isa guney - Academia.edu (original) (raw)

Papers by isa guney

DergiPark (Istanbul University), Dec 19, 2022

Bezmialem science, Apr 1, 2021

Objective: Paragangliomas are rare tumors arising from extraadrenal chromaffin tissue, which are ... more Objective: Paragangliomas are rare tumors arising from extraadrenal chromaffin tissue, which are widely distributed near or within the autonomic nervous system in the retroperitoneal sites and in the sympathetic ganglia of various viscera. We present a review of our 18-year institutional experience with resected abdominal paragangliomas. Methods: The data collected from 12 patients who underwent surgery due to abdominal paraganglioma in our clinic between 2002 and 2020 were analyzed retrospectively. Results: There were 12 patients in our study. The median age was 44 years (range: 21-81 years). The patients had one or more of the symptoms of headache (n=2, 16,6%), palpitations, abdominal pain (n=5, 41.6%), sweating (n=2, 16.6%) and hypertension (n=5, 41.6%), which are the classic clinical symptoms. One of the cases (1/12; 8,3%) was detected incidentally. The mass location was in the retroperitoneal region in 10 cases (83.3%) and in the pelvic region in 2 cases (16.6%). Five of the patients applied to our clinic with episodes of paroxysmal hypertension, and vanillylmandelic acid and metanephrine levels were found to be high in the blood and 24-h urinary tests. After a median follow-up period of 60 months, only 1 patient (8.3%) had metastasis and required reoperation 2 years after the first operation. One patient (8.3%) died on postoperative 36 th month due to cardiac problems. Conclusion: Abdominal paragangliomas are rare tumors whose optimal management requires the surgeon to be highly attentive to Amaç: Paragangliomalar, retroperitoneal bölgelerde otonom sinir sisteminin yakınında veya içinde ve çeşitli organların sempatik gangliyonlarında yaygın olarak dağılım gösteren ekstra-adrenal kromaffin dokusundan kaynaklanan nadir görülen tümörlerdir. Biz bu çalışmada 18 yıllık abdominal paraganglioma cerrahisine ait klinik deneyimimizi sunuyoruz. Yöntemler: 2002-2020 yılları arasında kliniğimizde abdominal paragangliomaya bağlı cerrahi uygulanan 12 hastadan elde edilen veriler retrospektif olarak incelendi. Bulgular: Çalışmamızda 12 hasta vardı. Ortalama yaş 44 (21-81) idi. Hastalarda klasik klinik semptomlar olan baş ağrısı (n=2,% 16,6), çarpıntı, karın ağrısı (n=5, 41,6), terleme (n=2, %16,6) ve hipertansiyon (n=5, %41,6) mevcuttu. Olgulardan biri (1/12; %8,3) insidental olarak tespit edildi. Kitle yerleşimi 10 olguda (%83,3) retroperitoneal bölgede, 2 olguda (%16,6) ise pelvik bölgede idi. Kliniğimize paroksismal hipertansiyon atakları ile başvuran hastaların beşinde kan ve 24 saatlik idrar testlerinde vanil mandelik asit ve metanefrin düzeyleri yüksek bulundu. Ortalama 60 aylık takip süresi boyunca sadece 1 hastada (%8,3) metastaz gelişti ve bu hasta ilk ameliyatından 2 yıl sonra tekrar ameliyat edildi. Bir hastada (%8,3) ameliyat sonrası 36. ayda kardiyak problemler nedeniyle mortalite gelişti. Sonuç: Abdominal paragangliomalar nadir görülen tümörler olup optimal yönetiminde cerrahın hastalık seyri boyunca son derece dikkatli olmasını gerektirir. Bu süreç, fonksiyonel veya

Turkiye Klinikleri Nuclear Medicine - Special Topics, 2016

Turkish journal of hematology, Nov 19, 2020

Kemik iliği infiltrasyonu (Kİİ), lenfoma evresini, sağkalımı ve tedaviyi etkiler. Lenfoma hastala... more Kemik iliği infiltrasyonu (Kİİ), lenfoma evresini, sağkalımı ve tedaviyi etkiler. Lenfoma hastalarında Kİİ' ni saptamada kemik iliği biyopsisi (KİB) ve positron emisyon tomografi-bilgisayarlı tomografi (PET/BT)' nin performanslarını değerlendirmek istedik. Gereç ve Yöntemler: 269 non-Hodgkin lenfoma (NHL) ve 110 hodgkin lenfoma (HL) hastası retrospektif olarak değerlendirildi. Kİİ' ni saptamada PET/BT ve KİB için duyarlılık, negatif prediktif değer (NPD) ve doğruluk hesaplandı. Bulgular: NHL olgularında Kİİ' ni saptamada PET/BT için duyarlılık, NPD ve doğruluk sırasıyla %65, %78 ve %84.4 iken KİB için %55, %73.4 ve %79.9 idi. Diffüz büyük B hücreli lenfoma ve folliküler lenfoma için PET/BT performansı KİB' den daha iyi iken; mantle-cell lenfoma, burkitt's lenfoma ve primer mediastinal B hücreli lenfomada KİB performansı daha iyiydi. HL olgularında PET/BT için duyarlılık, NPD ve doğruluk sırasıyla %91.3, %97.75 ve %98.18 iken KİB için %56.52, %89.69 ve %90.91 idi. KİB yapılması ile NHL grubunda 43 (%15.9), HL grubunda ise 2 (%1.8) olgunun düşük evrelenmesinden korunmuş olundu. Sonuç: Kİİ' ni saptamada NHL alt tiplerine göre değişmekle birlikte PET/BT ve KİB birbirini tamamlayıcı yöntemlerdir. HL' de ise Kİİ' ni saptamak için PET/BT önemli bir tanı aracıdır ve KİB olguların önemli kısmında gerekli değildir. Anahtar Sözcükler: Lenfoma, kemik iliği infiltrasyonu, PET/BT, kemik iliği biyopsisi Objective: Bone marrow infiltration (BMI) affects the stage of lymphoma, survey, and treatment. We aimed to evaluate the performance of bone marrow biopsy (BMB) and positron emission tomography-computed tomography (PET/CT) in detecting bone marrow infiltration in lymphoma patients. Materials and Methods: 269 non-Hodgkin's lymphoma (NHL) and 110 Hodgkin's lymphoma (HL) patients were evaluated retrospectively. Sensitivity, negative predictive value (NPV) and accuracy were calculated for PET/CT and BMB in detecting BMI. Results: Sensitivity, NPV and accuracy for PET/CT in detecting BMI in NHL cases were 65%, 78% and 84.4%, respectively, while 55%, 73.4% and 79.9% for BMB. PET/CT performance for diffuse large B-cell lymphoma and follicular lymphoma was better than BMB, whereas the performance of BMB was better for mantle-cell lymphoma, Burkitt's lymphoma and primary mediastinal B-cell lymphoma. Sensitivity, NPV and accuracy for PET-CT in HL cases were 91.3%, 97.75% and 98.18%, respectively, while 56.52%, 89.69% and 90.91% for BMB. Due to BMB, 43 (15.9%) patients in the NHL group and 2 (1.8%) patients in the HL group were protected from downstaging. Conclusion: PET/CT and BMB, although their results vary according to the NHL subtypes, are complementary methods in determining the BMI. In HL, PET/CT is an important diagnostic tool for detecting BMI, and BMB is not necessary in a significant proportion of cases.

CardioVascular and Interventional Radiology

Namık Kemal tıp dergisi, Sep 2, 2020

The study protocol conforms the ethical guidelines of the 1975 Declaration of Helsinki and the st... more The study protocol conforms the ethical guidelines of the 1975 Declaration of Helsinki and the study was approved by the local Ethics Committee and Institutional Review Board as meeting number 57, in 2016.

Üroonkoloji bülteni, Apr 1, 2020

We aimed to investigate the reliability and effectiveness of laparoscopic adrenalectomy (LA) in l... more We aimed to investigate the reliability and effectiveness of laparoscopic adrenalectomy (LA) in large adrenal masses by comparing LA results for large-and small-volume (<5 cm) masses. Materials and Methods: Patients who underwent LA due to adrenal mass between February 2004 and December 2018 in our clinic were retrospectively analyzed. The patients were divided into two groups as mass size <5 cm (group I) and ≥5 cm (group II). Patients who underwent open adrenalectomy and whose data were not available were excluded from the study. Perioperative data, postoperative results, complications, and histopathological results were examined. Results: There were 62 patients who underwent LA. Thirty-three patients (53.2%) had a left adrenal mass, and 29 patients (46.8%) had a right adrenal mass. Of the 62 adrenal masses, 46 (74.2%) had a diameter of <5 cm (group I), and 16 (25.8%) were ≥5 cm (group II). The mean tumor size was 3.2±0.15 and 6.4±3.5 cm in group I and group II, respectively. There was no statistically significant difference between the groups in terms of age, operative time, and blood loss. The average length of hospital stay was 37.6±20.9 hours in group I, while it was 49.8±22.9 hours in group II and was significantly longer in group II (p<0.05). Intraoperative blood pressure elevation occurred in one patient in group I and II. In a patient with suspected malignancy in group II, the surgery was shifted to open surgery as the capsule over the mass was opened. Hypopotasemia was observed in one patient, and atelectasis was observed in one patient in group I, and pneumonia was observed in one patient in group II. Conclusion: LA is a minimally invasive surgical method that can be applied safely in experienced centers in masses larger than 5 cm with no suspected invasion in preoperative imaging.

Bone Marrow Transplantation, Dec 13, 2004

Figure 2 Characteristic mixture of cells of various sizes, some plasma cells, large transformed c... more Figure 2 Characteristic mixture of cells of various sizes, some plasma cells, large transformed cells and small lymphocytes.

Molecular Imaging and Radionuclide Therapy, Oct 3, 2017

Super scan is a well-known finding described in skeletal scintigraphy characterized by uniform sy... more Super scan is a well-known finding described in skeletal scintigraphy characterized by uniform symmetrically increased radiopharmaceutical uptake by bones and consequently diminished renal parenchymal activity. Sy et al. hypothesized that the faint visualization of renal cortex in bone scintigraphy might be the result of increased uptake of radiopharmaceutical by pathologic bones and reduced phosphate excretion. The super scan on 18 F-fluorodeoxyglucose positron emission tomography/ computed tomography (18 F-FDG PET/CT) has been observed in various conditions such as prostate cancer, lung cancer, renal adenocarcinoma, gastric cancer and primitive neuroectodermal tumor of the kidney. Herein we report the first case of super scan in a 68-year-old-woman with parathyroid carcinoma observed both in 18 F-FDG PET/CT and Tc-99m methylene diphosphonate bone scintigraphy. There were extensive hypermetabolic lesions throughout the skeleton in 18 F-FDG PET/CT. In contrast to the intense hypermetabolism of the skeleton; the liver, skeletal muscles of the limbs, mediastinum, bowel and especially the brain showed very low FDG uptake. Additionally, there was increased skeletal radiotracer uptake relative to soft tissue, and faint genitourinary tract activity in bone scintigraphy.

PubMed, 2020

Aim: We aimed to evaluate; (i) the accuracy of ultrasonography (US), contrast-enhanced magnetic r... more Aim: We aimed to evaluate; (i) the accuracy of ultrasonography (US), contrast-enhanced magnetic resonance imaging (cMRI) and 18F-fluorodeoxyglucose positron emission tomography/computed tomography (18F-FDG PET/CT) for detection of axillary lymph node metastases (ALNMs), (ii) the role of late prone imaging, and (iii) the effect of PET/CT on preoperative staging of breast cancer. Material and methods: From June 2015 to January 2019, 236 breast cancer patients were preoperatively exam ined using US, cMRI, and PET/CT and whom underwent pathological evaluations of axillary lymph nodes were analyzed. The sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV), and accuracy (ACC) of US, cMRI, and PET/CT for ALNMs were determined. Results: There were 235 female and one male in our study. The mean age was 55,6±11,3 years. Of 158 patients who were histopathologically evaluated, 85 patients (36%) were negative and 73 patients (30.9%) were positive for ALNMs. The remaining 78 patients who were only radiologically evaluated with US and/or cMRI, 24 patients (10.2%) were negative and 54 patients (22.9%) were positive for ALNMs. The sensitivity, specificity, PPV, NPV, and ACC of PET/CT were 80.0%, 92.2%, 92.0%, 80.3%, and 85.7%, re spectively. The axillary lymph node, which was suspicious in supine imaging, remained in the suspicious group again in prone imaging in PET/CT. Conclusions: There is no single absolute modality for de tecting ALNMs in breast cancers to replace sentinel lymph node biopsy or axillary lymph node dissection. If ALNM is suspected based on PET/CT, axillary lymph node dissection without sentinel lymph node biopsy might be a better option because it is related to high possibilities of ALNM. Key words: Axillary lymph node metastasis, Magnetic resonance imaging, Ultrasonography, 18F-FDG PET/CT.

PubMed, 2020

Aim: In patients with colorectal cancer an accurate diagnostic work-up is mandatory in order to p... more Aim: In patients with colorectal cancer an accurate diagnostic work-up is mandatory in order to perform the most specific treatment. In this study, we aimed to evaluate the accuracy of computed tomography (CT), magnetic resonance imaging (MRI) and 18F-fluorodeoxyglucose positron emission tomography/computed tomography (18F-FDG PET/CT) for detection of regional lymph node metastases (RLNMs) and the additional value of PET/CT in the preoperative staging of colorectal cancer. Material and methods: From June 2015 to May 2018, 72 colorectal cancer patients were preoperatively examined using CT, MRI, and PET/CT. Histopathological examination of regional lymph nodes were performed in 53 patients who underwent colorectal surgery. The sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV), and accuracy (ACC) of CT, MRI, and PET/CT for RLNMs, and the additional value of PET/CT in distant metastases were determined. Results: There were 44 male and 28 female in our study. The mean age was 61±11 years. Histopathologically, 27 patients (51%) were negative and 26 patients (49%) were positive for RLNMs. The sensitivity, specificity, PPV, NPV, and ACC of PET/CT were 88.5%, 59.3%, 67.6%, 84.2%, and 73.6%, respectively. PET/CT changed the patient management with diagnostic contribution to the suspicious lesions identified by radiological imaging modalities. Conclusion: PET/CT is a useful tool in the evaluation of colorectal cancer, and it allows to metabolically characterize undetermined lesions suspected for recurrence of disease, to perform a complete pre-surgical staging and to identify occult metastatic disease. PET/CT should be considered an essential diagnostic tool in the management of patients with colorectal cancer, especially in the preoperative staging. Key words: Colorectal Cancer, Computed tomography, Magnetic resonance imaging, Positron emission tomography.

Cukurova Medical Journal, Jun 30, 2019

Öz Purpose: In this study, we aimed to determine the role of lymphoscintigraphy in patient manage... more Öz Purpose: In this study, we aimed to determine the role of lymphoscintigraphy in patient management of sentinel lymph node (SLN) biopsy. Materials and Methods: 25 skin cancer patients (16 malignant melanoma, 9 epidermoid carcinoma) were included in the study. Tc-99m Nanocolloid intradermal injection was applied to all patients on the day of operation. The projections of the sentinel lymph nodes on the skin were marked during preoperative lymphoscintigraphy. Patients were taken into operation after the marking. The lymph nodes with projections on the skin were detected by intraoperative gamma probe and excised. After removing all the sentinel nodes for histopathological examination, care was taken to reduce the residual radioactivity count in the bed, where sentinel lymph nodes were removed, to less than 10% of the activity of the most active activity of the resected node. Results: A total of 86 SLNs and 54 non-SLNs were surgically removed and all nodes were sent to the Department of Pathology for histopathological examination. Four patients had metastases in sentinel lymph nodes. These patients were reoperated under elective conditions for extensive surgery. Conclusion: Lymphatic mapping method with lymphoscintigraphy and intraoperative gamma probe have a high specificity and sensitivity ratio and minimize the morbidity. This method was thought to be a routine procedure in malignant skin tumors because of its determination of micrometastases, eliminating possible metastasis pathways, staging and guiding adjuvant therapy.

Turkiye Klinikleri Nuclear Medicine - Special Topics, 2018

Turkiye Klinikleri Nuclear Medicine - Special Topics, 2018

Journal of Women's Imaging, Dec 1, 2004

Chordomas are rare neoplasms of the axial skeleton that arise from notochordal remnants. There ha... more Chordomas are rare neoplasms of the axial skeleton that arise from notochordal remnants. There have been a few reports describing its scintigraphic findings on bone scan. We present here bone scan findings of a woman with both sacrococcygeal chordoma and huge myoma uteri. In this case, bone scintigraphy demonstrated a cold lesion corresponding to the sacrococcygeal chordoma and an increased uptake around the periphery of the defect. Bone imaging did not show any other bone pathology. However, a large area of increased tracer uptake was seen extending from the abdomen to the pelvis strongly suggesting soft tissue mass. Surgical specimen revealed a leiomyoma of the uterus.

Molecular Imaging and Radionuclide Therapy, Feb 1, 2019

Extra-pulmonary accumulation of Tc-99m-macroaggregated albumin (MAA) is described as uptake areas... more Extra-pulmonary accumulation of Tc-99m-macroaggregated albumin (MAA) is described as uptake areas out of the lung in perfusion scintigraphy. If the particles spread throughout the body before reaching the lung via venous collaterals or due to right-to-left shunt, or if the particles are too small to occlude the pulmonary capillaries, then the agent can be seen at different locations of the body. Extra-pulmonary accumulation of Tc-99m-MAA can be detected mostly in the liver as well as in the brain, kidney, thyroid, myocardium, spleen and vertebra. Herein, we present lung scanning images with unexpected hepatic accumulation of Tc-99m-MAA. This pulmonary perfusion scintigraphy was performed in a patient with end-stage renal disease due to dyspnea in the post-operative period of kidney transplantation.

Journal of Oncological Sciences, Apr 1, 2018

Marginal zone lymphoma (MZL) is low grade lymphoma and accounts about 5% of all lymphomas and 5 e... more Marginal zone lymphoma (MZL) is low grade lymphoma and accounts about 5% of all lymphomas and 5 e10% of MZLs are localized in the lung. Interstitial Lung Disease (ILD) is a group of systemic diseases characterized by diffuse inflammation in lung and there is a long list for differential diagnosis. Here we represent a 53 years old man who had been followed as ILD by the department of chest diseases for 1,5 years. Biopsy taken by wedge resection was reported as MZL.

BMC Cancer, Mar 6, 2021

Background: Neuroendocrine tumours (NETs) arise from hormone-producing or nervous system cells an... more Background: Neuroendocrine tumours (NETs) arise from hormone-producing or nervous system cells and can develop from anywhere in the body. They have heterogeneous origins from skin to gastrointestinal track and a complicated histology. Thus, there is an inevitable need for genomic profiling to determine the exact genetics of each tumour for prognosis and treatment strategies to overcome the disease's complexity. For this purpose, nextgeneration-sequencing (NGS) is the most reliable methodology for both germ-line and somatic studies to make a clinical diagnosis. In this study, we analyse liquid biopsies, formalin fixed paraffin embedded (FFPE) tissues, and peripheral blood samples for their ability to provide information for actionability. Methods: A customized multi-gene panel comprised of Succinate Dehydrogenase Complex Iron Sulfur Subunit B (SDHB), Succinate Dehydrogenase Complex Subunit C (SDHC), Cell Division Cycle 73(CDC73), Calcium Sensing Receptor (CASR), Platelet Derived Growth Factor Receptor Alpha (PDGFRA), Succinate Dehydrogenase Complex Flavoprotein Subunit A (SDHA), Ret Proto-Oncogene (RET), Succinate Dehydrogenase Complex Assembly Factor 2(SDHAF2), Menin 1(MEN1), Succinate Dehydrogenase Complex Subunit D (SDHD), MYC Associated Factor X (MAX) and Protein Kinase CAMP-Dependent Type I Regulatory Subunit Alpha (PRKAR1A) genes was constructed to assess multiple specimen types including: 3 liquid biopsies, 6 FFPE tissues, and 26 peripheral blood samples from 35 unique NET patients. Quality-control and bioinformatics analyses were performed using QCI-Analyze and QCI-Interpret. Results: The three liquid biopsies and the 6 FFPE tissue samples were evaluated for somatic mutations; while the 26 peripheral blood samples were analysed using the germ-line pipeline. Five (55.6%) of the nine patients that were studied for somatic changes carried actionable mutations related to therapy sensitivities. Through the germ-line studies, we observed a 50% positivity rate for disease predisposition with 16 variants classified according to ACMG (American College of Medical Genetics) Standards and Guidelines.

Clinical Nuclear Medicine, Jul 1, 2005

... 2. Slavin JD Jr, Skarzynski JJ, Spencer RP. Radionuclide demonstration of urinary bladder-to-... more ... 2. Slavin JD Jr, Skarzynski JJ, Spencer RP. Radionuclide demonstration of urinary bladder-to-colon fistula following radiation therapy. Clin Nucl Med. 1985;10:829. Cited Here... 3. Panoutsopoulos G, Ilias I, Yiannakopoulos V. Vesicocecal fistula detected during dynamic ...

Cancer management and research, Apr 1, 2019

The aim of this study was to evaluate the prognostic and predictive value of neutrophilto-lymphoc... more The aim of this study was to evaluate the prognostic and predictive value of neutrophilto-lymphocyte ratio (NLR), derived neutrophil-to-lymphocyte ratio (DNLR), lymphocyte-tomonocyte ratio (LMR), and platelet-to-lymphocyte ratio (PLR) in soft tissue sarcoma (STS) cases treated with pazopanib. Materials and methods: The study population included 26 STS cases treated with pazopanib for at least 3 months. NLR, DNLR, LMR, and PLR were evaluated at baseline, and at third month of therapy and also compared with response to pazopanib. Median measurements were taken as cutoff for NLR (4.8), DNLR (3.1), LMR (3.6), and PLR (195). The associations between these cutoff values and survival times (progression-free survival [PFS] and overall survival [OS]) were assessed by Kaplan-Meier curves and Cox proportional models. Results: Patients with low pretreatment NLR and DNLR had longer OS (P=0.022, P=0.018), but low PLR was found to be associated only with longer OS. Additionally, decrease in NLR and DNLR after 3 months of therapy as compared with pretreatment measurements was found to be associated with an advantage for OS (P=0.021, P=0.010, respectively) and PFS (P=0.005, P=0.001, respectively). Response to pazopanib; changes in NLR, DNLR, LMR, and PLR; and >3 metastatic sites were found to be independent risk factors in univariate analysis, but NLR was the only independent risk factor in multivariate analysis. Conclusion: Low pretreatment and decrease in NLR and DNLR values, and regression/stable disease after 3 months of pazopanib are predictive factors for longer OS and PFS.

DergiPark (Istanbul University), Dec 19, 2022

Bezmialem science, Apr 1, 2021

Objective: Paragangliomas are rare tumors arising from extraadrenal chromaffin tissue, which are ... more Objective: Paragangliomas are rare tumors arising from extraadrenal chromaffin tissue, which are widely distributed near or within the autonomic nervous system in the retroperitoneal sites and in the sympathetic ganglia of various viscera. We present a review of our 18-year institutional experience with resected abdominal paragangliomas. Methods: The data collected from 12 patients who underwent surgery due to abdominal paraganglioma in our clinic between 2002 and 2020 were analyzed retrospectively. Results: There were 12 patients in our study. The median age was 44 years (range: 21-81 years). The patients had one or more of the symptoms of headache (n=2, 16,6%), palpitations, abdominal pain (n=5, 41.6%), sweating (n=2, 16.6%) and hypertension (n=5, 41.6%), which are the classic clinical symptoms. One of the cases (1/12; 8,3%) was detected incidentally. The mass location was in the retroperitoneal region in 10 cases (83.3%) and in the pelvic region in 2 cases (16.6%). Five of the patients applied to our clinic with episodes of paroxysmal hypertension, and vanillylmandelic acid and metanephrine levels were found to be high in the blood and 24-h urinary tests. After a median follow-up period of 60 months, only 1 patient (8.3%) had metastasis and required reoperation 2 years after the first operation. One patient (8.3%) died on postoperative 36 th month due to cardiac problems. Conclusion: Abdominal paragangliomas are rare tumors whose optimal management requires the surgeon to be highly attentive to Amaç: Paragangliomalar, retroperitoneal bölgelerde otonom sinir sisteminin yakınında veya içinde ve çeşitli organların sempatik gangliyonlarında yaygın olarak dağılım gösteren ekstra-adrenal kromaffin dokusundan kaynaklanan nadir görülen tümörlerdir. Biz bu çalışmada 18 yıllık abdominal paraganglioma cerrahisine ait klinik deneyimimizi sunuyoruz. Yöntemler: 2002-2020 yılları arasında kliniğimizde abdominal paragangliomaya bağlı cerrahi uygulanan 12 hastadan elde edilen veriler retrospektif olarak incelendi. Bulgular: Çalışmamızda 12 hasta vardı. Ortalama yaş 44 (21-81) idi. Hastalarda klasik klinik semptomlar olan baş ağrısı (n=2,% 16,6), çarpıntı, karın ağrısı (n=5, 41,6), terleme (n=2, %16,6) ve hipertansiyon (n=5, %41,6) mevcuttu. Olgulardan biri (1/12; %8,3) insidental olarak tespit edildi. Kitle yerleşimi 10 olguda (%83,3) retroperitoneal bölgede, 2 olguda (%16,6) ise pelvik bölgede idi. Kliniğimize paroksismal hipertansiyon atakları ile başvuran hastaların beşinde kan ve 24 saatlik idrar testlerinde vanil mandelik asit ve metanefrin düzeyleri yüksek bulundu. Ortalama 60 aylık takip süresi boyunca sadece 1 hastada (%8,3) metastaz gelişti ve bu hasta ilk ameliyatından 2 yıl sonra tekrar ameliyat edildi. Bir hastada (%8,3) ameliyat sonrası 36. ayda kardiyak problemler nedeniyle mortalite gelişti. Sonuç: Abdominal paragangliomalar nadir görülen tümörler olup optimal yönetiminde cerrahın hastalık seyri boyunca son derece dikkatli olmasını gerektirir. Bu süreç, fonksiyonel veya

Turkiye Klinikleri Nuclear Medicine - Special Topics, 2016

Turkish journal of hematology, Nov 19, 2020

Kemik iliği infiltrasyonu (Kİİ), lenfoma evresini, sağkalımı ve tedaviyi etkiler. Lenfoma hastala... more Kemik iliği infiltrasyonu (Kİİ), lenfoma evresini, sağkalımı ve tedaviyi etkiler. Lenfoma hastalarında Kİİ' ni saptamada kemik iliği biyopsisi (KİB) ve positron emisyon tomografi-bilgisayarlı tomografi (PET/BT)' nin performanslarını değerlendirmek istedik. Gereç ve Yöntemler: 269 non-Hodgkin lenfoma (NHL) ve 110 hodgkin lenfoma (HL) hastası retrospektif olarak değerlendirildi. Kİİ' ni saptamada PET/BT ve KİB için duyarlılık, negatif prediktif değer (NPD) ve doğruluk hesaplandı. Bulgular: NHL olgularında Kİİ' ni saptamada PET/BT için duyarlılık, NPD ve doğruluk sırasıyla %65, %78 ve %84.4 iken KİB için %55, %73.4 ve %79.9 idi. Diffüz büyük B hücreli lenfoma ve folliküler lenfoma için PET/BT performansı KİB' den daha iyi iken; mantle-cell lenfoma, burkitt's lenfoma ve primer mediastinal B hücreli lenfomada KİB performansı daha iyiydi. HL olgularında PET/BT için duyarlılık, NPD ve doğruluk sırasıyla %91.3, %97.75 ve %98.18 iken KİB için %56.52, %89.69 ve %90.91 idi. KİB yapılması ile NHL grubunda 43 (%15.9), HL grubunda ise 2 (%1.8) olgunun düşük evrelenmesinden korunmuş olundu. Sonuç: Kİİ' ni saptamada NHL alt tiplerine göre değişmekle birlikte PET/BT ve KİB birbirini tamamlayıcı yöntemlerdir. HL' de ise Kİİ' ni saptamak için PET/BT önemli bir tanı aracıdır ve KİB olguların önemli kısmında gerekli değildir. Anahtar Sözcükler: Lenfoma, kemik iliği infiltrasyonu, PET/BT, kemik iliği biyopsisi Objective: Bone marrow infiltration (BMI) affects the stage of lymphoma, survey, and treatment. We aimed to evaluate the performance of bone marrow biopsy (BMB) and positron emission tomography-computed tomography (PET/CT) in detecting bone marrow infiltration in lymphoma patients. Materials and Methods: 269 non-Hodgkin's lymphoma (NHL) and 110 Hodgkin's lymphoma (HL) patients were evaluated retrospectively. Sensitivity, negative predictive value (NPV) and accuracy were calculated for PET/CT and BMB in detecting BMI. Results: Sensitivity, NPV and accuracy for PET/CT in detecting BMI in NHL cases were 65%, 78% and 84.4%, respectively, while 55%, 73.4% and 79.9% for BMB. PET/CT performance for diffuse large B-cell lymphoma and follicular lymphoma was better than BMB, whereas the performance of BMB was better for mantle-cell lymphoma, Burkitt's lymphoma and primary mediastinal B-cell lymphoma. Sensitivity, NPV and accuracy for PET-CT in HL cases were 91.3%, 97.75% and 98.18%, respectively, while 56.52%, 89.69% and 90.91% for BMB. Due to BMB, 43 (15.9%) patients in the NHL group and 2 (1.8%) patients in the HL group were protected from downstaging. Conclusion: PET/CT and BMB, although their results vary according to the NHL subtypes, are complementary methods in determining the BMI. In HL, PET/CT is an important diagnostic tool for detecting BMI, and BMB is not necessary in a significant proportion of cases.

CardioVascular and Interventional Radiology

Namık Kemal tıp dergisi, Sep 2, 2020

The study protocol conforms the ethical guidelines of the 1975 Declaration of Helsinki and the st... more The study protocol conforms the ethical guidelines of the 1975 Declaration of Helsinki and the study was approved by the local Ethics Committee and Institutional Review Board as meeting number 57, in 2016.

Üroonkoloji bülteni, Apr 1, 2020

We aimed to investigate the reliability and effectiveness of laparoscopic adrenalectomy (LA) in l... more We aimed to investigate the reliability and effectiveness of laparoscopic adrenalectomy (LA) in large adrenal masses by comparing LA results for large-and small-volume (<5 cm) masses. Materials and Methods: Patients who underwent LA due to adrenal mass between February 2004 and December 2018 in our clinic were retrospectively analyzed. The patients were divided into two groups as mass size <5 cm (group I) and ≥5 cm (group II). Patients who underwent open adrenalectomy and whose data were not available were excluded from the study. Perioperative data, postoperative results, complications, and histopathological results were examined. Results: There were 62 patients who underwent LA. Thirty-three patients (53.2%) had a left adrenal mass, and 29 patients (46.8%) had a right adrenal mass. Of the 62 adrenal masses, 46 (74.2%) had a diameter of <5 cm (group I), and 16 (25.8%) were ≥5 cm (group II). The mean tumor size was 3.2±0.15 and 6.4±3.5 cm in group I and group II, respectively. There was no statistically significant difference between the groups in terms of age, operative time, and blood loss. The average length of hospital stay was 37.6±20.9 hours in group I, while it was 49.8±22.9 hours in group II and was significantly longer in group II (p<0.05). Intraoperative blood pressure elevation occurred in one patient in group I and II. In a patient with suspected malignancy in group II, the surgery was shifted to open surgery as the capsule over the mass was opened. Hypopotasemia was observed in one patient, and atelectasis was observed in one patient in group I, and pneumonia was observed in one patient in group II. Conclusion: LA is a minimally invasive surgical method that can be applied safely in experienced centers in masses larger than 5 cm with no suspected invasion in preoperative imaging.

Bone Marrow Transplantation, Dec 13, 2004

Figure 2 Characteristic mixture of cells of various sizes, some plasma cells, large transformed c... more Figure 2 Characteristic mixture of cells of various sizes, some plasma cells, large transformed cells and small lymphocytes.

Molecular Imaging and Radionuclide Therapy, Oct 3, 2017

Super scan is a well-known finding described in skeletal scintigraphy characterized by uniform sy... more Super scan is a well-known finding described in skeletal scintigraphy characterized by uniform symmetrically increased radiopharmaceutical uptake by bones and consequently diminished renal parenchymal activity. Sy et al. hypothesized that the faint visualization of renal cortex in bone scintigraphy might be the result of increased uptake of radiopharmaceutical by pathologic bones and reduced phosphate excretion. The super scan on 18 F-fluorodeoxyglucose positron emission tomography/ computed tomography (18 F-FDG PET/CT) has been observed in various conditions such as prostate cancer, lung cancer, renal adenocarcinoma, gastric cancer and primitive neuroectodermal tumor of the kidney. Herein we report the first case of super scan in a 68-year-old-woman with parathyroid carcinoma observed both in 18 F-FDG PET/CT and Tc-99m methylene diphosphonate bone scintigraphy. There were extensive hypermetabolic lesions throughout the skeleton in 18 F-FDG PET/CT. In contrast to the intense hypermetabolism of the skeleton; the liver, skeletal muscles of the limbs, mediastinum, bowel and especially the brain showed very low FDG uptake. Additionally, there was increased skeletal radiotracer uptake relative to soft tissue, and faint genitourinary tract activity in bone scintigraphy.

PubMed, 2020

Aim: We aimed to evaluate; (i) the accuracy of ultrasonography (US), contrast-enhanced magnetic r... more Aim: We aimed to evaluate; (i) the accuracy of ultrasonography (US), contrast-enhanced magnetic resonance imaging (cMRI) and 18F-fluorodeoxyglucose positron emission tomography/computed tomography (18F-FDG PET/CT) for detection of axillary lymph node metastases (ALNMs), (ii) the role of late prone imaging, and (iii) the effect of PET/CT on preoperative staging of breast cancer. Material and methods: From June 2015 to January 2019, 236 breast cancer patients were preoperatively exam ined using US, cMRI, and PET/CT and whom underwent pathological evaluations of axillary lymph nodes were analyzed. The sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV), and accuracy (ACC) of US, cMRI, and PET/CT for ALNMs were determined. Results: There were 235 female and one male in our study. The mean age was 55,6±11,3 years. Of 158 patients who were histopathologically evaluated, 85 patients (36%) were negative and 73 patients (30.9%) were positive for ALNMs. The remaining 78 patients who were only radiologically evaluated with US and/or cMRI, 24 patients (10.2%) were negative and 54 patients (22.9%) were positive for ALNMs. The sensitivity, specificity, PPV, NPV, and ACC of PET/CT were 80.0%, 92.2%, 92.0%, 80.3%, and 85.7%, re spectively. The axillary lymph node, which was suspicious in supine imaging, remained in the suspicious group again in prone imaging in PET/CT. Conclusions: There is no single absolute modality for de tecting ALNMs in breast cancers to replace sentinel lymph node biopsy or axillary lymph node dissection. If ALNM is suspected based on PET/CT, axillary lymph node dissection without sentinel lymph node biopsy might be a better option because it is related to high possibilities of ALNM. Key words: Axillary lymph node metastasis, Magnetic resonance imaging, Ultrasonography, 18F-FDG PET/CT.

PubMed, 2020

Aim: In patients with colorectal cancer an accurate diagnostic work-up is mandatory in order to p... more Aim: In patients with colorectal cancer an accurate diagnostic work-up is mandatory in order to perform the most specific treatment. In this study, we aimed to evaluate the accuracy of computed tomography (CT), magnetic resonance imaging (MRI) and 18F-fluorodeoxyglucose positron emission tomography/computed tomography (18F-FDG PET/CT) for detection of regional lymph node metastases (RLNMs) and the additional value of PET/CT in the preoperative staging of colorectal cancer. Material and methods: From June 2015 to May 2018, 72 colorectal cancer patients were preoperatively examined using CT, MRI, and PET/CT. Histopathological examination of regional lymph nodes were performed in 53 patients who underwent colorectal surgery. The sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV), and accuracy (ACC) of CT, MRI, and PET/CT for RLNMs, and the additional value of PET/CT in distant metastases were determined. Results: There were 44 male and 28 female in our study. The mean age was 61±11 years. Histopathologically, 27 patients (51%) were negative and 26 patients (49%) were positive for RLNMs. The sensitivity, specificity, PPV, NPV, and ACC of PET/CT were 88.5%, 59.3%, 67.6%, 84.2%, and 73.6%, respectively. PET/CT changed the patient management with diagnostic contribution to the suspicious lesions identified by radiological imaging modalities. Conclusion: PET/CT is a useful tool in the evaluation of colorectal cancer, and it allows to metabolically characterize undetermined lesions suspected for recurrence of disease, to perform a complete pre-surgical staging and to identify occult metastatic disease. PET/CT should be considered an essential diagnostic tool in the management of patients with colorectal cancer, especially in the preoperative staging. Key words: Colorectal Cancer, Computed tomography, Magnetic resonance imaging, Positron emission tomography.

Cukurova Medical Journal, Jun 30, 2019

Öz Purpose: In this study, we aimed to determine the role of lymphoscintigraphy in patient manage... more Öz Purpose: In this study, we aimed to determine the role of lymphoscintigraphy in patient management of sentinel lymph node (SLN) biopsy. Materials and Methods: 25 skin cancer patients (16 malignant melanoma, 9 epidermoid carcinoma) were included in the study. Tc-99m Nanocolloid intradermal injection was applied to all patients on the day of operation. The projections of the sentinel lymph nodes on the skin were marked during preoperative lymphoscintigraphy. Patients were taken into operation after the marking. The lymph nodes with projections on the skin were detected by intraoperative gamma probe and excised. After removing all the sentinel nodes for histopathological examination, care was taken to reduce the residual radioactivity count in the bed, where sentinel lymph nodes were removed, to less than 10% of the activity of the most active activity of the resected node. Results: A total of 86 SLNs and 54 non-SLNs were surgically removed and all nodes were sent to the Department of Pathology for histopathological examination. Four patients had metastases in sentinel lymph nodes. These patients were reoperated under elective conditions for extensive surgery. Conclusion: Lymphatic mapping method with lymphoscintigraphy and intraoperative gamma probe have a high specificity and sensitivity ratio and minimize the morbidity. This method was thought to be a routine procedure in malignant skin tumors because of its determination of micrometastases, eliminating possible metastasis pathways, staging and guiding adjuvant therapy.

Turkiye Klinikleri Nuclear Medicine - Special Topics, 2018

Turkiye Klinikleri Nuclear Medicine - Special Topics, 2018

Journal of Women's Imaging, Dec 1, 2004

Chordomas are rare neoplasms of the axial skeleton that arise from notochordal remnants. There ha... more Chordomas are rare neoplasms of the axial skeleton that arise from notochordal remnants. There have been a few reports describing its scintigraphic findings on bone scan. We present here bone scan findings of a woman with both sacrococcygeal chordoma and huge myoma uteri. In this case, bone scintigraphy demonstrated a cold lesion corresponding to the sacrococcygeal chordoma and an increased uptake around the periphery of the defect. Bone imaging did not show any other bone pathology. However, a large area of increased tracer uptake was seen extending from the abdomen to the pelvis strongly suggesting soft tissue mass. Surgical specimen revealed a leiomyoma of the uterus.

Molecular Imaging and Radionuclide Therapy, Feb 1, 2019

Extra-pulmonary accumulation of Tc-99m-macroaggregated albumin (MAA) is described as uptake areas... more Extra-pulmonary accumulation of Tc-99m-macroaggregated albumin (MAA) is described as uptake areas out of the lung in perfusion scintigraphy. If the particles spread throughout the body before reaching the lung via venous collaterals or due to right-to-left shunt, or if the particles are too small to occlude the pulmonary capillaries, then the agent can be seen at different locations of the body. Extra-pulmonary accumulation of Tc-99m-MAA can be detected mostly in the liver as well as in the brain, kidney, thyroid, myocardium, spleen and vertebra. Herein, we present lung scanning images with unexpected hepatic accumulation of Tc-99m-MAA. This pulmonary perfusion scintigraphy was performed in a patient with end-stage renal disease due to dyspnea in the post-operative period of kidney transplantation.

Journal of Oncological Sciences, Apr 1, 2018

Marginal zone lymphoma (MZL) is low grade lymphoma and accounts about 5% of all lymphomas and 5 e... more Marginal zone lymphoma (MZL) is low grade lymphoma and accounts about 5% of all lymphomas and 5 e10% of MZLs are localized in the lung. Interstitial Lung Disease (ILD) is a group of systemic diseases characterized by diffuse inflammation in lung and there is a long list for differential diagnosis. Here we represent a 53 years old man who had been followed as ILD by the department of chest diseases for 1,5 years. Biopsy taken by wedge resection was reported as MZL.

BMC Cancer, Mar 6, 2021

Background: Neuroendocrine tumours (NETs) arise from hormone-producing or nervous system cells an... more Background: Neuroendocrine tumours (NETs) arise from hormone-producing or nervous system cells and can develop from anywhere in the body. They have heterogeneous origins from skin to gastrointestinal track and a complicated histology. Thus, there is an inevitable need for genomic profiling to determine the exact genetics of each tumour for prognosis and treatment strategies to overcome the disease's complexity. For this purpose, nextgeneration-sequencing (NGS) is the most reliable methodology for both germ-line and somatic studies to make a clinical diagnosis. In this study, we analyse liquid biopsies, formalin fixed paraffin embedded (FFPE) tissues, and peripheral blood samples for their ability to provide information for actionability. Methods: A customized multi-gene panel comprised of Succinate Dehydrogenase Complex Iron Sulfur Subunit B (SDHB), Succinate Dehydrogenase Complex Subunit C (SDHC), Cell Division Cycle 73(CDC73), Calcium Sensing Receptor (CASR), Platelet Derived Growth Factor Receptor Alpha (PDGFRA), Succinate Dehydrogenase Complex Flavoprotein Subunit A (SDHA), Ret Proto-Oncogene (RET), Succinate Dehydrogenase Complex Assembly Factor 2(SDHAF2), Menin 1(MEN1), Succinate Dehydrogenase Complex Subunit D (SDHD), MYC Associated Factor X (MAX) and Protein Kinase CAMP-Dependent Type I Regulatory Subunit Alpha (PRKAR1A) genes was constructed to assess multiple specimen types including: 3 liquid biopsies, 6 FFPE tissues, and 26 peripheral blood samples from 35 unique NET patients. Quality-control and bioinformatics analyses were performed using QCI-Analyze and QCI-Interpret. Results: The three liquid biopsies and the 6 FFPE tissue samples were evaluated for somatic mutations; while the 26 peripheral blood samples were analysed using the germ-line pipeline. Five (55.6%) of the nine patients that were studied for somatic changes carried actionable mutations related to therapy sensitivities. Through the germ-line studies, we observed a 50% positivity rate for disease predisposition with 16 variants classified according to ACMG (American College of Medical Genetics) Standards and Guidelines.

Clinical Nuclear Medicine, Jul 1, 2005

... 2. Slavin JD Jr, Skarzynski JJ, Spencer RP. Radionuclide demonstration of urinary bladder-to-... more ... 2. Slavin JD Jr, Skarzynski JJ, Spencer RP. Radionuclide demonstration of urinary bladder-to-colon fistula following radiation therapy. Clin Nucl Med. 1985;10:829. Cited Here... 3. Panoutsopoulos G, Ilias I, Yiannakopoulos V. Vesicocecal fistula detected during dynamic ...

Cancer management and research, Apr 1, 2019

The aim of this study was to evaluate the prognostic and predictive value of neutrophilto-lymphoc... more The aim of this study was to evaluate the prognostic and predictive value of neutrophilto-lymphocyte ratio (NLR), derived neutrophil-to-lymphocyte ratio (DNLR), lymphocyte-tomonocyte ratio (LMR), and platelet-to-lymphocyte ratio (PLR) in soft tissue sarcoma (STS) cases treated with pazopanib. Materials and methods: The study population included 26 STS cases treated with pazopanib for at least 3 months. NLR, DNLR, LMR, and PLR were evaluated at baseline, and at third month of therapy and also compared with response to pazopanib. Median measurements were taken as cutoff for NLR (4.8), DNLR (3.1), LMR (3.6), and PLR (195). The associations between these cutoff values and survival times (progression-free survival [PFS] and overall survival [OS]) were assessed by Kaplan-Meier curves and Cox proportional models. Results: Patients with low pretreatment NLR and DNLR had longer OS (P=0.022, P=0.018), but low PLR was found to be associated only with longer OS. Additionally, decrease in NLR and DNLR after 3 months of therapy as compared with pretreatment measurements was found to be associated with an advantage for OS (P=0.021, P=0.010, respectively) and PFS (P=0.005, P=0.001, respectively). Response to pazopanib; changes in NLR, DNLR, LMR, and PLR; and >3 metastatic sites were found to be independent risk factors in univariate analysis, but NLR was the only independent risk factor in multivariate analysis. Conclusion: Low pretreatment and decrease in NLR and DNLR values, and regression/stable disease after 3 months of pazopanib are predictive factors for longer OS and PFS.