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Öğe Acquired lymphangioma circumscriptum of the vulva secondary to radiotherapy(Int Scientific Literature, Inc, 2010) Akansu, Bulent; Atik, Esin; Altintas, Suleyman; Serarslan, Gamze; Dolapcioglu, Kenan; Canda, M. SerefettinBackground: Lymphangioma circumscriptum is a benign lesion of the lymphatics. The primary form of the disease is generally seen at birth or during childhood, whereas the secondary (acquired) form is a result of radiotherapy or a surgical procedure. Case Reoprt: A 38-year-old female patient was admitted to hospital with the complaint of skin eruptions on her vulva. About 10 years before she had had a total abdominal hysterectomy and bilateral salpingo-oophorectomy because of squamous cell carcinoma of the cervix and radiotherapy had been performed to the perineal region after surgery. Papillary-like lesions on the skin were seen in gross examination. These lesions were diagnosed as acquired lymphangioma circumscriptum by microscopy. Conclusions: Acquired lymphangioma is a benign lesion which can appear many years after radiotherapy. Several pre-malignant and malignant lesions can also occur following radiotherapy in this region. Therefore it is important for the clinician and pathologist to be aware of this situation and be careful when making the differential diagnosis.Öğe A Case of Nonhealing Leg Ulcer: Basal Cell Carcinoma(Galenos Yayincilik, 2008) Balci, Didem Didar; Yenin, Julide Zehra; Atik, Esin; Akansu, BulentA 75-year-old woman was admitted to our outpatient clinic with a three-year history of a painless, nonhealing ulcer located on the left lower leg. She had no response to previous therapy with local wound care. Skin examination revealed an ulcer 2.7 x 3.7 cm in size, and the surrounding skin showed minimal erythema. The surface of the ulcer demonstrated shiny granulation tissue. Biopsy of the ulcer edge and base showed basal cell carcinoma. Venous Doppler ultrasonography and dermatological examination did not reveal chronic venous insufficiency. Basal cell carcinomas rarely arise from previous long-term ulcers or developing de novo. We suggest that patients who develop non-healing leg ulcers, should be examined for basal cell carcinoma.Öğe Expression of cyclooxygenase-2 and its relation to histological grade, inducible nitric oxide synthase, matrix metalloproteinase-2, CD-34, Caspase-3, and CD8 in invasive ductal carcinoma of the breast(Saudi Med J, 2010) Atik, Esin; Akansu, Bulent; Bakaris, Sevgi; Aban, NedimObjectives: To assess by immunohistochemistry the cyclooxygenase-2 (COX-2) expression in invasive ductal carcinoma and its possible correlation with the histological grade, inducible nitric oxide synthase (iNOS), matrix metalloproteinase-2 (MMP2), and other common immunohistochemical parameters (CD-34, Caspase-3, and CD8). Methods: This was a retrospective pathology archive study including 50 female patients and was performed in Mustafa Kemal University, Hatay, and Sutcu Imam University, Kahraman Maras, Turkey. The routine hematoxylin-eosin staining and COX-2, iNOS, MMP-2, CD-34, CASP-3, and CD8 immunoperoxidase techniques were performed on paraffin-embedded tissues. Results: The mean value of COX-2 was 274.02 +/- 54.49 and MMP-2 was 263.42 +/- 54.30, whereas the mean iNOS values were 258.10 +/- 56.05. CD-34 staining also yielded positive results as 26.18 +/- 8.00. The mean value of CASP-3 was 284.06 +/- 41.2 and CD8 was 164.17 +/- 69.5. This reveals an inverse correlation between CASP-3 reactivity and CD8 (Spearman correlation [r]= -0.33, p=0.01). There was also an inverse correlation between iNOS reactivity and patients age (r = -0.29, p=0.03). There was a positive correlation with COX-2 and MMP-2 (p=0.00), but there was no relation with COX-2 and other parameters. Conclusion: COX-2 expression is an important parameter for invasive ductal carcinoma of the breast. We found a positive correlation between COX-2 and MMP-2, whereas, we could not show direct correlation between COX-2 and iNOS, CD-34, CASP-3, and CD8.Öğe Factors Predicting Non- Sentinel Lymph Node Involvement in Sentinel Node Positive Breast Carcinoma(De Gruyter Open Ltd, 2011) Durak, Merih Guray; Akansu, Bulent; Akin, Mehmet Mustafa; Sevinc, Ali Ibrahim; Kocdor, Mehmet Ali; Saydam, Serdar; Harmancioglu, OmerObjective: In routine practice, axillary lymph node dissection is performed in early invasive breast cancer patients with positive sentinel node biopsy. However, sentinel node is the only involved axillary node in 40-70% of patients, and determining factors that predict axillary non-sentinel node involvement will therefore prevent unnecessary axillary lymph node dissection and decrease morbidity. Material and Method: In this study, 119 invasive breast cancer patients with sentinel node metastasis who underwent axillary lymph node dissection between 1998-2009 at our institution were studied. Primary tumor characteristics and features of the metastatic tumors in sentinel nodes, such as microanatomic location, size of metastasis, and the ratio of metastatic tumor area to the total sentinel node area were evaluated. Student's t-test and multivariate logistic regression were used for statistical analysis. Results: The mean age of the patients was 50.7 years (28-80). Forty-three patients (36%) had invasive ductal and 25 patients (21%) had invasive lobular carcinoma. Most of the patients had either pT1 (44%) or pT2 (54%) tumors. Fifty-four patients (45%) had no further positive nodes in the axilla. The metastatic deposits in the sentinel node were subcapsular in 16 patients (13%). The percent area of sentinel node occupied by tumor (p<0.001), number of sentinel nodes (p=0.041), and microanatomic location of metastatic tumor (p=0.002) were significantly associated with non-sentinel node metastasis in univariate analysis. The percent area of sentinel node occupied by tumor (p<0.001) and number of sentinel nodes (p=0.033) remained significantly associated with non-sentinel node involvement in multivariate analysis. Conclusion: In patients with invasive breast cancer and positive sentinel node, area percent of sentinel node occupied by tumor, and the number of sentinel nodes removed are independently predictive of non-sentinel node involvement.Öğe Intravenous leiomyomatosis of uterus: A case report(De Gruyter Open Ltd, 2006) Atik, Esin; Altintas, Suleyman; Akansu, Bulent; Zeteroglu, Sahin; Gungoren, ArifIntravenous leiomyomatosis is an uncommon variant of uterine leiomyomas. These tumors originate from smooth muscle cells of veins or lymphatics. Generally, they can't be diagnosed before surgery. Both gross and histopathological findings are important for diagnosis. Growing into the right ventricle through inferior vena cava may be seen in some of the cases. Benign cystic lung metastases have been also reported. In this article, a 42 year-old woman who had 3 children applied to our outpatient clinic of gynecology with pelvic pain and abnormal menstrual bleeding which had started 7 years ago, is presented. In physical examination uterus was palpated as hard, painful, and abnormally large. Total abdominal hysterectomy and unilateral salphingo-oophorectomy was performed with myomatosis uteri prediagnosis. During operation, frozen section specimen was diagnosed as intravenous leiomyomatosis. By presenting this case, we aim both to emphasize the importance of post-diagnosis follow-up of patients, and also evaluate intravenous leiomyomatosis in the light of literature.Öğe Massive Edema of the Ovary: Case Report(De Gruyter Open Ltd, 2010) Akansu, Bulent; Atik, Esin; Altintas, Suleyman; Gungoren, Arif; Canda, M. SerefettinMassive ovarian edema is a rare condition characterized by marked enlargement of one or both ovaries as a result of accumulation of edema fluid in stroma. It is a benign lesion and is generally seen in young females between 6-33 years of age. Our aim is to remind that massive ovarian edema should be considered in the differential diagnosis especially in young patients to avoid aggressive treatment. Our patient was a 17-year-old female who was admitted to our hospital with complaints of irregular menstruation and right groin pain for the last 3 months. There was no remarkable finding in the physical examination. 'Sex-cord stromal tumor (luteinized thecoma)' could not be excluded in the intraoperative frozen section. The diagnosis was reported as 'massive ovarian edema' with routine examination. Pathological evaluation is required because of the difficulty of differentiating these lesions from malignant lesions with radiological methods in the pre-operative period. Although it is a rare lesion, clinicians and pathologists should consider it in the differential diagnosis to avoid aggressive treatment.Öğe Periosteal Chondroma of the Ischium; An Unusual Location(De Gruyter Open Ltd, 2012) Akansu, Bulent; Atik, Esin; Altintas, Suleyman; Kalacı, Aydıner; Canda, SerefettinPeriosteal chondroma is a rare benign tumor of hyaline cartilage. Periosteal chondroma arising in the ischium is an extremely rare event. By presenting this case report, we aim to remind that differential diagnosis of these lesions should be carefully performed especially for unusual locations. A 51-year-old man visited the orthopedics clinic with the complaints of left pelvic mass and pain lasting about one year. Computed tomography showed a solid mass with abundant specks of calcification that was 4x5 cm in diameter and associated with the ischium of the left pelvic bone. There was no evidence of penetration into the medullary cavity and cortical sclerosis. No radiological aggressive appearance was observed. The lesion was removed with the covering periosteum. Microscopically, there were lobules of hyaline cartilage composed of chondrocytes with foci of endochondral ossification and calcification. The case was reported as 'periosteal' chondroma'. In conclusion, this case report presents a case of periosteal chondroma, a rare tumor, which occurred in an unusual location and age range. The differential diagnosis of periosteal chondroma from malignant lesions is necessary for avoiding aggressive and inappropriate treatment.Öğe Villous adenoma of the urinary bladder: rare location(Termedia Publishing House Ltd, 2012) Atik, Esin; Akansu, Bulent; Davarci, Mursel; Inci, Mehmet; Yalcinkaya, Fatih; Rifaioglu, MuratVillous adenomas are common lesions of the gastrointestinal tract but they are rarely located in the urinary tract including the urinary bladder. There are a few case reports and series in the literature. Here we report a 43-year-old male patient who had a polypoid lesion located on the left lateral wall of the urinary bladder. Transurethral resection was performed. The diagnosis was 'villous adenoma of urinary bladder' with clinical and histopathological findings. Villous adenomas are mostly seen in elderly males. The coexistence of villous adenoma with adenocarcinoma, squamous cell carcinoma, and urothelial carcinoma was observed but there is not clear evidence about progression to carcinoma, in spite of its colonic counterpart. Generally complete surgical resection is accepted as curative but there are no exact data about follow-up and recurrence. By presenting this case, we aim to emphasize that it is a rare but important lesion because of coexistence with malignancies and uncertain malignant potential.
