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    Extra-gastrointestinal stromal tumor of the pancreas
    (2011) Erkan N.; Çoker A.; Postaci H.; Cengiz Yilmaz; Elif Selek; Erdem Goker
    Background: Primary pancreatic gastrointestinal stromal tumors are very rare. Here in we present a malignat extragastrointestinal tumor of the pancreas that was managed multi-disciplinarily. Case presentation: A 64 -year -old male patient presented with a several month history of progressive fatique, nausea, loss of appetite and weight loss. Physical examination revealed a large, painless and smoooth epigastric mass. Laboratory data including tumour markers were within normal limits except a mild anemia. An abdominal CT scan revealed a predominantly cystic mass with solid component that had a 22x14 cm in size originating from body of the pancreas. The patient underwent laparotomy and distal pancreatectomy, splenectomy and wedge resection over gastric wall was made. Pathology revealed a malignant extragastrointestinal tumor of the pancreas. During follow-up period of two years, metastases located on 6-7th segment of liver was detected. Patient was treated as adjuvant by imatinib mesylate. Eventhuogh that adjuvant treatment, liver metastases showed progression. Five years after the first initial diagnosis, patient was reoperated for metastatectomy and bisegmentectomy, cholecystectomy and Roux en Y hepaticojejenostomy was made Postoperative period was uneventful and adjuvant imatinib mesylate treatment (400 mg bid) was continued. During follow-up period of 34 months following second surgery, multiple hepatic metasteses were detected and he was death due to multiple organ failure 8 years after initial diagnosis. Conclusion: Although rare in the pancreas, GIST should be considered in differential diagnosis of pancreatic masses and GIST patients with liver metastases require combined multimodal management from the outset.
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    Is there any non-invasive marker replace the needle liver biopsy predictive for liver fibrosis, in patients with chronic hepatitis?
    (2009) Vardar R.; Vardar E.; Demir S.; Sayhan S.E.; Bayol Ü.; Yildiz C.; Postaci H.
    Background/Aims: Non-invasive serum markers are being used to determine fibrosis score as an alternative to liver biopsy. The aim of the present study was to evaluate the accuracy and predictive value of the non-invasive markers in identifying the presence or absence of significant fibrosis in patients with chronic viral hepatitis. Methodology: A total of 557 patients (401 chronic hepatitis B (CHB), 156 chronic hepatitis C (CHC)) were enrolled into the study retrospectively. Liver biopsies were evaluated histopathologically according to the Knodell scoring system. Laboratory values such as aspartate aminotransferase (AST), alanine aminotransferase (ALT), ?-glutamyltranspeptidase (GGT) and platelet count (PLT) was tested on the same day of liver biopsy. Using these laboratory values, AST/ALT ratio (AAR), age-platelet index (API) and AST/PLT ratio index (APRI), GGT/ PLT ratio index (GAPI) and AST to GGT ratio (AGR) were calculated. Results: Advanced liver fibrosis including stage 3-4 was observed in 197 (49%) of patients with CHB, 84 (54%) of patients with CHC. Mean age and GGT were higher and PLT was lower in patients with advanced liver fibrosis (stage 3-4) than those in patients with absence of significant fibrosis (stage 0-1) (p<0.001). But, there was no statistically significant relationship for mean value of AST and ALT between patients with stage 0-1 and stage 3-4. The API and GAPI were found to be significantly associated with the fibrosis score and correlation co-efficient (r) were 0.35 and 0.23, respectively (p<0.001), while the APRI, AAR and AGR values were not associated with the fibrosis score in all of the patients (p>0.05). But, APRI has showed correlation with liver fibrosis in patients with CHC contrary to patients with CHB. Conclusion: Age, GGT, PLT, API and GAPI are significantly associated with the extent of fibrosis. But these non-invasive markers can not replace liver biopsy. © H.G.E. Update Medical Publishing S.A.
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    Sentinel lymph node biopsy in breast cancer: Predictors of axillary and non-sentinel lymph node involvement
    (Galenos Publishing House, 2013) Postaci H.; Zengel B.; Yararbaş U.; Uslu A.; Eliyatkin N.; Akpinar G.; Cengiz F.; Durusoy R.
    Background: Sentinel lymph node biopsy is a standard method for the evaluation of axillary status in patients with T1-2N0M0 breast cancers. Aims: To determine the prognostic significance of primary tumour-related clinico-histopathological factors on axillary and non-sentinel lymph node involvement of patients who underwent sentinel lymph node biopsy. Study design: Retrospective clinical study. Methods: In the present study, 157 sentinel lymph node biopsies were performed in 151 consecutive patients with early stage breast cancer between June 2008 and December 2011. Results: Successful lymphatic mapping was obtained in 157 of 158 procedures (99.4%). The incidence of larger tumour size (2.543±1.21 vs. 1.974±1.04), lymphatic vessel invasion (70.6% vs. 29.4%), blood vessel invasion (84.2% vs. 15.8%), and invasive lobular carcinoma subtype (72.7% vs. 27.3%) were statistically significantly higher in patients with positive SLNs. Logistic stepwise regression analysis disclosed tumour size (odds ratio: 1.51, p=0.0021) and lymphatic vessel invasion (odds ratio: 4.68, p=0.001) as significant primary tumour-related prognostic determinants of SLN metastasis. Conclusion: A close relationship was identified between tumour size and lymphatic vessel invasion of the primary tumour and axillary lymph node involvement. However, the positive predictive value of these two independent variables is low and there is no compelling evidence to recommend their use in routine clinical practice. © Trakya University Faculty of Medicine.