþmelere raðmen sindirim sistemi kaynaklý tümörlere baðlý geliþen peritonitis karsinomatoza’yý (PC) ameliyat öncesi tanýmak güçtür.
YÖNTEM ve GEREÇLER: Bu çalýþmada ameliyat öncesi tanýmlanamayan PC saptanan hastalarýn evreleme tetkikleri geriye dönük olarak gözden geçirilmiþtir. Ocak 2012- Kasým 2015 tarihleri arasýnda 82 hasta deðerlendirilmiþtir.
BULGULAR: Kýrkbeþ (%54.8) hasta mide, 24 hasta (%29.2) kolorektal, 13 hasta (%15.8) pankreas ve safra yolu kaynaklý tümörler nedeniyle opere edilmiþti. Hastalarýn tümüne evreleme amaçlý Bilgisayarlý Tomografi (BT) çekilmiþ, 26 hastaya ayrýca karýn ultrasonografisi (USG), 4 hastaya Manyetik Rezonans Görüntüleme (MRG) yapýlmýþtýr. Sekiz hastaya ise Pozitron Emisyon Tomografisi (PET-BT) uygulanmýþtýr. Kýrk (%48,7) hastaya cerrahi bypass ve diðer palyatif iþlemler uygulanýrken, 42 hastaya ek cerrahi iþlem uygulanmamýþtýr. Tamamýna laparotomi uygulanmýþ hastalardan oluþan bizim serimizde tüm hastalara preoperatif BT çekilmiþ, on hastada bulgular þüpheli ancak laparotomiden vazgeçirecek kadar spesifik olmadýðý yönünde yorumlanmýþtýr. En fazla þüpheli bulguya mide kaynaklý PC’lý hastalarda rastlanmýþtýr (8/45). Bizim çalýþmamýzda 8 hastaya uygulanan PET/BT’nin 4’ü þüpheli olarak yorumlanmýþ ancak PC varlýðýný dýþlayacak kadar güçlü bulgulara rastlanmamýþtýr.
TARTIÞMA ve SONUÇ: Ameliyat öncesi konvansiyonel radyolojik görüntüleme yöntemleri ile PC’yý saptayabilmek halen güçtür. Farklý görüntüleme yöntemlerinin birlikte kullanýlmasý baþarý oranýný arttýrabilir. Özellikle lokal ileri ve sýnýrda rezektable hastalarda birlikte tümör belirteç yüksekliði de saptanmasý halinde PC ihtimalinin yüksek olduðu bilinmelidir. Bu hastalarda palyatif giriþimler planlanmýyorsa evreleme laparoskopisi uygun bir alternatif olarak karþýmýza çýkmaktadýr.

INTRODUCTION: Peritoneal dissemination may develop in many digestive system and gynecological cancers. Despite advances in imaging technologies, it is difficult to diagnose PC induced by digestive system tumors before surgery.
METHODS: In this study, staging tests used in patients with PC that unidentified preoperatively were reviewed retrospectively. Eighty-two patients were evaluated in between January 2012 and November 2015.
RESULTS: Forty-five (54.8%) patients had been operated with stomach cancer, 24 patients (29.2%) with colorectal, and 13 patients (15.8%), pancreas and biliary tract cancers. Computerized Tomography (CT) was taken to all patients for staging, 26 patients were also evaluated with abdominal ultrasonography (USG) and 4 patients with magnetic resonance imaging (MRI). Positron Emission Tomography (PET-CT) was applied to eight patients. While 40 (48.7%) patients underwent surgical bypass and other palliative procedures, no additional surgical procedures were performed in 42 patients. In our series of patients who all have undergone laparotomy, all patients were evaluated with preoperative CT and suspicious findings identified in 10 patients were interpreted as not being specific to quit laparotomy. The most suspicious findings were reported in PC patients with gastric cancer (8/45). In our study, the PET/CT findings of 4 out of 8 patients evaluated were interpreted as suspicious, but they were not strong enough to exclude PC.
DISCUSSION AND CONCLUSION: It is still difficult to diagnose PC before surgery with conventional radiological imaging techniques. Combined use of different imaging modalities together can increase the success rate. It should be known that the probability of PC is especially high in patients with tumor marker elevation and locally advanced and borderline resectable disease findings. If palliative interventions are not planned in these patients, staging laparoscopy emerges as a suitable alternative.

GÝRÝÞ ve AMAÇ: Bu çalýþmada kliniðimizdeki evre 1 over granüloza hücreli tümör (GHT) hastalarýn klinik verileri eþliðinde tedavi ve takip uygulamalarý ile bunlarýn sonuçlarý tartýþýlmýþtýr.
YÖNTEM ve GEREÇLER: Temmuz 2006 - Aralýk 2015 yýllarý arasýnda kliniðimizde evre 1 GHT tanýsý alan 15 hasta klinikopatolojik özellikleri, uygulanan tedaviler ve uzun süreli takip sonuçlarý açýsýndan deðerlendirilmiþtir.
BULGULAR: Medyan yaþý 52 (24-71) idi. FIGO Evreleme Sistemine göre 9 hasta evre IA iken 6 hasta evre IC idi. Hastalarýn yarýsý (53.3%) uterin kanama ile baþvurdu. En sýk (73.3%) yerleþim yeri ise sol over idi. Cerrahi tedavi olarak 10 hastaya total abdominal histerektomi+ bilateral salpingooferektomi+bilateral pelvik-paraaortik lenf nodu diseksiyonu+omentektomi, 2 hastaya sadece total abdominal histerektomi+bilateral salpingooferektomi ve 3 hastaya ise fertilite koruyucu cerrahi uygulanmýþtý. 3 hastada perinöral invazyon (PNI) ve 2 hastada lenfovasküler invazyon (LVI) saptandý. Endometrium histopatolojik deðerlendirilmesinde, 6 hasta ile en fazla basit atipisiz hiperplazi saptandý. Toplam yedi hastaya adjuvan tedavi olarak 3 kür [Bleomisin, Etoposid, Sisplatin (BEP)] kemoterapi rejimi verildi. Medyan takip süresi 77.9 ay (4.1-108.5 ay) ve genel saðkalým 77.9 ay (95% CI, 39.6-116.3)idi. Takiplerde hiçbir hastada nüks geliþmedi.
TARTIÞMA ve SONUÇ: Over GHT nadir görülmektedir. Erken evre hastalarda adjuvan tedavi uygulanacak hastalarý belirlemek üzere yüksek riskli grubunu saptamak için randomize çok merkezli prospektif çalýþmalara ihtiyaç vardýr.

INTRODUCTION: We aimed to evaluate the clinicopathological characteristics of patients with stage 1 granulosa cell ovarian carcinoma (GCOC).
METHODS: Between July 2006 – December 2015, the clinical and pathological parameters, treatment features and long term follow up outcomes of 15 patients with stage 1 GCOC were evaluated retrospectively.
RESULTS: : Median age was 52 (24-71).According to FIGO staging system, 9 patients had stage 1A disease and 6 patientshad stage IC GCOC. Half of (53.3%) of the patients presented with uterine bleeding (53.3%) and left over (73.3%) was the most common localization. Ten patients had abdominal hysterectomy-bilateral salphingoopherectomy-pelvic paraaortic lymph node dissection-omentectomy and whereas 3 patients had total abdominal hysterectomy-bilateral salphingoopherectomy and 2 patients had fertility sparing surgery as a surgical procedure. 3 patients had perineural invasion, 2 patients had lymphovascular invasion.Histopathological evaluation of endometrium revealed simple hyperplasia without atypia in 6 patients. As adjuvant setting, 7 patients received 3 cycles of chemotherapy [bleomycin +etoposid+ cisplatin (BEP)]. Median follow up was 77.9 months (4.1 max=18.5 month) and median overall survival was 77.9 ay (95% CI, 39.6-116.3). None of the patients relapsed durring follow-up.
DISCUSSION AND CONCLUSION: Over granulosa cell carcinoma is rare. Randomized prospective clinical trials are needed to find out the high risk group for adjuvant chemotherapy.

GÝRÝÞ ve AMAÇ: Yüksek riskli prostat kanseri hastalarýnda en iyi tedavi yaklaþýmýnýn ne olduðu, halen tartýþmaya açýk bir konudur. Önerilen tedavi yaklaþýmlarý; cerrahi (radikal retropubik prostatektomi) veya radyoterapi (RT) + androjen deprivasyon tedavisi (ADT) dir. Çalýþmamýzda yüksek riskli prostat kanserinde cerrahi ve radyoterapinin onkolojik sonuçlarýný karþýlaþtýrdýk.

YÖNTEM ve GEREÇLER: Ocak 2008-Haziran 2015 arasýnda kliniðimizde yüksek riskli prostat kanseri tanýsýyla tedavi edilen 50 hasta retrospektif olarak incelendi. Açýk radikal retropubik prostatektomi (RRP) yapýlan 20 hasta cerrahi grubuna, RT+ADT tedavisi verilen 30 hasta radyoterapi grubuna dahil edildi. Gruplar tedavi sonrasý takipte, biyokimyasal nüks (BKN), biyokimyasal nükssüz sað kalým (BFSK),kanser spesifik sað kalým (KSK) ve genel sað kalým (GSK) açýsýndan incelendi.
BULGULAR: Hastalarýn ortalama yaþý 65.9 (51- 83 aralýðýnda), ortalama baþlangýç PSA seviyeleri 24.2 (1- 94.9 aralýðýnda) ve ortalama takip süresi 50.24 ay (6- 104 aralýðýnda)olarak hesaplandý. Takip süresi cerrahi grupta 55.7 ay, RT grubunda 46.6 ay idi. Hasta yaþý, baþlangýç PSA deðeri ve klinik evre RT grubunda daha yüksek saptandý ancak anlamlý bir istatistiksel fark bulunmadý. Cerrahi grupta biyopsi ve prostatektomi patolojilerine göre; 4 (% 20) hastada upgrading, 10 (% 50) hastada downstaging gözlendi. Gleason patern 5 gözlenen 4 (% 20) hastanýn hepsinde BKN saptandý.Radyoterapi grubunda ise hiçbir hastanýn biyopsisinde patern 5 saptanmadý.
TARTIÞMA ve SONUÇ: Literatürdeki pek çok çalýþmaya benzer þekilde, bizim çalýþmamýzda da yüksek riskli prostat kanserinde RT+ADT uygulanan hastalarýn RRP uygulananlara göre, daha iyi onkolojik sonuçlar içerdiðini saptadýk.

INTRODUCTION: The best treatment approach is still a matter of debate in high-risk prostate cancer patients. Recommended treatment approaches are surgery (radical retropubic prostatectomy) or radiotherapy (RT) + androgendeprivationtherapy (ADT). In our study, we compared the oncological outcomes of surgery and radiotherapy in high-risk prostate cancer.
METHODS: Fifty patients who were treated with high-risk prostate cancer in our clinic were retrospectively studied between January 2008 and June 2015. Twenty patients with open radical retropubic prostatectomy (RRP) were included in the surgical group and 30 patients with RT + ADT therapy were included in the radiotherapy group. Groups were evaluated in terms of biochemical recurrence (BCN), biochemical recurrence-free survival (BFSR), cancer-specific survival (CFS), and overall survival (GFS).
RESULTS: Mean age of the patients was calculated 65.9 (range 51-83), mean baseline PSA levels were 24.2 (range 1-94.9), and mean follow-up was 50.24 months (range 6-84). The follow-up period was 55.7 months in the surgical group and 46.6 months in the RT group. Patient age, initial PSA level and clinical stage were found higher in RT group but no significant statistical difference was found. According to biopsy and prostatectomy pathologies in the surgical group; 4 (20%) patients were upgrading and 10 (50%) patients were downstaging. Four patients (20%) which observed Gleason pattern 5 was detected biochemical recurrence. No pattern 5 was detected in the biopsy of any patient in the radiotherapy group.
DISCUSSION AND CONCLUSION: Similar to many studies in the literature, we found that patients treated with RT + ADT in high risk prostate cancer had beter oncologic outcomes than those with RRP.

GÝRÝÞ ve AMAÇ: Bu çalýþmanýn amacý; meme koruyucu cerrahi ve radyoterapi tedavisi sonrasýnda yapýlan ilk mammografik incelemenin daha ileri radyolojik incelemeler ve rekürren tümör tespiti üzerine etkilerini incelemektir.
YÖNTEM ve GEREÇLER: Meme kanseri nedeniyle meme koruyucu cerrahi ve radyoterapi uygulanmýþ ve ameliyat sonrasý 2 yýllýk süre içinde en az 1 kez bilateral mammografik görüntüleme yapýlmýþ 278 hasta incelemeye dahil edildi. Radyoterapinin tamamlanmasýndan sonraki ilk 6 ayda mammografi yapýlanlar Grup 1, 6 ay-2 yýl arasýnda mammografi yapýlanlar Grup 2 olarak sýnýflandýrýldý.
BULGULAR: Grup 1’i oluþturan 197 hastaya ilk mammografik tetkik radyoterapiden ortalama 15 hafta sonra (6-24 hafta) yapýlmýþtý. Mammografideki anormal/þüpheli bulgular nedeniyle bu gruptaki 38 hastaya (%19.2) ilave meme ultrasonu, 7 hastaya da (%3.5) meme manyetik rezonans görüntüleme yapýlýrken, 8 hastaya eksizyonel biyopsi uygulandý ve hiçbirinin patolojisi malign deðildi. Grup 2’deki hastalarýn sadece 15’ine (%10.4) ilave ultrason ve sadece 2’sine manyetik rezonans görüntüleme istendi. Grup 2’de sadece 1 hastaya þüphe üzerine biyopsi yapýldý ve sonucu malign olarak rapor edildi.
TARTIÞMA ve SONUÇ: Meme koruyucu cerrahiyle tedavi edilen hastalarýmýzýn sonuçlarý, radyoterapinin tamamlanmasýný takip eden 6 ay içinde yapýlan mammografilerin gereksiz ilave radyolojik tetkikler ve gereksiz biyopsilere neden olduðunu ortaya koymaktadýr.

INTRODUCTION: The aim of this study is to reveal the impact of first mammographic screening timing after Breast Conserving Surgery (BCS) and Radiotherapy (RT) on further radiological evaluations, biopsies and recurrent tumor detection.
METHODS: Two hundred and seventy eight patients treated with BCS and RT with at least one bilateral mammography (MG) obtained within two years of postoperative period were evaluated. Patients screened with MG within 6 months of RT completion constituted Group-1 and the rest (6 months to 2 years) were grouped as Group-2.
RESULTS: One hundred and ninety-seven patients in Group-1 were screened with MG in a mean time of 15 weeks (6-24 weeks) after RT has completed. Additionally, 38 patients in this group were further evaluated with ultrasonography (19.2%) and 7 with breast Magnetic Resonance Imaging (MRI) (3.5%) due to abnormal/suspicious findings on MG imaging and 8 of them underwent excisional biopsy proving no malignant disease. Additional ultrasonography scans were needed in 15 patients (10.4%) and MRI (1.3%) for 2 patients in Group-2 and one biopsy was performed, confirming a recurrent tumor.
DISCUSSION AND CONCLUSION: Our study suggests early mammography within 6 months of RT completion may result in unnecessary additional radiological imaging and unnecessary biopsies after breast conserving therapy.

GÝRÝÞ ve AMAÇ: Paraganglioma, nadir görülen, aðrýsýz, yoðun vasküler yapýya sahip tümördür. Paraganglioma için tedavi seçenekleri, cerrahi, konvansiyonel radyoterapi, stereotaktik radyocerrahi ya da bu modalitelerin kombinasyonudur.
Bu çalýþmanýn amacý, farksiyone stereotaktik radyoterapi ile tedavi edilen paragangliomalý hastalarýn tedavi sonuçlarýný deðerlendirmektir

YÖNTEM ve GEREÇLER: Kliniðimizde tedavi edilen, fraksiyone stereotaktik radyoterapi yöntemi ile tedavi edilen dokuz hasta deðerlendirildi. Ýki hasta kadýn, diðerleri erkekdi. Uygulanan tedavi dozu median 5 fraksiyonda 25 Gy idi.
BULGULAR: Median takip 65 ay (46-71 ay) dý. Hastalarýn tümü tedavi sonrasý 6 ayda bir manyetik rezonans görüntüleme(MRI) ile deðerlendirildi. Lezyonlar 3 hastada stabil iken, 1 hastada tam cevap, diðer beþ hastada parsiyel cevap elde edildi. Hastalarýn hiçbirinde akut toksisite görülmedi. Ýki hastada ise takiplerde geç toksisite görüldü
TARTIÞMA ve SONUÇ: Bizim deneyimlerimize göre, paraganglioma tedavisinde, CyberKnife® (Accuray Incorporated, Sunnyvale, CA) ile fraksiyone stereotaktik radyoterapinin, baþarýlý bir tedavi seçeneði olduðu görülmüþtür.

INTRODUCTION: Paraganglioma are rare, indolent and highly vascular tumors. The treatment options for paraganglioma include surgery, conventional external beam radiotherapy (EBRT), stereotactic radio-surgery (SRS) or combination of these modalities. EBRT has been used to treat unresectable tumors and patients with residual or recurrent lesions after surgery
The aim of this study is evaluated the results of treatment in patients with paraganglioma who were treated with fractioned stereotactic radiotherapy

METHODS: Nine patients with paraganglioma, who were treated with fractioned stereotactic radiotherapy, were retrospectively evaluated.Two patient was male, and others were female. The median dose to the tumor was 25 Gy in median 5 fractions
RESULTS: Median follow-up was 65 months (range, 46-71 months). All patients were evaluated with magnetic rezonance imaging, every 6 months. Lesions were stable in 3 patients, and it was observed complete response in 1 patient and partial response in 5 patients. We did not observe any treatment related acute toxicity in our patients. We observed late toxicity in 2 patients.
DISCUSSION AND CONCLUSION: In conclusion, according to our experience, fractioned stereotactic radiotherapy with CyberKnife® (AccurayIncorporated, Sunnyvale, CA) seems to be successful treatment option in the management of paraganglioma.

GÝRÝÞ ve AMAÇ: Kolorektal kanser cerrahisi sonrasý yeniden baþvurunun görülme sýklýðý ve oluþumu için yüksek riskli hasta gruplarýnýn tanýmlanmasý için gerekli parametreler halen net olarak belirlenmemiþtir.
YÖNTEM ve GEREÇLER: Bu çalýþma, prospektif bir veri tabaný kullanýlarak kolorektal kanser cerrahisi geçirmiþ olan hastalarýn retrospektif analizidir. Taburculuktan sonraki ilk 30 gün içerisinde hastane yatýþý gerektiren yeniden baþvuru asýl deðiþken olarak belirlendi.
BULGULAR: Toplam 187 kolorektal kanser cerrahisi geçiren hasta dikkate alýndýðýnda, yaþ ortalamasý 59,9±13,5 yýl olan 17 hasta (%9%), taburculuk sonrasý ortalama 11,6±8,2 gün sonra yeniden hastaneye yatýrýldý. Yeniden baþvurunun en sýk rastlanýlan etyolojik sebepleri arasýýnda enfektif komplikasyonlar (n=5), eviserasyon (n=3), anastomoz problemleri (n=3) ve intraabdominal kanama/asit geliþimi (n=3) yer almaktaydý. Yeniden baþvuru ile erkek cinsiyet (p=0.033), açýk cerrahiye dönüþ (p=0.009), ilk yatýþ esnasýnda herhangi bir komplikasyon geliþimi (p=0.025), herhangi bir eþ zamanlý çoklu organ rezeksiyon gerekliliði (p=0.048) ve T evresi (p=0.046) arasýnda anlamlý iliþki olduðu gösterildi. Lojistik regresyon analizi, bu faktörler arasýndan erkek cinsiyet (p=0.041) ve herhangi bir eþ zamanlý çoklu organ rezeksiyon gerekliliðinin (p=0.045) yeniden baþvuru geliþimi ile anlamlý bir þekilde iliþkili olduðunu gösterdi.
TARTIÞMA ve SONUÇ: Her ne kadar erkek cinsiyet ve herhangi bir eþ zamanlý çoklu organ rezeksiyon gerekliliðinin yeniden baþvuru geliþimi ile anlamlý bir þekilde iliþkili olduðu gösterilmekle birlikte, kiþisel risk faktörlerinin belirlenmesi için ileri çalýþmalara ihtiyaç vardýr.

INTRODUCTION: Incidence of re-admission after colorectal cancer surgery and the parameters to define high-risk patients for its occurrence remain to be clarified.
METHODS: This study was a retrospective analysis of patients with colorectal cancer surgery using a prospective database. Readmission necessitating hospitalization within the first 30 days following discharge was regarded as major outcome.
RESULTS: Considering a total of 187 colorectal cancer patients, 17 (9%) with a mean age of 59.9±13.5 years were re-hospitalized after a mean of 11.6±8.2 days following discharge. Infective complications (n=5), evisceration (n=3), anastomotic problems (n=3) and intraabdominal hematoma/ascites (n=3) were the most commonly encountered surgical etiologies for readmission. There was a close relationship between readmission and male sex (p=0.033), conversion to open surgery (p=0.009), development of any type of complication during index admission (p=0.025), need for concurrent multi-organ resections of any type (p=0.048) and T stage (p=0.046). Logistic regression analysis showed that male sex (p=0.041) and need for concurrent multi-organ resections of any type (p=0.045) were significantly related with development of readmission.
DISCUSSION AND CONCLUSION: Although male sex and need for concurrent multi-organ resections were shown to be related with development of readmission, more research is needed to individualize risk factors.

GÝRÝÞ ve AMAÇ: Papiller tiroid kanseri (PTK) tiroid bezinin en sýk karþýlaþýlan kanseridir. Primer tedavi sonrasý lateral boyunda %50’nin üzerinde, santral bölgede ise %25’in üzerinde bölgesel rekürrens ile karþýlaþýlýr. Bu yazýda, preoperatif ultrason haritalama (PUH) ve Radioguided Occult Lesion Localization (ROLL) yöntemini kombine kullandýðýmýz PTK rekürrensi nedeniyle reopere olmuþ hastalardaki deneyimimizi sunmak amaçlanmýþtýr.
YÖNTEM ve GEREÇLER: Daha önce PTK ve lokal bölgesel metastaz nedeni ile total tiroidektomi (TT) ve santral/lateral boyun diseksiyonu uygulanmýþ 8 hasta lokal bölgesel rekürrens nedeni ile reopere edildiler. Nükslerin araþtýrýlmasýnda yüksek çözünürlüklü ultrasonografi, ince iðne aspirasyon sitolojisi ve kan Tg düzeyleri kullanýldý. Nüksleri ispatlanmýþ ve sitopatolojik incelemede yüksek Tg seviyeleri saptanan olgular opere edildiler. Her hastanýn yaþý, cinsiyeti, primer tümör boyutu, ilk ameliyatýn þekli, adjuvan tedavileri, nükse kadar geçen süresi, ameliyatýn yeri ve süresi, iþaretli ve iþaretsiz lezyonlarýn sayýsý ve haritada iþaretli/ iþaretsiz lezyonlardaki ve haritada bahsedilmeyen lezyonlardaki metastatik ve çýkarýlan lezyonlarýn sayýsý kaydedildi.
BULGULAR: Lokalizasyon çalýþmasý sonrasý çýkarýlan 20 lezyondan 16’sýnýn malign olduðu görüldü. Haritalama sýrasýnda iþaretli lezyonlar dýþýnda 36 ek lezyon da þüpheli olarak tanýmlanmýþtý. Bu lezyonlarýn 34’ü tanýmlanan anatomik yerleþimlerinde ve bölgelerde bulunarak çýkarýldý. Ýki lezyon ise haritalamada tanýmlanan alanlarda bulunamadý. Bu 34 lezyondan 27’sinin malign olduðu gösterildi. Postoperatif takiplerde, bir hastada 7 günde kendiliðinden gerileyen þilöz kaçak ve seroma geliþti.
TARTIÞMA ve SONUÇ: Santral ve boyun bölgesine reoperasyon planlanan PTK li hastalarda ROLL ve preoperatif haritalama tekniðinin ameliyat güvenliði ve konforuna katký saðlar.

INTRODUCTION: Papillary thyroid carcinoma (PTC) is the most-frequent type of thyroid cancer. Following primary treatment, regional metastasis in the cervical region can be seen in more than 50 percent of cases and in the central region in more than 25 percent of cases. Our aim is to present our experiences with patients operated on for the recurrence of papillary thyroid cancer with the combined use of pre-operative ultrasonographic mapping and radio-guided occult lesion localisation.
METHODS: Eight patients who had already undergone total thyroidectomy and central/lateral neck dissection for papillary thyroid carcinoma were re-operated on due to locoregional metastasis. High-resolution ultrasonography, fine needle aspiration cytology and blood Tg levels were used to search for recurrences. The patients with proven recurrences and high Tg wash-out levels in cytopathologic aspirates were operated on. For each patient, age, gender, size of the primary tumor, type of previous surgery, adjuvant treatments, time to recurrence, site and duration of surgery, numbers of marked and non-marked lesions, and the metastatic and total numbers of marked/non-marked and non-mentioned lesions in the maps were recorded.
RESULTS: Sixteen lesions of 20 lesions removed after localisation were found to be malignant. In addition to the marked lesions during mapping, 36 additional lesions had been defined as suspicious. Thirty-four of these lesions were found at exact anatomic sites and localisations described and removed. Two lesions could not be found at areas described during mapping. Of 34 lesions, 27 were found to be metastatic. During the postoperative follow-up, chylous leak with spontaneous regression in 7 days and seroma occurred in one patient.
DISCUSSION AND CONCLUSION: Radio-guided occult lesion localisation and pre-operative mapping contribute to the safety and comfort of patients in planned re-operations on lateral and central neck regions.

GÝRÝÞ ve AMAÇ: Önemi belirlenemeyen atipik skuamöz hücreler (ASC-US) tanýsý koyduðumuz Papanicolau (PAP) smear örneklerinin, tekrar üretilebilirliði, Bethesda taný kriterlerinden hangilerini karþýladýðý ve taný kriterlerinin servikal histopatolojiye yansýmasýný araþtýrmayý planladýk. Ayrýca Pap smear sonucu ASC-US olan hastalarýn servikal biyopsi örneklerinde p16 antikor varlýðý araþtýrýldý.
YÖNTEM ve GEREÇLER: Bölümümüzde 2006-2013 yýllarý arasýnda ASC-US tanýsý konulan hastalardan servikal histopatolojik incelemesi yapýlmýþ olan 33 hastayý çalýþmamýza dahil ettik. Tüm Pap smear örnekleri iki patolog tarafýndan, ayný anda tekrar deðerlendirildi. Her örneðin 2001 Bethesda ASC-US taný kriterlerinden hangilerini karþýladýðý ayrý ayrý belirlendi. Her biyopsi örneði p16 antikoru ile boyandý.
BULGULAR: Bölümümüzde Pap smear sonucu ASC-US olan raporlarýn tekrar üretilebilirlik oraný %88 olarak bulundu. Bethesda’nýn 4 taný kriterinden herhangi biri için, CIN 1 ve malignite yönünden negatif vakalarda görülme sýklýklarý bakýmýndan anlamlý bir farklýlýða rastlanamadý (p>0,05). Tüm ASC-US vakalarýnda örnek baþýna pozitif taný kriteri sayýsý ortalamasý ise 2,7±0,9’dur. Malignite yönünden negatif olarak raporlanmýþ ve CIN olarak raporlanmýþ vakalarda ortalama kaç kriterin bir arada pozitif olduðu incelendi, istatistiksel olarak anlamlý bir farklýlýk olmadýðý görüldü. ASC-US tanýsý konulan vakalarýn histopatolojik örneklerinde p16 boyanma oraný %18 olarak bulundu. Çalýþmamýzda p16 immünohistokimyasal boyamanýn CIN tanýsý koymada duyarlýlýðý %46, özgüllüðü ise %100’dür.
TARTIÞMA ve SONUÇ: Pap smear incelemelerinde Bethesda sistemi kullanýlarak ASC-US tanýsý konulan vakalarýmýzýn %39’unda altta yatan bir servikal intraepitelyal neoplazi bulunduðu saptanmýþtýr. Bethesda ASC-US taný kriterlerinden hiçbiri olasý neoplastik deðiþiklikleri öngörmede tek baþýna diðer kriterlerden üstün deðildir. ASC-US tanýsý konulurken Bethesda taný kriterlerinin her birinin varlýðý ayrý ayrý araþtýrýlmalý ve en az 2, tercihen 3 kriterin pozitif olmasý tercih edilmelidir. p16 antikorunun yalancý pozitiflik oranýnýn oldukça düþük olduðu, bu sayede neoplazi potansiyeli taþýyan vakalarýn belirlenmesinin kolaylaþtýðý görülmüþtür. Ýlerleyen yýllarda p16 boyanmasýnýn sitopatolojiyle birlikte kullanýlabilecek önemli bir tanýsal araç haline geleceði düþünülmektedir.

INTRODUCTION: We aimed to investigate reproducibility of diagnosis, presence of Bethesda criteria and their reflection to histopathology in Papanicolau (PAP) smears with atypical squamous cells of undetermined significance (ASC-US). We also searched for p16 antibody positivity in cervical biopsy specimens of the patients with diagnosis of ASC-US.
METHODS: 33 patients who had undergone cervicopathologic evaluation were chosen from patients given ASC-US diagnosis in our department between 2006 and 2013 for this study. All the Pap smear specimens were re-evaluated simultaneously by two pathologists. The specimens were evaluated for positivity of each Bethesda ASC-US diagnostic criteria separately. The biopsy specimens were stained with p16 antibody.
RESULTS: The reproducibility rate of cytology reports for Pap smear specimens diagnosed as ASC-US was found 88%. Neither of the Bethesda diagnostic criteria showed significant precedence over each other for frequency of presence in cervical intraepithelial neoplasia (CIN) 1 and non-malignant cases (P>0.05). Mean number of positive diagnostic criteria was 2.7±0.9 when ASC-US cases were considered altogether. There was no statistically significant difference between CIN cases and non-malignant cases for average number of positive diagnostic criteria. Histopathology specimens of these cases had an 18% of staining rate for p16 antibody. It was found that immunohistochemical staining had a 46% of sensitivity and 100% specificity for diagnosing CIN.
DISCUSSION AND CONCLUSION: An underlying cervical intraepithelial neoplasia was determined in 39% of cases diagnosed as ASC-US using Bethesda diagnostic criteria. Neither of the Bethesda diagnostic criteria exhibited superiority alone in foreseeing probable neoplastic changes. Presence of each Bethesda diagnostic criteria should be analyzed independently and existence of at least two, favorably three criteria should be preferred for diagnosing ASC-US. p16 antibody showed low false positive rate, thus distinguishing the cases with a potential of neoplastic formation became rather easy. p16 staining will become an important diagnostic instrument when used concomitant with cytopathology.

GÝRÝÞ ve AMAÇ: Kliniðimizde tümör ön tanýsý ile incelenen ve patolojik inceleme sonucu tümör benzeri lezyon saptanan olgularýn deðerlendirilmesi amaçlandý.
YÖNTEM ve GEREÇLER: Ocak 1987-Ocak 2012 yýllarý arasýnda kemik ve yumuþak doku tümörü ön tanýsý ile ileri inceleme yapýlan 349 olgu retrospektif olarak incelendi. Olgular yaþ, cinsiyet, lokalizasyon, patolojik taný ve özellikleri açýsýndan deðerlendirildi. Elde edilen veriler SPSS 15.0 sistemine aktarýlarak analiz edildi. Verilerin normal daðýlýma uyup uymadýðý Shapiro-Wilk testi ile deðerlendirildi.
BULGULAR: 349 olgunun 175’i (%50.1) erkek, 174’ü (%49.9) kadýn ve yaþ ortalamasý 35.3 idi. Lezyonlarýn 101’i (%28.9) femur ve uylukta, 56’sý (%16) tibia, fibula ve baldýrda lokalize idi. Lezyonlarýn incelenmesi sonucunda 79’unun (%22.6) normal doku olduðu, 74’ünün (%21.2) iltihabi olay, 63’ünün (%18.1) ise osteomiyelit olduðu görüldü. Verilerimiz tümör ile en çok enfeksiyon ve normal doku reaksiyonunun karýþtýðýný gösterdi.
TARTIÞMA ve SONUÇ: Kemik ve yumuþak doku tümörünü þüphelendiren kliniðe ve özelliklere sahip olan her olgu aksi ispat edilene kadar tümör kabul edilerek bu yönde ileri tetkik ve tedavisi düzenlenmelidir. Bu yaklaþým morbidite ve mortaliteye sebep olan tümörün erken taný ve tedavisine olanak saðlayacaktýr.

INTRODUCTION: The purpose of this study was to assess the cases that were examined with a prediagnosis of tumor but were found to have tumor-like lesions as a result of pathological examination.
METHODS: 349 cases that had undergone advanced examination with a prediagnosis of bone and soft tissue tumor and had been found not to have tumor between January 1987 and January 2012 were examined retrospectively. The cases were assessed in terms of age, gender, localization, pathological diagnosis and features. The data were analyzed by SPSS 15.0. Shapiro-Wilk test was used to find out whether the data were distributed normally.
RESULTS: 175 (50.1%) of 349 cases were men, while 174 (49.9%) were women and the average age was 35.3. 101 (28.9%) of the lesions were localized in the femur and thigh while 56 (16%) were localized in tibia, fibula and calf. Results of the examinations of lesions showed that 79 (22.6%) were normal tissue, 74 (21.2%) were inflammatory and 63 (18.1%) were osteomyelitis. Our data showed that infections and normal tissue reaction were most commonly mistaken for tumor.
DISCUSSION AND CONCLUSION: Each case with the clinic and features which bring to mind bone and soft tissue tumor should be accepted as tumor unless otherwise proven and advanced examination and treatment should be organized accordingly. This approach will allow the early diagnosis and treatment of tumor which causes morbidity and mortality.

Radikal prostatektomi uygulanan olgularda prostat volümünün onkolojik ve fonksiyonel sonuçlara etkisi bulunmaktadýr. Büyük volümlü prostata sahip olgular da radikal prostatektominin zorluklarý mevcuttur. Bu olgu sunumunda büyük prostatlý hastaya radikal prostatektomi yapýlmýþ ve fonksiyonel ve onkolojik sonuçlara volümün etkisi araþtýrýlmýþtýr.

Prostate volume has an impact on oncologic and functional outcomes in patients who underwent radical prostatectomy. There are the challenges of radical prostatectomy in patients with large-volume prostate. In this report radical prostatectomy was underwent in patients with large prostates and volume effects were investigated in functional and oncologic results.

Ýntrakranial hipertansiyonla komplike olan lenfoma tanýlý 41 yaþýndaki kadýn hastanýn MR bulgularýný sunuyoruz. Bizim olgumuzda baþ aðrýsý ve görme bulanýklýðý olmasý üzerine yapýlan göz muayenesinde papil ödemle birlikte normal görme keskinliði saptanmýþtýr. Kranial ve orbita MRG sinde empty sella, optik sinirde tortiozite, skleral düzleþme, optik disk düzeylerinde protrüzyon, optik sinir etrafýnda artmýþ BOS izlenmiþtir. MR venografisinde sað sigmoid sinüste fokal bir alanda sinyal kaybý izlenmiþ olup tromboza ait olabileceði düþünülmüþtür. Olgumuzun MR bulgularý eþliðinde intrakranial hipertansiyonun MR bulgularýný sunmayý amaçladýk.

We herein report MR findings in a case of lymphoma complicated with intracranial hypertension in a 41 year old woman. Our patient presented with headache and blurred vision. Ophthalmic examination revealed normal visual acuity (20/20) in both eyes with papilledema. We saw empty sella, optic nerve tortuosity, scleral flattening, optic nerve head protrusion, increased perioptic cerebrospinal fluid on brain and orbit magnetic resonance imaging. Magnetic resonance venography of the brain showed lack of flow in the right sigmoid dural sinuses suggestive of venous thrombosis. We aim to present intracranial hypertension MR features with our patient's MRI findings.

Bikornuat uterusta ortaya çýkan endometrial karsinom nadiren rapor edilmiþtir. Sunulan olgu 75 yaþýnda postmenapozal yakýnmasý olan hastada tanýmlanmýþtýr. Daha önce sunulanlardan farký bikornuat uterusun bir taraftaki boynuzunda endometrial karsinom, diðer taraftaki boynuzunda endometrial polip belirlenmesidir ve bunlarýn her ikisi de postmenapozal kanama nedenidir.

Endometrial carcinomas arising in a bicornuate uterus has been very rarely reported before. Our case report has been identified in 75-year-old patient with postmenopausal bleeding. Unlike previously reported cases, our case showed endometrial carcinoma in one horn and endometrial polyp in the other horn of bicornuate uterus, both of which are among the causes of postmenopausal bleeding.

Serviks kanseri dünyada kadýnlarda en sýk görülen dördüncü kanser türüdür. Hastalarýn %30'unda ilk 2 yýl içinde rekürrens saptanýr. En sýk görülen rekürrens yerleri parametrium, pelvik lenf nodlarý ve vajinadýr. Uzak organ metastazlarý en sýk karaciðer, akciðer ve kemik dokuda görülür. Yumuþak doku, iskelet kasý ve abdominal duvarda metastatik tutulum son derece nadirdir. Abdominal duvarda dren yeri ve insizyon yerinde, laparaskopi sonrasý port giriþ yerlerinde tümör tutulumlarý bildirilmiþtir. Biz nadir görülmesi nedeniyle iki vakada skuamöz hücreli serviks kanserinin abdominal duvarda metastatik tutulumunu rapor ettik.

Cervix carcinoma is the fourth most common cancer in women in the world. In 30 % of patients recurrence occurs in the first 2 years. It is mostly recurs in parametrium, pelvic lymph nodes and vagina respectively. It metastasizes most frequently to liver, lung and bones. Metastasis to soft tissue, skeletal muscle or abdominal wall is too rare. In the literature, it has been reported tumor involvement of the entrance of drainage catheter or abdominal wall incision or entrance of ports after laparoscopy. We have reported here 2 cases of abdominal wall metastasis of squamous cell cervix carcinoma since it was seen rarely.

Glomus tümörü, glomus cisminin arteryal segmentinden kaynaklý vasküler bir tümördür. Oral kavite ve bukkal mukozada nadiren görülen bu oluþum benign ve malign mukozalar lezyonlarla karýþabilmektedir. Bukkal mukozada beyaz renkli, aðrýlý lezyon ile tarafýmýza baþvuran 54 yaþýnda erkek hastadan alýnan biopsi glomus tümörü olarak raporlandý. Tedavide total kitle eksizyonu bacak cildinden alýnan kýsmý kalýnlýkta cilt grefti ile rekonstrükte edildi. Bir yýlýk takibinde nüks izlenmedi. Bu lokalizasyonda nadiren görülen glomus tümörü literatür eþliðinde sunuldu.

Glomus tumor is a vascular tumor originating from the arterial segment of the glomus body. This formation is rarely seen in the oral cavity and buccal mucosa and can be mixed with benign and malignant mucosal lesions. Histopathological evaluation of the biopsy taken from a 54 year-old patient who presented with a painful white lesion in the buccal mucosa was reported to be a glomus tumor. For treatment of this tumor, total mass excision was performed and reconstruction was performed with a split-thickness skin graft obtained from the skin of the lower extremity. No recurrence was observed during one year of follow-up. A glomus tumor rarely seen in this localization is presented here in light of literature findings.

Langerhans hücreli histiositoz (LCH) CD-1a boyanmasý gösteren klonal proliferatif lenfohistiositik bir hastalýktýr. Hastalýk unifokal veya multifokal tek bir sitemi veya birçok sitemi tutacak þekilde geniþ bir klinik seyir gösterebilir. Tutulan alana göre diabetes insipitus, iþitme kaybý veya týrnak deðiþiklikleri oluþabilir. Burada atipik presentasyon gösteren iki vakayý litaretür derlemesi ile beraber sunduk.

Langerhans cell histiocytosis (LCH) is a clonal proliferative lymphohistiocytic disorder with mainly CD-1a positive staining. It has a wide spectrum of unifocal or multifocal mono or multisystemic disease. Rare symptoms like diabetes insipidus, hearing loss or nail distrophy might also occur according to the involved sites. In here, two cases of LCH with atypical presentation are reported with review of the literature.

Nöroendokrin Tümörler (NET) kromaffin benzeri hücrelerden köken alýr. Nadiren görülürler, vücudun herhangi bir yerini tutabilirler. Görüldükleri bölgeye ve organa göre farklý klinik ile ortaya çýkarlar. Çoðunlukla benign seyirlidirler ancak agresif de seyredebilirler. Rektal NET ler %90 oranýnda asemptomatik olup insidental olarak kolonoskopi esnasýnda saptanýrlar. Burada Fournier Gangreni nedeniyle ostomi açýlan ve ostomisinin kapatýlmasý öncesinde rutin uyguladýðýmýz kolonoskopi esnasýnda rektumda saptanan nöroendokrin tümör (NET G1) olgusunu sunduk.

Neuroendocrine tumors (NET) are originated from chromaffin-like cells. They are rarely seen anywhere in the body and they occur with many different clinical situations by regions and organs where they appear. They are mostly benign but they can be aggressive. Rectal NETs are asymptomatic 90% and they are detected incidentally during colonoscopy. We presented a case that was opened ostomy for fournier’s gangrene and diagnosed NET during routine colonoscopy, before the closing ostomy.

Kardiyak rabdomiyom (KRM) çocuklarda primer kardiyak tümörlerin en yaygýn tipidir. Prognoz genellikle iyidir ve kendiliðinden gerileyip kaybolmasý neredeyse KRM doðasý gereði olmasý beklenen bir sonuçtur. Bu yazýda doðum öncesi tespit edilen büyük KRM olan bir yenidoðan sunulmuþtur. Takipte KRM'in doðuma kadar büyüdüðü ve doðumdan sonra beklendiði üzere kendiliðinden küçüldüðü görülmüþtür. Yedinci günde KRM'in tekrar büyüdüðü ve mitral kapak üzerine yerleþik yeni bir KRM'in de eklenmesi ile önemli subaortik darlýða yol açtýðý görülmüþtür. Cerrahi giriþim teknik zorluklar nedeniyle planlanmamýþ ve everolimus baþlanmýþtýr. Olgu yaþamýnýn 12. gününde kaybedilmiþtir. Sonuç olarak, tam mekanizma anlaþýlmadýðý sürece, kendiliðinden gerileme KRM'ler için doðal bir sonuç olarak beklenmemeli ve KRM olan bütün yenidoðanlar kendiliðinden küçülme baþlamýþ olsalar da muhtemel büyüme yönünden dikkatle takip edilmelidirler.

Cardiac rhabdomyoma (CRHM) is the most common type of primary cardiac tumors in children. The prognosis is generally favourable and spontaneous regression is almost accepted as natural history for CRHM. This report presents a newborn with large CRHM that was diagnosed prenatally. In the follow up, CRHM was enlarged until birth and spontaneously regressed after birth as expected. At the 7th day, CRHM was enlarged again and formed moderate subaortic stenosis with addition of a new CRHM located on the mitral valve. Surgical intervention was not planned for technical difficulties and everolimus was started. The patient was exitus at the 12th day of his life. In conclusion, until the exact mechanism is not understood, regression must not be accepted as natural history of CRHM and all of the newborns with CRHM including those that spontaneous regression begun must be followed carefully for possible enlargement.

Mesane adenokarsinomlarý genellikle metastatik orijinlidirler. Primer mesane adenokarsinomlarý çok nadir görülürler. Prognozlarý kötüdür. Taný anýnda çoðunlukla kasa invaze olmuþ durumdadýrlar. Radyoterapinin etkili olmadýðý bu tümörlerde, kemoterapi deneyimi ise azdýr. Erken evrede tespit edilen primer mesane adenokarsinomlarýnda, en iyi tedavi seçeneði halen radikal sistektomidir.

Adenocarcinomas of the bladder are mostly metastatic in origin. Primary adenocarcinomas are very rare bladder tumours. During diagnosis they are usually muscle invasive. Their prognosis are poor. Radiotherapy has little effect if any, at this tumour, Experience for chemotherapy is sparse. Currently, the best treatment choice for localised primary bladder adenocarcinoma is radical cystectomy.