-
[show abstract]
[hide abstract]
ABSTRACT: AIM: To share our experience in ovary-sparing surgery for teratomas in children. PATIENTS AND METHODS: The medical records of nine patients (mean age of 11.2 years, r 6-15 years) who had undergone ovary-sparing surgery for teratoma were analyzed retrospectively. Mean duration for follow-up was 29.5 months (r 15-75 months). RESULTS: Five patients suffered from chronic abdominal pain; two had acute colicky abdominal pain. In two patients, there was no presenting clinical symptom. Two patients were operated on emergency basis due to symptoms related with acute abdomen. On the other hand, seven were operated electively. Ultrasonography was performed in all patients. Additionally, MRI and tumor markers were performed in all but two. Main radiologic findings consisted of heterogenous cystic and solid ovarian masses predictive of teratoma. The definitive diagnosis in emergency cases were as follows: perforated appendicitis plus teratoma [1]; torsion of the ovarian mass with teratoma [1]. The final diagnosis in electively treated seven patients were: unilateral ovarian teratoma [4], bilateral ovarian teratoma [1], bilateral teratoma plus appendiceal inflammatory mass [1], unilateral teratoma and contralateral corpus hemorrhagicum cyst [1]. The operations were performed by open conventional surgery in six and laparoscopy in three patients. The procedures were ovary-sparing surgery in 12 ovaries, appendectomy in 2 patients and detorsion of ovary in 1 patient. The main indication for ovary-sparing surgery was the "existence of a perfect dissection plane between the tumor margins and healthy ovarian tissue". The remaining ovarian tissue was evaluated macroscopically for residual lesions. Frozen section was performed in three suspected patients and the ovarian margins were free of any tumor cell. The pathologic diagnosis was: mature cystic teratoma in 10, immature teratoma in 1 and corpus hemorrhagicum cyst in 1. The postoperative outcome and follow-up was uneventful. CONCLUSION: Heterogenous ovary mass containing solid and cystic portions with echogenic areas on ultrasound imaging is highly suggestive of ovarian teratomas. Emergent surgical intervention is indicated if there is any suspicion of ovarian torsion. Otherwise, MRI is performed for further radiological evaluation. Based on radiologic findings, ovary-sparing surgery can be safely performed if the preoperative diagnosis is teratoma and there is always a plane of dissection between the normal ovary and cyst wall.
Pediatric Surgery International 12/2012; · 1.25 Impact Factor
-
[show abstract]
[hide abstract]
ABSTRACT: Eosinophilic cystitis is an inflammatory condition characterized by eosinophilic infiltration of whole layers of the bladder wall. The condition occurs more commonly in adults. We report a case of eosinophilic cystitis mimicking a bladder tumor in a 5-year-old boy with symptoms of dysuria and urinary incontinence. The diagnosis was confirmed by histopathology and he underwent clinical treatment with trimethoprim-sulfamethoxazole and antihistamine (cetirizine). The symptoms fully resolved in follow up, which is continuing. Although very rare, eosinophilic cystitis should be considered in cases of dysuria and increased bladder wall thickness but no identified urinary tract infection.
Journal of pediatric urology 05/2012; · 1.38 Impact Factor
-
[show abstract]
[hide abstract]
ABSTRACT: Myofibroma/myofibromatosis is a rare mesenchymal disorder that is part of a heterogeneous group of approximately 20 disorders that are classified primarily according to the proliferation of benign fibrous elements. These lesions can arise during a wide range of ages, with many occurring in the first decade of life, and they are slightly more common in males than females. The etiology of this disease is not well understood. Clinically, patients with myofibroma/myofibromatosis present with various signs, ranging from superficial, cutaneous, purplish macules to freely movable subcutaneous masses to deep-seated fixed lesions. The definitive diagnosis is made on histopathologic grounds. The destructive clinical behavior of myofibroma/myofibromatosis in the setting of insufficient pre- or perioperative diagnostic evaluations (e.g., a failure to perform fine-needle aspiration or frozen-section biopsy) may guide the clinician toward a radical surgical procedure rather than a simple excision.
Ear, nose, & throat journal 07/2011; 90(7):E1-4. · 0.66 Impact Factor
-
Canan Akyüz,
Bilgehan Yalçin,
Inci Yildiz,
Volkan Hazar,
Asim Yörük,
Gülnur Tokuç,
Ferhan Akici,
Nebil Büyükpamukçu,
Gülsev Kale,
Lale Atahan, [......],
Ayhan Dağdemir,
Emin Darendeliler,
Serdar Sander,
Uğur Kuyumcuoğlu,
Naciye Ozşeker,
Funda Corapçioğlu,
Atilla Tanyeli,
Oznur Düzovali,
G Burça Aydin,
Münevver Büyükpamukçu
[show abstract]
[hide abstract]
ABSTRACT: To standardize diagnosis and treatment of childhood Wilms tumor (WT) in Turkey.
Between 1998 and 2006, WT patients were registered from 19 centers. Patients <16 years with unilateral WT whose treatment started in first postoperative 3 weeks were included. Treatments were stage I favorable (FH) and unfavorable histology (UH) patients, VCR + Act-D; stage IIA FH, VCR + Act-D; stage IIB FH, VCR + Act-D + radiotherapy (RT); stage III-IV FH, VCR + Act-D + adriamycin (ADR) + RT; stages II-IV UH tumors, VCR + Act-D + ADR + etoposide + RT.
165/254 registered cases were eligible (bilateral, 5.9%) [median age 3.0 years; M/F: 0.99; 50/165 cases < or =2 years]. 9.7% cases had UH tumors. Disease stages were stage I 23.6%; IIA 36.4%; IIB 5.5%; III 22.4%; IV 12.1%. Cases >2 years had significantly more advanced disease. 1/11 cases with recurrent disease died; 2/165 had progressive disease, 2/165 had secondary cancers, and all 4 died. In all cases 4-year OS and EFS were 92.8 and 86.5%, respectively. Both OS and EFS were significantly worse in stage IV.
Despite problems in patient management and follow-up, treatment results were encouraging in this first national experience with a multicentric study in pediatric oncology. Revisions and modifications are planned to further improve results and minimize short- and long-term side effects.
Pediatric Hematology and Oncology 04/2010; 27(3):161-78. · 0.89 Impact Factor
-
[show abstract]
[hide abstract]
ABSTRACT: To identify misdiagnostic points of hemangiopericytomas (HPs) of the head and neck.
We reviewed our clinical records from 2000 to 2007 retrospectively and identified 5 patients with HP of the head and neck. The records of each patient with head and neck HP were evaluated for age, sex, location of primary, clinical course, treatment, and tumor embolization (if performed). Pathologic slides of all patients were reviewed to identify histologic features and correlation with the clinical course and outcome for each lesion.
Five patients with HP that arose from head and neck sites were identified. Five patients included 3 women and 2 men aged 9 to 52 years, with an average of 33.2 years. Each lesion of the patients derived from different parts of the head and neck. The most common complaints were painless mass (3 of 5) and nasal airway obstruction (3 of 5). Magnetic resonance imaging of the 3 patients reflected hyperintense on T2-weighted imaging and hypointense on T1-weighted imaging with diffuse enhancement after intravenous administration of gadolinium. Angiography was performed to all these 3 patients, and only 1 patient with cranial HP involvement did not show significant vascularity. Two patients had preoperative histopathologic results. All patients were operated on with appropriate approach. Pathologic slides of all patients were investigated and graded according to the tumor diameter, cellularity, mitotic rate, and necrosis.
Differential diagnosis of clinical features and radiologic and pathologic aspects must be managed more carefully. Diagnostic way of these tumors has different pitfalls for the clinician.
The Journal of craniofacial surgery 06/2009; 20(3):930-5. · 0.81 Impact Factor
-
[show abstract]
[hide abstract]
ABSTRACT: Chemical and physical effects of cementation cause radiographic and histological changes at bone-cement interface. These changes can be of interest in the assessment of the residual lesions and subsequent recurrences after local resection and cementation of local aggressive tumours.
The aim of the study was to evaluate the evolution and determine the stages of the changes that occur at the bone-cement interface after cementation of cavitary lesions.
We operated on 16 hind legs of 8 sheep (Ovies Aries) under general anaesthesia (Xylasin HCl, Ketamin HCl and Forane). A bone cavity of 12 cm(3) was produced by curettage of the distal femoral condyle and was filled with cement. Control radiographs were taken at 2 days; 3, 6 and 12 weeks, and again at 6 months. One sheep each time was killed after second day and sixth month and two sheep each time after the third, sixth and 12th week and the specimens underwent pathological examination.
After the first 3 weeks, a reactive fibrous membrane was detected on pathological examinations. This membrane consisted of granulation tissue, necrotic bone and bone marrow, which were replaced gradually by fibrous tissue. The radiographic revelation of this fibrous membrane was a radiolucent zone of 0.5-1.5 mm at 3 weeks. A Sclerotic rim appeared around this radiolucent zone at 6 weeks. With new bone formation the fibrous membrane disappeared at 3 months. This was seen on radiographs as the replacement of the radiolucent zone by a sclerotic ring of 0.5-2 mm. This sclerotic ring disappeared at 6 months, when a diffuse sclerosis and cortical bone thickening was detected on radiographs.
According to our findings we suggest to consider the pathological processes at the bone-cement interface in 3 phases: (1) Reactive phase (first 3 weeks); (2) Resorption phase (3-6 weeks), and (3) Formation phase (6 weeks to 6 months). We have distinguished five different radiographic stages: Stage 1-Early stage with no apparent zone (first 3 weeks); Stage 2-Radiolucent zone (3-6 weeks); Stage 3-Radiolucent zone with a sclerotic rime (6 weeks to 3 months); Stage 4-sclerotic ring (after 3 months) and Stage 5-Diffuse cortical thickening (after 6 months). Determining the phases of tissue reaction after cementation and its radiographic revelation will ease the diagnosis of residual lesions and subsequent recurrences after local resection and cementation of local aggressive tumors.
Archives of Orthopaedic and Trauma Surgery 07/2008; 128(10):1187-91. · 1.37 Impact Factor
-
[show abstract]
[hide abstract]
ABSTRACT: Renal osteodystrophy is one of the major causes of morbidity in patients receiving long-term dialysis treatment for renal failure and after transplantation. Its clinical implications include high-turnover bone disease, low-turnover bone disease, osteomalacia, osteosclerosis, and osteoporosis. A 13-year-old boy who had been on dialysis treatment for renal failure was admitted with a pathologic supracondylar femur fracture after a minor trauma. Radiological studies showed cystic lesions in the femoral supracondyle, left acetabular roof, and right proximal and distal tibia. Based on radiologic appearances of the lesions and on histopathologic findings of the lesion excised from the right distal tibia, brown tumor and fibrous dysplasia were considered in the differential diagnosis. Initially, serum parathyroid hormone level was slightly increased and calcium level was normal, but during follow-up, serum parathyroid hormone level increased significantly, enabling the diagnosis of brown tumor.
acta orthopaedica et traumatologica turcica 02/2008; 42(4):296-301. · 0.34 Impact Factor
-
[show abstract]
[hide abstract]
ABSTRACT: Liposarcoma is one of the most common soft tissue sarcomas in adults. Atypical lipomatous tumour (ALT) rarely occurs in the head and neck region. Histopathologic grade of these tumours affect prognosis of this disease. The mainstay of treatment for ALT is surgical excision. In this article, a case of a huge ALT arising from the head and neck region and invading nearly entire left hemi-facial region is presented. Clinical and histopathologic features and therapeutic approaches related to this tumour are discussed reviewing the literature.
Archiv für Klinische und Experimentelle Ohren- Nasen- und Kehlkopfheilkunde 09/2007; 264(8):947-50. · 1.29 Impact Factor
-
[show abstract]
[hide abstract]
ABSTRACT: Alveolar soft part sarcoma (ASPS) is a rare malignancy. It has generally a poor prognosis. Survival depends on the presence of metastases. Approximately, one-fourth of the cases are encountered in the head and neck region, mostly in the orbits and tongue. Surgery is accepted as the most effective treatment, radiotherapy and chemotherapy may be used as adjuvant treatments. Since it is a highly vascular tumor, profuse bleeding may occur during surgery. In this article, we report a case of ASPS occurring in the larynx, an extremely rare location for this rather unusual tumor. To our knowledge, only three cases of laryngeal ASPS have been previously reported in the English literature.
Archiv für Klinische und Experimentelle Ohren- Nasen- und Kehlkopfheilkunde 05/2007; 264(4):445-9. · 1.29 Impact Factor
-
[show abstract]
[hide abstract]
ABSTRACT: There is a controversy in the literature whether testicular nubbins carry malignancy risk and excision of the nubbin is necessary in patients with nonpalpable testis. It is also controversial whether vanishing testis has the same etiopathogenesis and risk with true undescended testis. The aim of this study is to investigate the histological findings of testicular nubbins in patients with nonpalpable testis and to question etiology and surgical indications for vanishing testis. We reviewed the histopathological results of 44 testicular nubbins in 40 patients (mean age: 4.1 years, range 1-13 years) with nonpalpable testis between 1992 and 2004, retrospectively. Exploration revealed 5 intraabdominal and 39 inguinal testicular nubbins. Of 44 specimens only 5 (11.3%) from inquinal testicular nubbins were found to have seminiferous tubules. Two of the five had seminiferous tubule structures with viable germ cells showing maturation correlating with age. The other two with scarce seminiferous tubules were seen on only a single area and one had Sertoli cells only. None of the excised tissue had malignant degeneration. The vas deferens was identified in 23 (52.2%), vessels in 26 (59%), calcification in 14 (31.8%) and hemosiderin in 12 (27.2%) of excised tissue. Presence of calcification in one-third of the nubbins supports vascular accident thesis in the etiopathogenesis of vanishing testis. The possibility for the presence of seminiferous tubules and viable germ cells in the testicular nubbin is low. These facts decrease theoritical risk of malingnancy. Therefore, an inguinal exploration for testicular nubbin in patients with vas deferens and vessels entering into the inquinal canal diagnosed at laparoscopy can be postponed untill testicular prosthesis implantation and the nubbin can be removed at this operation.
Pediatric Surgery International 02/2007; 23(1):41-4. · 1.25 Impact Factor
-
[show abstract]
[hide abstract]
ABSTRACT: This study aimed to develop an alternative thermoinactivation method for biological inactivation of microscopic contamination on the cavity wall following curettage of local aggressive tumors. Hot saline irrigation was applied at various temperatures to bone cavity, with or without tourniquet on the extremity and temperature changes and local effects were investigated in vivo.
Bone cavities 12 cm3 in size were created in the condylar regions of the hind legs in nine female adult sheep. The cavities were irrigated by hot saline solution at 60, 70, 75, 80, or 100 degrees C, with and without the presence of a tourniquet, and the temperatures 1, 2, 3, and 10 mm distant to the cavity wall were recorded. The animals were sacrificed postoperatively at 2 days, 3 and 6 weeks, and 3 and 7 months for histologic studies.
The mean body temperature and temperature inside the bone prior to surgery were measured as 38.1 degrees C and 27.34 degrees C, respectively. Tourniquet application caused a mean decrease of 1.5 degrees C (range 1-2 degrees C) in bone temperature. The highest temperatures measured below 80 degrees C and at 80 degrees C were 55.5 degrees C and 62.5 degrees C in the cavity, and 40.5 degrees C and 42.5 degrees C in the bone, respectively. At 100 degrees C, the color of the bone together with the surrounding soft tissue and muscle tissue turned to yellow-brown-black, and the animal died on the second postoperative day. At temperatures <or=80 degrees C, the color of the bone and surrounding tissues appeared normal and no early complications were encountered. Histologic studies showed no bone marrow or bone necrosis at 60 degrees C, only bone marrow necrosis at 70 degrees C and 75 degrees C, and in addition to bone marrow necrosis, bone necrosis at 80 degrees C. At these temperatures no evidence for soft tissue necrosis were observed.
Our results show that, in order to achieve bone necrosis at 1-mm and 2-mm distances from the cavity wall, the optimum temperature for hot saline irrigations applied to the bone cavity is 80 degrees C.
acta orthopaedica et traumatologica turcica 01/2007; 41(3):225-32. · 0.34 Impact Factor
-
[show abstract]
[hide abstract]
ABSTRACT: Gastric cancer metastatic to skeletal muscle is an unusual entity. Surgery, systemic chemotherapy, or radiotherapy to the metastatic mass can be treatment options for achiving palliation. Case Report: A patient with multiple skeletal muscle metastases that occurred during follow-up after gastrectomy and adjuvant chemo-radiotherapy is reported. Magnetic resonance imaging (MRI) demonstrated soft-tissue masses involving the posterior right paralumbar and posterior left paradorsal muscles. Biopsy showed metastatic infiltrating adenocarcinoma. The patient did not respond to palliative chemotherapy. Palliative radiotherapy was administered to the painful mass. Based on this case, the diagnosis of muscle metastases and treatment options for palliation are discussed.
Radiation Medicine 03/2006; 24(2):150-3.
-
[show abstract]
[hide abstract]
ABSTRACT: To assess the role of preoperative radiotherapy in patients with nonmetastatic high-grade osteosarcoma of the extremities for limb-sparing surgery and to compare the response of neoadjuvant therapies, local control, and survival with the literature results.
Forty-six patients with osteosarcoma of the limbs who were treated within a limb salvage protocol including preoperative radiotherapy and chemotherapy between 1987 and 2002, were retrospectively analyzed. Median age was 17 years (range, 14-66 years). Treatment was started with neoadjuvant chemotherapy. Cisplatin, epidoxorubicin, ifosfamide, and methotrexate were used in different combinations. Preoperative radiotherapy was applied, usually between the second and third cycle of chemotherapy. Radiotherapy was given (35 Gy in 10 fractions) to 44 patients. Two patients were treated with 46 Gy at 2 Gy/day. Definitive surgery was administered after the third course of chemotherapy. Chemotherapy was complete 6 courses postsurgery.
Median follow-up time was 44 months (range, 2-154 months). Forty-four patients had limb-sparing surgery, whereas 2 had amputation. Tumor necrosis rate was >/=90% in 87% of the patients (Huvos Grade 3-4). Two patients had local failures, and 26 patients (56.5%) had distant metastases. The 5-year local control and overall survival rates were 97.5% and 48.4%, respectively. On univariate analysis, age </=18 years, Huvos Grade 4, lower-extremity localization, and surgery within 1 month significantly survived better than the others. On multivariate analysis, Huvos grade (p = 0.01), age (p = 0.01), interval between neoadjuvant chemotherapy and surgery (p = 0.02), and extremity localization (p = 0.02) were significant prognostic factors for actuarial survival. Severe complication developed in 20% of the patients.
Preoperative radiotherapy helps to increase the chance of extremity-sparing surgery with good local control and necrosis rate when combined with chemotherapy.
International Journal of Radiation OncologyBiologyPhysics 08/2005; 62(3):820-8. · 4.11 Impact Factor
-
[show abstract]
[hide abstract]
ABSTRACT: The authors present a 4-year-old boy who had a large mucin-hypersecreting hepatobiliary cystadenoma. The tumor caused a hepato-colo-cutaneous fistula, which produced a large amount of external fluid loss. Total excision and the repair of the fistula could be possible after shrinkage of the tumor with the use of selective embolization of the feeding artery by interventional radiology.
Journal of Pediatric Surgery 02/2004; 39(1):E6-8. · 1.45 Impact Factor
-
[show abstract]
[hide abstract]
ABSTRACT: Intra-articular hemangioma of the knee is a rare cause of pain and spontaneous hemarthrosis, often seen as an internal derangement of the joint in children and young adults. The tumor is observed in two different forms: the synovial hemangioma or the arteriovenous malformation named also as hemangiohamartomas. They may cause hemorrhagic synovitis and arthropathy, probably as a result of recurrent episodes of intra-articular bleeding and mechanical irritation. Four cases of intra-articular hemangioma of the knee are presented in this study. Two of our cases were diagnosed as synovial hemangioma with the lesions localized inside the knee and the other 2 were intermediate type with the tumor extending to the muscle group and the skin. After magnetic resonance imaging and angiographic assessment, arthroscopic excision was performed in the localized type of the tumor. The other 2 cases received only diagnostic arthroscopy and biopsy followed by conservative treatment due to the extensive localization of the tumors and the serious chondral lesions. The decision of the treatment modality is very difficult in intra-articular hemangioma of the knee because, when combined with chondral degeneration, the incidence of local recurrence is high.
Arthroscopy The Journal of Arthroscopic and Related Surgery 04/2003; 19(3):E17. · 3.02 Impact Factor
-
[show abstract]
[hide abstract]
ABSTRACT: A twenty-two-year-old male patient presented with complaints of muscle atrophy and shoulder pain. Clinical and radiological studies showed a ganglion cyst near the spinoglenoid notch and a diagnosis of compression of the inferior branch of the suprascapular nerve was made. Following open excision of the cyst by a posterior approach, the patient's complaints subsided. A year after the operation recurrence of the lesion was detected. Arthroscopic control showed no intrarticular lesion. The patient still experiences minimal pain from time to time.
acta orthopaedica et traumatologica turcica 02/2003; 37(1):73-8. · 0.34 Impact Factor
