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Metastatic disease is a relatively rare cause of orbital tumors. While many different types of primary malignancies have been documented, lung and breast cancers are the most prevalent ones among them. Herein, three cases of orbital metastasis from breast cancer are reported. The first patient had no history of primary malignancy, and the initial presentation was orbital metastasis from advanced breast cancer. The second patient had a history of neo-adjuvant chemotherapy, mastectomy, and adjuvant radiotherapy. The recurrence of the disease was diagnosed via symptomatic metastasis to orbit involving the lateral rectus muscle. The third patient had a history of mastectomy, adjuvant radiotherapy, and hormone therapy. Considering that even patients without a diagnosis of primary malignancy may present with orbital metastasis, ophthalmologists' awareness of this issue is critical. [ABSTRACT FROM AUTHOR]

PURPOSE High-risk breast lesions (HRLs) are associated with future risk of breast cancer. Considering the pathological subtypes, malignancy upgrade rate differs according to each subtype and depends on various factors such as clinical and radiological features and biopsy method. Using artificial intelligence and machine learning models in breast imaging, evaluations can be made in terms of risk estimation in different research areas. This study aimed to develop a machine learning model to distinguish HRL cases requiring surgical excision from lesions with a low risk of accompanying malignancy. METHODS A total of 94 patients who were diagnosed with HRL by image-guided biopsy between January 2008 and March 2020 were included in the study. A structured database was created with clinical and radiological characteristics and histopathological results. A machine learning prediction model was created to make binary classifications of lesions as malignant or benign. Random forest, decision tree, K-nearest neighbors, logistic regression, support vector machine (SVM), and multilayer perceptron machine learning algorithms were used. Among these algorithms, SVM was the most successful. The estimations of malignancy for each case detected by artificial intelligence were combined and statistical analyses were performed. RESULTS Considering all cases, the malignancy upgrade rate was 24.5%. A significant association was observed between malignancy upgrade rate and lesion size (P = 0.004), presence of mammography findings (P = 0.022), and breast imaging-reporting and data system category (P = 0.001). A statistically significant association was also found between the artificial intelligence prediction model and malignancy upgrade rate (P < 0.001). With the SVM model, an 84% accuracy and 0.786 area-under-the-curve score were obtained in classifying the data as benign or malignant. CONCLUSION Our artificial intelligence model (SVM) can predict HRLs that can be followed up with a lower risk of accompanying malignancy. Unnecessary surgeries can be reduced, or second line vacuum excisions can be performed in HRLs, which are mostly benign, by evaluating on a case-by-case basis, in line with radiology-pathology compatibility and by using an artificial intelligence model. [ABSTRACT FROM AUTHOR]

Vascular tumors are rare in the breasts, and the most common forms include hemangiomas and angiosarcomas. Hemangiomas are rare benign vascular tumors. Most of them are asymptomatic and nonpalpable clinically, and the vast majority of such lesions are detected incidentally by mammography. Breast hemangiomas are difficult to diagnose using conventional imaging modalities since their imaging findings are variable. The following is a case presentation of an asymptomatic forty-five-year old female patient who was diagnosed with a rare hemangioma. Physical examination, ultrasonography (US) and mammographic examination were normal. Dynamic contrast enhanced magnetic resonance imaging (MRI) showed a non-mass pathological enhancement. After a short-term follow up, a comparative MRI was obtained and biopsy was planned, due to the heterogeneous non-mass enhancement on MRI. Needle core biopsy with US guidance was performed, resulting in benign findings. However, because of the discordance between imaging and histopathology, an MRI-guided wire localization followed by open surgical biopsy was performed. Histopathologic evaluation reported capillary hemangioma. The imaging findings, including US, mammography and MRI, of hemangioma are reviewed and described in this case report. [ABSTRACT FROM AUTHOR]

The level of axillary lymph node involvement in breast cancer is a critical decision factor for adjuvant therapy and the most important indicator of prognosis and survival. Sentinel lymph node biopsy is a minimally invasive technique with low morbidity in axillary staging of breast cancer. Radiocolloid substances (Technetium-99m) and/or blue dyes such as methylene blue or isosulfan blue are used during sentinel lymph node biopsy. Isosulfan blue stain is frequently used in sentinel lymph node biopsy and rarely causes complications. The present case report presents a severe decrease in SpO2 due to methemoglobinemia following isosulfan blue administration as well as skin and urine signs and inconsistency with clinical picture in a 67-year-old, 77 kg, ASA II female case who underwent sentinel lymph node biopsy under general anesthesia. [ABSTRACT FROM AUTHOR]

Environmental pollutants such as organochlorine pesticides (OCPs), polychlorinated biphenyls (PCBs) and polybrominated diphenyl ethers (PBDEs), so called persistent organic pollutants (POPs) have been known to interfere various ion channels in organism, which is the main mechanism of action especially for OCPs. Furthermore, all PCBs and several congeners of OCPs and PBDEs were recently listed as "carcinogen" by the IARC depending on evaluation of epidemiological studies. On the other hand, there have been very little data on the relation between various cancers and tissue burden of these toxicants. In majority of the human studies on a possible association between POPs and cancers, exposure data have been based on statement-based interviews, which potentially impair the accuracy and reliability of quantitative assessment. In order to accurately assess whether environmental exposure to POPs increase risk of kidney, stomach and breast cancers, tumour tissues as well as blood and urines were collected from surgically operated patients. Cellular DNA and protein oxidative damage markers (8-OHdG and dityrosine, respectively), have also been analysed in the patient and healthy control groups, and assessed whether there are changes in these parameters. The data suggest that majority of POPs in cancerous tissues were associated with cancers in patients, while they are less conclusive in blood of the same patients. DNA and protein damage markers were found to be higher in urines of kidney cancer patients compared to healthy volunteers, although inter-individual variability obscured statistical significances. Current findings confirmed that glutathione S-transferase theta1 (GSTT1) nullpolymorphism is a risk factor Bforro ukgidhnte tyo cyaonuc ebry, |a nEdP cIyptsowchicrohme P450 1A1 (CYP1A1) is a risk factor for stomach cancer. Data suggest that environmental exposure to POPs may induce tumour initiation and/or progression in humans however, blood concentrations of the same pollutants do not adequately reflect tissue concentrations except dichlorodiphenyldichloroethylene (DDE), the major metabolite of the notorious organochlorine pesticide dichlorodiphenyltrichloroethylene (DDT). Possible role of interaction of POPs with ion channels in cancer initiation and/or progression remain to be explored. [ABSTRACT FROM AUTHOR]

Objective: In this study, we aimed to review retrospectively the data of 10 patient who were treated and followed-up in our clinic and to review the current approaches in the diagnosis and treatment of autoimmune pancreatitis (AIP). Material and Methods: We reviewed 10 patients retrospectively who were operated on and had the diagnosis of AIP histopathologically in the Ege University School of Medicine Department of General Surgery. Results: Between June 2001-November 2010, 10 patients who were diagnosed as AIP were examined retrospectively. Radiologically, a pancreatic mass was found in the pancreatic head with ultrasound in 7 (70%) of 10 patients and suspicious lesions were identified in the head of the pancreas in 3 (30%) patients. All patients were operated on in our clinic with the preliminary diagnosis of pancreatic head tumor; 8 patients underwent Whipple's procedure, 1 patient underwent pylorus preserving pancreaticoduodenectomy, and in 1 patient an exploratory pancreatic biopsy (frozen section) was carried out. Conclusion: Autoimmune pancreatitis is a disease with increasing incidence and characterized by lymphoplasmocytic cell infiltration and fibrosis. Patients with a pancreatic mass, if there is an autoimmune disease or chronic pancreatitis suspected in the detailed history, it is necessary to evaluate patients in terms of AIP serologically to protect the patients from an incoorectng diagnosis and morbidity of surgery. [ABSTRACT FROM AUTHOR]

Objective: Omitting axilary lymph node dissection (ALND) following SLNB with residual cancer in patients with locally advanced disease after neoadjuvan chemotherapy (NAC) is still controversial. In this study, we evaluated factors affecting local recurrence and outcome in patients with locally advanced breast cancer (LABC), who underwent sentinel lymph node (SLN) without ALND after NAC. Materials and Methods: Between 2003 to 2018, 265 patients with clinically node-positive LABC who received NAC and underwent SLNB without ALND were retrospectively analyzed. All patients had whole breast and/or regional nodal irradiation. All recurrences of axilla, peripheric lymphatic, and breast were accepted as locoregional recurrence. Results: Median age of patients was 45 (23-70). Of those, 191 patients (72%) were clinically T1-2, and 74 patients (28%) were clinically T3-4 before receiving NAC. Of those, whereas 220 patients were cN1 (83%), and 45 patients were cN2-3 (17%). The median number of SLNs removed was 3 (1-7), and the the median lymph node number retrieved was 4 (1-7). Of 265 patients, 184 patients (64%) were treated with breast conserving therapy (BCT), whereas the remaining underwent mastectomy. Of patients, 69% had negative SLNs, and the remaining 81 patients (31%) had positive SLNs (34 micrometastasis, 14 isolated tumor cells and 29 macrometastases), and the majority had (90%) no extracapsular lymph node invasion. At a median follow up time of 39 months (12-172), none of the patients developed an axillary recurrence. The ipsilateral breast cancer recurrence rate was found to be 4.1% among patients with BCT. Furthermore, one patient (0.4%) with macrometastatic SLNB including extracapsular invasion was found to have locoregional recurrence including thoracic wall and supraclavicular region metastasis. Fiveyear locoregional recurrence (LRR)-free, disease-free survival (DFS) and disease specific survival (DSS) rates were found as 95.1%, 88.5% and 94.2%, respectively. No difference could be found in 5-year LRR-free survival, DFS, and DSS rates between patients with a negative or positive SLNB (LRR-rate: SLNB-negative, 97% vs SLNB-positive, 90%, p=0.20; DSS: SLN(-): 96.5% vs SLNB(+): 94.2; p=0.37;DFS: SLN(-)90% vs SLN(+) 84.7; p=0.14). Conclusion: Our findings suggest ALND could be safely avoided in patients with LABC who underwent SLNB after receiving NAC in selected patients with good responders to NAC including patients with negative SLNs or low tumor burden such as micrometastasis/ITC or macrometastis without extracapsular extension esas long as axillary radiation therapy is provided. [ABSTRACT FROM AUTHOR]

Objective: According to recent epidemiologic reports, young breast cancer incidence is higher than incidence in European and American population. Whether assessing young age as a poor prognostic factor or not in the management of breast cancer patients is still a debate. Even though it shows an aggressive clinical course, there is not enough research about etiology. We aim to analyze the differences between breast cancer patients under and over 40 years. Materials and Methods: Between January 1998 and January 2019, a total of 23,594 patients were analyzed from National Breast Cancer Database (NBCD). Demographic, clinic, and pathologic features of patients were compared for patients younger than and 40 age and for >40. Results: Median age was 50 (18-97). 4535 (19%) patients were younger than and 40 age (84% of them were >30), and 19,059 (81%) were >40. In categorical univariate analysis, there were significantly less patients with pathologic T1 (%41 vs %47), N0 (%49 vs %55), and stage 1 (%25 vs %31) disease in young age group than >40 group (p<0.001). Mastectomy (%41 vs %39; p=0.024) and axillary dissection rates (%71 vs %65; p=0.001) were high in <40 group. Pathologically, patients in <40 group significantly presented with more invasive ductal carcinoma (%76 vs %73; p=0.001), higher histologic grade (%54 vs 42; p=0.001), more multi-focality/centricity (%19 vs %15), oestrogen (ER) (%31 vs %24; p=0.001) and progesterone receptor (PR) (%38 vs %35; 0=0.009) negativity, hormone receptor negativity (%24 vs %20; p=0.001) and HER2-neu positivity (%32 vs %27; p=0.001). Furthermore, patients <40 had lower number of luminal-A (%23 vs %33; p=0.001) disease but higher number of luminal-B HER2+ (%18 vs %12; p=0.001) and triple negative disease (%15 vs %10; p=0.001). Multivariate logistic regression analysis of significant variables demonstrated that invasive ductal carcinoma type (1,06-1,43), ER (1,26-1,87) and PR (1,21-1,75) negativity, high histologic grade (1,43-1,87), multi-focality/centricity (1,26-1,72), T3-T4 tumours (81,06-1,66), and axilla positivity were significantly correlated with breast cancers in younger age group. Conclusion: Our findings revealed that breast cancer in <40 group has higher rates of hormone receptor negativity and higher Ki-67 levels, triple negativity, and more accompanied with multi-focality/centricity. Based on the underlying histopathologic features and presentation with more advanced stage in younger patients, mastectomy and axillary dissection rates were higher for this group. Therefore, young breast cancer may have a more dismal prognosis. [ABSTRACT FROM AUTHOR]

Objective: With the development of neoadjuvant chemotherapy (NACT) drugs, neoadjuvant chemotherapy is increasingly used in the treatment of breast cancer. Complete or near complete response rates in primary tumour are progressively increasing as well metastatic lymph nodes in the axilla are regressed. While surgeons had previously thought that lymph nodes at all axillary levels should be completely removed, it has been shown that has no effect on survival. Limited lymph node dissection for staging is sufficient. One reason for this tendency is the possible morbidity of axillary dissection (AD), which decreases the comfort of life. Therefore, surgeons are now looking for ways to not perform unnecessary axillary dissection. AD is gradually being replaced by sentinel lymph node biopsy (SLNB). It is known that lymph node negativity can be achieved after chemotherapy. In this study, we investigated the effect of neoadjuvant chemotherapy on axillary metastases. Material and Method: 154 patients who underwent neoadjuvant chemotherapy (NACT) and underwent breast conserving surgery / total mastectomy + AD were included in the study. The data were analyzed retrospectively. Fifteen patients had inflammatory breast cancer. Physical examination records, USG, MRI, PET/CT and axillary lymph node biopsy results before neoadjuvant chemotherapy were evaluated. Results were compared with pathological results of axillary dissection material. Results: Total mastectomy was performed in 117 patients and breast conserving surgery was preferred in 37 patients. In 32 patients who underwent fine needle aspiration biopsy before NACT, malignant lymph node was found in axilla. The pathology of AD was reported as malignant in 53.1% of these patients, and no malignancy was detected in 46.9% of them. 52.7% of 129 patients who has radiological axillary pathological lymph nodes were found to be malignant after NACT but 47.3% was as benign detected. When clinical, imaging and biopsy results were taken together, pathological axillary lymph nodes were detected in 138 patients. After NACT malignancy continued in 54.3% of them and response was obtained in 45.7%. Conclusion: Overall, approximately 46% of patients with NACT respond to chemotherapy in metastatic axillary lymph nodes. More studies can help us to answer the questions what type of breast cancer has a better response, which chemotherapy regimen are more effective. [ABSTRACT FROM AUTHOR]

Introduction: Toxoplasma gondii is an opportunistic protozoan and can be grown using several human cell lines. Breast cancer is the second leading cause of cancer death in women. Her2/Neu-expressing mammary cancer cell lines called TUBO can be grown in vitro. In recent years, protozoan parasites have become popular means of use in cancer therapy research. In this study, we analyzed whether T. gondii tachyzoites can destroy TUBO cells using a novel continuous feed medium approach. Methodology: Two sets of flasks (each containing four groups) containing TUBO cells were inoculated with T. gondii Ankara strain tachyzoites. First set containing 5×106 TUBO cells were inoculated with TUBO-tachyzoite ratios of 1:2, 1:1, 2:1, and 4:1 and second set containing 1×106 TUBO cells were inoculated with TUBO-tachyzoite ratios of 10:1, 100:1, 1000:1, and 2000:1. Thereafter, culture supernatants were harvested at various days until TUBO cells were destroyed and tachyzoites were counted. Results: In the first and second sets of flasks, TUBO cells were destroyed between days 8 to 12 and 12 to 25, respectively. In addition, the amount of tachyzoites increased 7- 43 and 595 to 112500 times in the first and second set of flasks, respectively. Conclusions: These results show that T. gondii tachyzoites successfully destroy Her2/Neu-expressing mammary cancer cells using a continuous feed medium approach. Although this idea may be too premature for the moment, the approach defined herein may support future researchers investigating the relationship between cancer and parasites which can make important progress toward saving cancer patient lives. [ABSTRACT FROM AUTHOR]

The level of axillary lymph node involvement in breast cancer is a critical decision factor for adjuvant therapy and the most important indicator of prognosis and survival. Sentinel lymph node biopsy is a minimally invasive technique with low morbidity in axillary staging of breast cancer. Radiocolloid substances (Technetium-99m) and/or blue dyes such as methylene blue or isosulfan blue are used during sentinel lymph node biopsy. Isosulfan blue stain is frequently used in sentinel lymph node biopsy and rarely causes complications. The present case report presents a severe decrease in SpO2 due to methemoglobinemia following isosulfan blue administration as well as skin and urine signs and inconsistency with clinical picture in a 67-year-old, 77 kg, ASA II female case who underwent sentinel lymph node biopsy under general anesthesia., Competing Interests: Conflict of Interest: No conflict of interest was declared by the authors.

The National Comprehensive Cancer Network (NCCN) guidelines recommend assessment with positron emission tomography with 2-deoxy-2-[fluorine-18]fluoro-D-glucose integrated with computed tomography (18F-FDG PET/CT) in staging of breast cancer, starting from the stage IIIA. Previously, PET/CT contributed to the accurate staging from the stage IIB. Our aim is to evaluate the contribution of 18F-FDG PET/CT in staging of breast cancer patients. A total of 234 patients were retrospectively evaluated. PET/CT was performed preoperatively in 114/234 and postoperatively in 120/234 patients. Initial staging was performed based on histopathological results in 125/234 and clinical results in 109/234 patients, according to the American Joint Committee on Cancer (AJCC) classification. All patients had a normal abdominal ultrasound and chest x-ray. Following PET/CT imaging, modification in the staging was performed in patients with the metastatic findings. In 42/234 (17.9%) patients hypermetabolic extra-axillary regional lymph nodes and in 65/234 patients (27.7%) distant metastatic involvement were detected with PET/CT. Modification in the staging was applied in 82/234 (35%) patients. Patient management was changed in 69/234 (29.4%) cases. The percentage of patients with upstaging, according to each stage, was as follows: IIA: 18.6%, IIB: 30%, IIIA: 46.3%, IIIB: 68.8%, and IIIC: 20.8%. In 43/43 patients, 99mTc-methylene diphosphonate (MDP) bone scan did not show additional bone metastasis. In 5/32 patients, metastatic involvement was detected with sentinel lymph node biopsy (SLNB), but preoperative PET/CT scan did not reveal hypermetabolic lymph nodes. Although our study was limited by the referral bias and lack of homogeneity in the referral group, PET/CT still significantly contributed to the accurate staging and management of our breast cancer patients, starting from the stage IIA.

Visceral leishmaniasis (VL) is one of the parasitic infections causing different pathogeneses of various systems including intraabdominal solid organs. L. donovani and L.infantum, particularly in Turkey, have been diagnosed in systemic infections. In the present case study, a 43-year-old woman with left upper abdominal pain, persistent fever and splenic pathology according to the radiological findings was investigated. Laboratory findings showed elevated liver function tests and anemia while radiological studies revealed splenomegaly, and nodular infiltration and laceration of the spleen. Because of enlarged intraabdominal lymph nodes observed during surgery, a lymph node biopsy and a liver biopsy were also performed along with the splenectomy. Results from the pathological examination of the spleen were nonspecific and the liver biopsy confirmed a diagnosis of granulomatosis hepatitis. Further examination of the hepatic granulomatosis including parasitic evaluation and serological evaluation with the rK39 dipstick test revealed VL. In conclusion, in cases of visceral organ pathology accompanied by persistent fever, and hematological disorders, parasitic infections, particularly VL, should be considered in the differential diagnosis.