Kemal Behzatoglu - Academia.edu (original) (raw)

Papers by Kemal Behzatoglu

Turk patoloji dergisi, 2020

OBJECTIVE Micropapillary urothelial carcinoma is an aggressive variant of urothelial carcinoma. E... more OBJECTIVE Micropapillary urothelial carcinoma is an aggressive variant of urothelial carcinoma. Evidence suggests that the relationship between the tumor and inflammatory cells is important in tumor progression and the treatment response. We evaluated the stromal lymphoid response in micropapillary urothelial carcinomas and compared it with conventional urothelial carcinomas. MATERIAL AND METHOD Among bladder transurethral resection materials diagnosed as 'invasive urothelial carcinoma' between January 2010-March 2017, cases with at least 5% micropapillary urothelial carcinoma were evaluated for age, gender, grade, stage, micropapillary urothelial carcinoma percentage, presence/percentage of accompanying conventional urothelial carcinoma/urothelial carcinoma variants, in situ urothelial carcinoma/micropapillary urothelial carcinoma, lymphovascular invasion, necrosis, and stromal lymphoid response. Stromal lymphoid response was scored as 0-1-2-3. All parameters were evaluated...

Urology Annals, 2019

Objective: The applicability of cystoscopy follow-up protocol that is indicated for low-risk nonm... more Objective: The applicability of cystoscopy follow-up protocol that is indicated for low-risk nonmuscle-invasive bladder cancer (NMIBC) in the guidelines was investigated for our population. Materials and Methods: Patients who underwent transurethral resection with a diagnosis of primary bladder tumor in our clinic within 10 years with low grade of pathology pTa and follow-up periods of at least 5 years were retrospectively reviewed. Fifty-one patients (39 males and 12 females) who were diagnosed with a low-risk NMIBC, had no recurrence at the 3-month control cystoscopy, and followed up for the first 2 years on 3-month basis with cystoscopy were included in the study. Results: The mean age of the patients was 57.37 ± 12.21 years (range: 29–80 years), and the mean duration of recurrence was 25.76 ± 32.45 months. In the cystoscopy follow-ups of 51 patients, up to the 6th month, a total of 12 (24%); up to the 9th month, a total of 21 (41%); up to the 12th month, a total of 30 (59%); up to the 15th month, a total of 36 (71%); up to the 18th month, a total of 36 (71%); up to the 21st month, a total of 39 (77%); and up to the 24th month, a total of 41 (80%) patients were reported to have recurrence. In the case of patients with no recurrence at the 9th month cystoscopy, it was determined that 50% of the patients had recurrence in the first 6 months and 67% in the first 2 years. Conclusion: The majority (80%) of recurrences in low-risk NMIBC occurred in the first 2 years. If the follow-up protocol described in the guidelines had been applied, patients with relapses would have a delay of at least 6 months of diagnosis. Therefore, even if there is no recurrence in the low-risk NMIBC at the 3rd and 9th months, it may be more appropriate to follow the cases in the first 2 years with follow-up cystoscopy every 3 months.

Acta Cytologica, 2019

Introduction: The Acibadem Health Group (AHG) has been using telepathology/digital pathology stat... more Introduction: The Acibadem Health Group (AHG) has been using telepathology/digital pathology stations since 2006. In 2013, the system was changed from videoconferencing to digital pathology (whole-slide imaging) utilizing 3DHISTECH scanners and software. In 2017, digital cytology started to be used for routine cytopathologic diagnosis for thyroid fine-needle aspiration (FNA) cases. Material and Methods: Two hundred and twenty-seven thyroid cases were received for analysis using telecytology (TC) during the period from November 2017 to May 2018. Rapid on-site evaluation was performed at the Atakent Hospital of the AHG by a cytotechnologist and scanned on the same day. For every case, there were Diff-Quik- and Papanicolaou-stained FNA smears. Each glass slide was digitized with a 3DHISTECH whole-slide scanner in 1 focal Z-plane at ×40 magnification. Results: Two hundred and twenty-seven thyroid FNA specimens were retrieved, of which 25 had histologic follow-up. Samples were classified...

Istanbul Medical Journal, 2017

In our study, the age and gender of patients and the stage and grade of conventional bladder urot... more In our study, the age and gender of patients and the stage and grade of conventional bladder urothelial carcinoma (UC) and bladder UC variants were investigated. Methods: Patients with UC diagnosed in our pathology clinic between 2010 and 2015 were identified using an electronic database. They were reexamined according to the World Health Organization 2004 (WHO) classification system, and the grade and stage of UC and concomitant UC variants were documented for each patient. In addition to these data, the age and gender of each patient were obtained from the electronic database. Results: Between 2010 and 2015, 1355 biopsies from 1081 different patients were present with the diagnosis of UC. Totally, 676 patients with recurrence were excluded. Finally, 679 patients were included. When all patients were screened in terms of newly identified variants in the WHO 2004 classification system, 153 patients (22.6%) had UC variants, forming at least 10% of the biopsy specimen. We identified 15 UC variants: squamous differentiation, glandular differentiation, and small cell, micropapillary, sarcomatoid, lymphoepithelioma-like, nested, large nested, large cell neuroendocrine, plasmacytoid, pleomorphic, trophoblastic, rhabdoid, chordoid, and undifferentiated carcinomas. Conclusion: Our study is the largest case series on UC in Turkey. Due to the large number of patients, we believe that the results reflect the present status of the frequency and stage of UC variants and the gender and age of patients at diagnosis.

Turk patoloji dergisi, Jan 23, 2018

Nested variant is bland-looking but aggressive subtype of urothelial carcinoma (UC). Cases having... more Nested variant is bland-looking but aggressive subtype of urothelial carcinoma (UC). Cases having significant muscle invasion do not cause problems but small and superficial biopsies may be challenging due to morphological similarities between nested variant urothelial carcinoma and benign urothelial lesions. We studied Glucose transporter 1 (GLUT-1), which is an integral membrane protein providing glucose pass through plasma membrane down its concentration gradient, to see if it is useful for the differential diagnosis. Twenty five cases of nested variant urothelial carcinoma and a control group consisting of 12 cases of cystitis glandularis, cystitis cystica and 4 cases of inverted papilloma were stained with GLUT-1 immunohistochemically. Membranous staining was scored on a scale of 0 to +3. Eleven of 25 nested variant UC cases showed a score of 2 and 14 of them showed a score of 3 on immunostaining with GLUT-1. Two cases showed a score of 1 and 10 cases did not show any staining ...

Turkish Journal of Pathology, 2016

Clear cell renal cell carcinoma with mucin secretion is an unexpected situation. Primary renal ad... more Clear cell renal cell carcinoma with mucin secretion is an unexpected situation. Primary renal adenocarcinoma and various metastatic carcinomas should be considered in the differential diagnosis. Prognostic significance is not yet fully known due to the limited number of reported cases, and these lesions have been grouped under unclassified renal cell carcinoma. In our study, clear cell renal cell carcinoma with significant luminal mucin secretion is discussed with its histological, histochemical and immunohistochemical features.

Breast Care, 2016

Background: Malignant phyllodes tumors of the breast are rare biphasic neoplasms. Only few cases ... more Background: Malignant phyllodes tumors of the breast are rare biphasic neoplasms. Only few cases related to pregnancy have been reported. Case Report: A 37-year-old woman presented with swelling and pain in her left breast as well as hyperemia on the breast skin, 4 weeks after labor. In her family history, her aunt and maternal cousin had had a breast cancer diagnosis. Clinical evaluation of the patient was consistent with a breast abscess. Therefore, abscess drainage and biopsy from the cavity wall were performed. However, the biopsy was diagnosed as malignant phyllodes tumor. An evaluation by ultrasonography showed a well-defined hypoechoic mass with many cystic spaces covering the entire breast tissue. Therefore, a simple mastectomy was performed. Microscopic examination revealed a high-grade malignant phyllodes tumor. Additionally, bone cyst-like areas in the form of sponge-like blood-filled non-endothelialized spaces were observed. Conclusions: Since the breasts become larger d...

Istanbul Medical Journal, 2015

Extraskeletal osteosarcomas are rarely observed tumors. Besides this, primary osteosarcomas of ut... more Extraskeletal osteosarcomas are rarely observed tumors. Besides this, primary osteosarcomas of uterus are rarer, and only 21 cases have been reported in the literature. It is generally seen at the postmenopausal period, and it progresses quite aggressively. Particularly, malignant mixed mullerian tumors (MMMTs) are important for differential diagnosis. Histopathological and immunohistochemical examination of a mass that was detected in the uterus of a 61-year-old postmenopausal patient revealed the diagnosis of primary chondroblastic osteosarcoma, and this very rare case is presented here.

Istanbul Medical Journal, 2011

Bu çalışmanın amacı, Dünya Sağlık Örgütü'ne göre sınıflandırılmış gastroenteropankreatik nöroendo... more Bu çalışmanın amacı, Dünya Sağlık Örgütü'ne göre sınıflandırılmış gastroenteropankreatik nöroendokrin tümörlerde (GEPNET) p16 ve siklin D1'in rolünü ve Ki 67 proliferasyon indeksini incelemektir. Gereç ve Yöntem: Toplam 41 olguluk GEPNET serisinin 16'sı iyi diferansiye nöroendokrin tümörden (İDNET), 17'si iyi diferansiye nöroendokrin karsinomdan (İDNEK) ve 8'i az diferansiye nöroendokrin karsinomdan (ADNEK) oluşmaktaydı. Bu tümör grupları p16, siklin D1 ve Ki 67 ekspresyonu açısından incelendi. Bulgular: p16 ve siklin D1 over ekspresyonu İDNET grubunun 8'inde (%50) ve 8'inde (%50), İDNEK grubunun 12'sinde (%70) ve 5'inde (%29), ADNEK grubunun 5'inde (%63) ve 5'inde (%63) izlendi. Düşük Ki 67 indeksi (≤ %2) İDNET grubunun 15'inde (%94), İDNEK grubunun 13'ünde (%76) mevcuttu. Sonuç: Bu çalışmada Ki 67 indeksi, İDNEK grubunda benign gruptaki gibi düşük bulunmuştur. Yüksek Ki 67 indeksi kötü prognoz ile ilişkilidir, ancak proliferatif aktivitenin düşük olması benign davranışın göstergesi olarak değerlendirilmemelidir. Çalışmamızda p16 ve siklin D1 ile ilgili anlamlı bir sonuç elde edilmemekle birlikte daha çok olgudan oluşan, retinoblastom (Rb) proteinin de dahil edildiği ve p16/siklin D1/Rb yolağının tümüyle incelendiği çalışmalarda daha anlamlı sonuçlar elde edilebilir.

Istanbul Medical Journal, 2012

Amaç: İğsi hücreli lipomun (İHL) histolojik ve tipik immünhistokimyasal özelliklerini araştırmak ... more Amaç: İğsi hücreli lipomun (İHL) histolojik ve tipik immünhistokimyasal özelliklerini araştırmak ve diğer subkütan yerleşimli benzer histolojik ve immünhistokimyasal özellikleri olan neoplazmlarla ayırıcı tanısını yapmaktır. Gereç ve Yöntem: İstanbul Eğitim ve Araştırma Hastanesi patoloji laboratuvarında lipom tanısı almış 3100 olguda son Dünya Sağlık Örgütü Yumuşak Doku Tümörleri Sınıflamasına göre alt tipler belirlendi ve bunların içinden 22 İHL çalışmaya alındı. Yirmi iki İHL olgusunda klinik (yaş, yerleşim, cinsiyet, nüks), morfolojik özellikler (tümör boyutu, alt tip, histoloji, mast hücre varlığı ve immünhistokimya), tümörlerin natürü ve ayrıcı tanı problemleri değerlendirildi. Bulgular: 3100 lipomun alt tiplere göre dağılımı şu şekildeydi: 2864 klasik lipom (%90), 293 anjiyolipom (%9), 1 kondroid lipom (%0,03), 1 miyolipom (%0,03 ve 22 iğsi hücreli lipom (%0,7). 22 iğsi hücreli lipomların 9'u fibröz, 3'ü miksoid, 1'i anjiyomatoid ve 9'u nonfibröz alt tipti. Erkek kadın oranı 18/4 olarak belirlendi. Olguların 2'si sırt, 3'ü omuz, 1'i ön kol, 1'i oral olup 15'ü baş-boyun bölgesinde yerleşimliydi. Ortalama tümör çapı 3,2 cm olup en büyük ve küçük çaplar 1 cm ve 6,1 cm olarak ölçüldü. Fibromatöz alt tipte belirgin olmak üzere Toluidine blue boyasıyla her olguda mast hücresi mevcuttu. Mast hücre sayısı on büyük büyütme alanında ortalama 23 olarak bulundu. S-100 tüm iğsi hücrelerde negatif ve yağ hücrelerinde pozitif olarak tespit edildi. CD34 olguların 21'inde pozitif, 1'inde negatif bulundu. Hiçbir olguda nüks izlenmedi. Sonuç: İğsi hücreli lipom, subkütan yerleşimli, iyi sınırlı, iğsi hücreli komponenti CD34 pozitif, mast hücrelerinden zengin bir tümör olup birçok subkütan tümörle ayırıcı tanı yapılmasını gerektiren nadir bir antitedir.

Annals of Diagnostic Pathology, 2015

between 2000 and 2012 were retrieved and reevaluated. Demographic features of the groups were ana... more between 2000 and 2012 were retrieved and reevaluated. Demographic features of the groups were analyzed from the institutional database. Only resection materials were included in the study. Biopsies and metastatic materials were excluded. 2.2. Immunohistochemical Analysis Immunohistochemical analysis of Chromogranin A (LK2H10+ PHE5, Neomarkers), Synaptophysin (27G12, Novacastra), and Neuron-Specific Enolase (Clone E 27, Neomarkers) was used to evaluate for neuroendocrine differentiation. All the cases were diffusely (>%50) and strongly positive for at least two neuroendocrine markers. Ki67 (RM-9106-R7, Neomarkers) immunostaining was performed for the proliferation index. One representative block was selected for Ki-67 index. 2.3. Classification, Grading and Staging The tumors are classified as WDETB, WDETUB,WDEC or PDEC according to the WHO 2000/2004 guidelines. Tumor diameter, localization, depth of invasion (gross local invasion for pancreas) and metastatic state are considered in this classification (Table 1, Table 2, Table 3). All the slides were re-reviewed for prognostic parameters such as angiolymphatic invasion, perineural invasion, necrosis, mitosis; blinded of the original diagnosis. Mitotic count and the ki-67 index were investigated for classifying the cases according to WHO 2010. Counting Ki-67 and mitosis were performed blinded by two pathologists. The mitotic index was expressed as the number of mitoses per 10 HPF (approximately 2 mm²) after evaluating at least 50 HPF (or the entire tumor area in case of small tumors). Proliferation zone cells

Diagnostic Pathology, 2009

Background: CD10 antigen is a 100-kDa-cell surface zinc metalloendopeptidase and it is expressed ... more Background: CD10 antigen is a 100-kDa-cell surface zinc metalloendopeptidase and it is expressed in a variety of normal and neoplastic lymphoid and nonlymphoid tissues. The aim of this study was to evaluate CD10 expression in urothelial carcinoma of the urinary bladder and to determine the correlation between immunohistochemical (IHC) CD10 expression and histopathologic parameters including grade and stage. Methods: 371 cases of urothelial bladder carcinomas, all from transurethral resections, were included in this study. Hematoxylin-eosin (HE) stained sections from each case were reevaluated histopathologically according to WHO 2004 grading system. The TNM system was used for pathologic staging. Selected slides were also studied by IHC and a semiquantitative scoring for CD10 expression based on the percentage of positive cells was performed. Results: 157 cases (42.3%) showed immunostaining while 214 cases (57.7%) were negative for CD10. 1+ staining was seen in 65 CD10 positive cases (41.4%), and 2+ in 92 cases (58.6%). Overall CD10 expression as well as 2+ immunostaining was significantly correlated with high histologic grade. Overall CD10 expression was also significantly higher in invasive pT1 and pT2-3 tumors compared to noninvasive pTa tumors. pT1 and pT2-3 tumors were also significantly correlated with 2+ immunostaining. Conclusion: To date, only a few comparative IHC studies have assessed CD10 expression in urothelial carcinoma of the urinary bladder and this study represents the largest series. Our findings indicate that CD10 expression is strongly correlated with high tumor grade and stage in urothelial carcinoma of the bladder, and that CD10 may be associated with tumor progression in bladder cancer pathogenesis.

Istanbul Medical Journal, 2014

Biz bu çalışmada; hücre birimleri, organizasyon ve arşitektürel yapılanmalar bakımından orijinali... more Biz bu çalışmada; hücre birimleri, organizasyon ve arşitektürel yapılanmalar bakımından orijinaline yakın sayılabilecek genel anlamda bir vücut yapımı gösteren matür kistik teratomlarda epidermisteki melanositler ve Langerhans hücrelerinin varlığı, birbiri ile sayısal ilişkileri ve birlikte bulunmaları halinde embriyolojik kaynakları hakkında fikir yürütebilmeyi amaçladık. Yöntemler: Sağlık Bakanlığı İstanbul Eğitim ve Araştırma Hastanesi Patoloji Bölümü'nde 2006-2009 yılları arasında rapor edilen 45 matür kistik teratom olgusu çalışmaya alındı. İmmünohistokimyasal olarak; melanositler için Human Melanoma Black-45 (HMB-45) ve Melanoma Antigens (Melan-A) recognized by T cells-1), Langerhans hücreleri için Cluster of Differentiation 1a (CD1a) ve Langerin uygulandı. Bulgular: Langerhans hücreleri olguların %100'ünde tespit edilmekle birlikte, melanositler %88,2'sinde mevcuttu. Sonuç: Bizim çalışmamıza göre Langerhans hücrelerinin, melanositlerin köken aldığı bilinen nöral krest dışında bir kaynaktan gelişmiş olabileceği ve bu iki hücre arasında ilişki olamayabileceği sonucuna vardık.

Istanbul Medical Journal, 2013

Amaç: B lenfosit belirteci olarak bilinen CD24, intrasellüler sinyal iletiminde, hücre-hücre ve h... more Amaç: B lenfosit belirteci olarak bilinen CD24, intrasellüler sinyal iletiminde, hücre-hücre ve hücre-matriks arasındaki haberleşmenin düzenlenmesinde de önemli rol almaktadır. Son 10 yılda CD24 salınımı ile birçok tümörün ilerlemesi ve prognozu arasında ilişki bulunmuştur. Bu çalışmadaki amacımız, CD24 salınımının mesane ürotelyal karsinomlarında, en önemli morfolojik prognostik parametreler olan tümör evresi ve diferansiyasyon derecesi ile karşılaştırmak ve etkinliğini tartışmaktır.

Turkish Journal of Pathology, 2013

Epitelyal splenik kistler dalağın nadir kistlerindendir. Dalağın primer epitel ya da endotel ile ... more Epitelyal splenik kistler dalağın nadir kistlerindendir. Dalağın primer epitel ya da endotel ile döşeli kistleri genellikle genç erişkinlerde görülür. 23 yaşındaki kadın hasta, karında dolgunluk hissi ile genel cerrahi polikliniğine başvurmuştur. Fizik muayenesinde splenomegali mevcut olan hastaya elektif cerrahi uygulanmıştır. Makroskobik olarak 10x6 cm'lik multiloküle kistik kitlenin içerisinden peynirimsi kıvamlı materyal boşalmıştır. Stratifiye skuamöz epitelle döşeli kistin immünohistokimyasal incelemesinde, sitokeratin ve CEA ile pozitif, kalretinin, BerEP4, HBME-1 ve F8 ile negatif sonuç elde edilerek, epidermoid kist olarak raporlandı. Epidermoid kist oluşumundaki etiyolojik teoriler ışığında kendi vakamızın etyopatogenezini tartıştık.

Hepatology international, Jan 4, 2010

Sclerosing cholangitis is a rare complication of Langerhans cell histiocytosis in children which ... more Sclerosing cholangitis is a rare complication of Langerhans cell histiocytosis in children which can result in liver failure. This combination is even rarer in adults.

European Journal of Obstetrics & Gynecology and Reproductive Biology, 2009

... Extrarenal Wilms' tumor of the uterus with ovarian dermoid cyst. Cem Leblebici: Affiliat... more ... Extrarenal Wilms' tumor of the uterus with ovarian dermoid cyst. Cem Leblebici: Affiliations. ... Istanbul Egitim Hastanesi, Patoloji Lab., Koca M Pasa, Fatih, Istanbul, Turkey. Tel.: +90 5055784122; fax: +90 212 589 32 35. email address ,; Pelin Yıldız: Affiliations. ...

Diagnostic Cytopathology, 2005

Acta Cytologica, 2004

Objective: This research aims to compare fine needle aspiration biopsy (FNAB) with magnetic reson... more Objective: This research aims to compare fine needle aspiration biopsy (FNAB) with magnetic resonance imaging (MRI) in differentiating between neoplasms found within the parotic gland. Methods: Using a retrospective methodology, records were reviewed from 74 cases who had surgery for a parotid neoplastic lesion between January 2013 and November 2018. 41 cases were men and 33 women, with a mean age of 51.3±12.8 years. In each instance, comparison was made between the eventual histopathological diagnosis and the results of evaluation by FNAB or MRI prior to surgery. The comparison looked at how the two methods influenced surgical choice, their ability to distinguish between malignant and benign lesions and power to predict histopathological subtype. Results: 57 cases (out of 74) represented benign lesions (77%), whilst 17 were malignant (23%). Superficial paro-tidectomy was carried out on 54, and total parotidectomy on 20 individuals. FNAB had a sensitivity in the detection of malignancy of 73.3% with a specificity of 100%. The accuracy was 93.4%. MRI, on the other hand, had a sensitivity in the detection of malignancy of 81.2% with a specificity of 90.5%. The accuracy was 88.4%. Amongst benign lesions found, the most frequently occurring were pleomorphic adenome and Warthin's tumour. MRI could accurately identify the histopathological type in 90% of such cases, whilst FNAB identified 89.1%. Conclusion: In distinguishing between benign and malignant neoplastic lesions of the parotid gland, FNAB and MRI have similar abilities. Although MRI is unable to adequately predict the histopathological subtype in malignant lesions, unlike FNAB, its role in surgical planning and tumour staging remains highly significant.

APMIS, 2007

Elastofibroma is a rare fibrous lesion characterized by accumulated abnormal elastic fibers whose... more Elastofibroma is a rare fibrous lesion characterized by accumulated abnormal elastic fibers whose etiology remains largely unknown. In this study, we analyzed seven cases of elastofibroma to further explore the characteristics of its cellular composition. Immunohistochemistry was performed for mast cell tryptase, S‐100 protein, vimentin, CD34, smooth muscle actin, desmin and collagen type IV. Histochemical staining methods for Gomori's trichrome and Verhoeff elastica‐van Gieson were also evaluated. Histopathologically, a haphazard array of collagen, eosinophilic amorphous fibers, and globules in a fibrous tissue was seen. The elastic nature of the fibers was confirmed by elastic stain, and with Gomori's trichrome collagen fibers were also demonstrated. The interspersed spindle or stellate cells were almost consistently positive for vimentin and frequently positive for CD34. Mast cell tryptase‐positive cells were present in five of the cases. Collagen type IV immunoreactivity...