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Özaslan E, Günşar F, Çiftçibaşı Örmeci A, Hatemi İ, Efe C, Akyol G, Turhan N, Barbet FY, Sağol Ö, Ataizi Çelikel Ç, Güllüoğlu M, Gökçe DT, İstemihan Z, Eşkazan T, İdilman R. Diagnosis and Treatment of Autoimmune Hepatitis: Questions, Answers, and Illustrative Cases: Endorsed by Autoimmune Liver Diseases Special Interest Group, Turkish Association for the Study of Liver. Turk J Gastroenterol 2023; 34:S1-S33. [PMID: 37947207 DOI: 10.5152/tjg.2023.23242] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/12/2023]
Abstract
Autoimmune hepatitis (AIH) is a rare, immune-mediated liver disease. It has a heterogeneous nature with varied clinical presentations. The management of patients with AIH is challenging in many ways. The main difficulties are inexperience due to the rarity of the disease, diagnostic confusion in controversial areas such as variant/overlap cases, acute presentations, the presence of non-alcoholic fatty liver disease or drug-induced liver injury features, and the long and complex course of treatment. Here, we provide a clear, concise, and visualized review regarding the diagnosis and treatment of AIH, including illustrative cases.
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Affiliation(s)
- Ersan Özaslan
- Department of Gastroenterology, University of Health Sciences, Ankara Bilkent City Hospital, Ankara, Turkey
| | - Fulya Günşar
- Department of Gastroenterology, Ege University, İzmir, Turkey
| | - Aslı Çiftçibaşı Örmeci
- Department of Gastroenterology, İstanbul University Çapa Faculty of Medicine, İstanbul, Turkey
| | - İbrahim Hatemi
- Department of Gastroenterology, İstanbul University Cerrahpaşa Faculty of Medicine, İstanbul, Turkey
| | - Cumali Efe
- Department of Gastroenterology, Harran University, Şanlıurfa, Turkey
| | - Gülen Akyol
- Department of Pathology, Gazi University, Ankara, Turkey
| | - Nesrin Turhan
- Department of Pathology, University of Health Sciences, Ankara Bilkent City Hospital, Ankara, Turkey
| | | | - Özgül Sağol
- Department of Pathology, Dokuz Eylül University, İzmir, Turkey
| | | | - Mine Güllüoğlu
- Department of Pathology, İstanbul University Çapa Faculty of Medicine, İstanbul, Turkey
| | - Dilara Turan Gökçe
- Department of Gastroenterology, Ankara Bilkent City Hospital, Ankara, Turkey
| | - Zülal İstemihan
- Department of Gastroenterology, İstanbul University Çapa Faculty of Medicine, İstanbul, Turkey
| | - Tuğçe Eşkazan
- Department of Gastroenterology, İstanbul University Cerrahpaşa Faculty of Medicine, İstanbul, Turkey
| | - Ramazan İdilman
- Department of Gastroenterology, Ankara University, Ankara, Turkey
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Ergenç M, Uprak TK, Akın Mİ, Hekimoğlu EE, Çelikel ÇA, Yeğen C. Prognostic significance of metastatic lymph node ratio in gastric cancer: a Western-center analysis. BMC Surg 2023; 23:220. [PMID: 37550669 PMCID: PMC10408136 DOI: 10.1186/s12893-023-02127-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2023] [Accepted: 07/27/2023] [Indexed: 08/09/2023] Open
Abstract
BACKGROUND Tumor-node-metastasis (TNM) staging is the central gastric cancer (GC) staging system, but it has some disadvantages. However, the lymph node ratio (LNR) can be used regardless of the type of lymphadenectomy and is considered an important prognostic factor. This study aimed to evaluate the relationship between LNR and survival in patients who underwent curative GC surgery. METHODS All patients who underwent radical gastric surgery between January 2014 and June 2022 were retrospectively evaluated. Clinicopathological features of tumors, TNM stage, and survival rates were analyzed. LNR was defined as the ratio between metastatic lymph nodes and total lymph nodes removed. The LNR groups were classified as follows: LNR0 = 0, 0.01 < LNR1 ≤ 0.1, 0.1 < LNR2 ≤ 0.25 and LNR3 > 0.25. Tumor characteristics and overall survival (OS) of the patients were compared between LNR groups. RESULTS After exclusion, 333 patients were analyzed. The mean age was 62 ± 14 years. According to the LNR classification, no difference was found between groups regarding age and sex. However, TNM stage III disease was significantly more common in LNR3 patients. Most patients (43.2%, n = 144) were in the LNR3 group. In terms of tumor characteristics (lymphatic, vascular, and perineural invasion), the LNR3 group had significantly poorer prognostic factors. The Cox regression model defined LNR3, TNM stage II-III disease, and advanced age as independent risk factors for survival. Patients with LNR3 demonstrated the lowest 5-year OS rate (35.7%) (estimated mean survival was 30 ± 1.9 months) compared to LNR 0-1-2. CONCLUSION Our study showed that a high LNR was significantly associated with poor OS in patients who underwent curative gastrectomy. LNR can be used as an independent prognostic predictor in GC patients.
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Affiliation(s)
- Muhammer Ergenç
- Department of General Surgery, Marmara University School of Medicine, Başıbüyük Campus Başıbüyük Mah. Maltepe Başıbüyük Yolu Sok. No: 9/1 Maltepe 34854, Istanbul, Turkey.
| | - Tevfik Kıvılcım Uprak
- Department of General Surgery, Marmara University School of Medicine, Başıbüyük Campus Başıbüyük Mah. Maltepe Başıbüyük Yolu Sok. No: 9/1 Maltepe 34854, Istanbul, Turkey
| | - Muhammed İkbal Akın
- Department of General Surgery, Marmara University School of Medicine, Başıbüyük Campus Başıbüyük Mah. Maltepe Başıbüyük Yolu Sok. No: 9/1 Maltepe 34854, Istanbul, Turkey
| | - Ece Elif Hekimoğlu
- Marmara University School of Medicine, Başıbüyük Campus Başıbüyük Mah. Maltepe Başıbüyük Yolu Sok. No: 9/1 Maltepe 34854, Istanbul, Turkey
| | - Çiğdem Ataizi Çelikel
- Department of Pathology, Marmara University School of Medicine, Başıbüyük Campus Başıbüyük Mah. Maltepe Başıbüyük Yolu Sok. No: 9/1 Maltepe 34854, Istanbul, Turkey
| | - Cumhur Yeğen
- Department of General Surgery, Marmara University School of Medicine, Başıbüyük Campus Başıbüyük Mah. Maltepe Başıbüyük Yolu Sok. No: 9/1 Maltepe 34854, Istanbul, Turkey
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Abdullazade S, Akarca FG, Esendağlı G, Turhan N, Erden E, Savaş B, Markoç F, Tunçel D, Özgüven Yılmaz B, Saka B, Hallaç Keser S, Şengiz Erhan S, Gücin Z, Sağol Ö, Aysal Ağalar A, Çelik S, Özer H, Erbarut Seven İ, Ataizi Çelikel Ç, Ekinci Ö, Eğilmez HR, Balcı S, Akyol G. The Contribution of Additional Sampling in Cholecystectomy Materials: A Multicenter Prospective Study. Turk Patoloji Derg 2020; 36:188-194. [PMID: 32364613 PMCID: PMC10510599 DOI: 10.5146/tjpath.2020.01483] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2019] [Accepted: 02/26/2020] [Indexed: 11/18/2022] Open
Abstract
OBJECTIVE Cholecystectomy materials are frequently encountered in routine practice. The aim of this study was to determine the true frequency of gallbladder lesions, the diagnostic consistency, and standardization of reports after macroscopic sampling and microscopic evaluation based on previously defined criteria. MATERIAL AND METHOD 14 institutions participated in the study within the Hepato-Pancreato-Biliary Pathology Study Group. Routinely examined cholecystectomies within the last year were included in the study in these institutions. Additional sampling was performed according to the indications and criteria. The number of blocks and samples taken in the first macroscopic examination and the number of blocks and samples taken in the additional sampling were determined and the rate of diagnostic contribution of the additional examination was determined. RESULTS A total of 5,244 cholecystectomy materials from 14 institutions were included in the study. Additional sampling was found to be necessary in 576 cases (10.98%) from all institutions. In the first macroscopic sampling, the mean of the numbers of samples was approximately 4 and the number of blocks was 2. The mean of the numbers of additional samples and blocks was approximately 8 and 4, respectively. The diagnosis was changed in 144 of the 576 new sampled cases while the remaining 432 stayed unaltered. CONCLUSION In this study, it was observed that new sampling after the first microscopic examination of cholecystectomy materials contributed to the diagnosis. It was also shown that the necessity of having standard criteria for macroscopic and microscopic examination plays an important role in making the correct diagnosis.
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Affiliation(s)
- Samir Abdullazade
- Department of Pathology, İzmir Tepecik Education and Research Hospital, İzmir, Turkey
| | - Fahire Göknur Akarca
- Department of Medical Pathology, Gazi University, Faculty of Medicine, Ankara, Turkey
| | - Güldal Esendağlı
- Department of Medical Pathology, Gazi University, Faculty of Medicine, Ankara, Turkey
| | - Nesrin Turhan
- Department of Pathology, Turkey Yüksek İhtisas Education and Research Hospital, Ankara, Turkey
| | - Esra Erden
- Department of Medical Pathology, Ankara University, Faculty of Medicine, Ankara, Turkey
| | - Berna Savaş
- Department of Medical Pathology, Ankara University, Faculty of Medicine, Ankara, Turkey
| | - Fatma Markoç
- Department of Pathology, Dr. Abdurrahman Yurtaslan Ankara Oncology Education and Research Hospital, Ankara, Turkey
| | - Deniz Tunçel
- Şişli Etfal Education and Research Hospital, İstanbul, Turkey
| | | | - Burcu Saka
- Department of Medical Pathology, Medipol University, Faculty of Medicine, İstanbul, Turkey
| | - Sevinç Hallaç Keser
- Department of Pathology, Lütfi Kırdar Education and Research Hospital, İstanbul, Turkey
| | | | - Zühal Gücin
- Department of Medical Pathology, Bezmialem Vakıf University, Faculty of Medicine, İstanbul, Turkey
| | - Özgül Sağol
- Dokuz Eylül University, Faculty of Medicine, İzmir, Turkey
| | | | - Sevinç Çelik
- Bozok University, Faculty of Medicine, Yozgat, Turkey
| | - Hatice Özer
- Cumhuriyet University, Faculty of Medicine, Sivas, Turkey
| | | | | | - Özgür Ekinci
- Department of Medical Pathology, Gazi University, Faculty of Medicine, Ankara, Turkey
| | | | | | - Gülen Akyol
- Department of Medical Pathology, Gazi University, Faculty of Medicine, Ankara, Turkey
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Esendağlı G, Akarca FG, Balcı S, Argon A, Erhan SŞ, Turhan N, Zengin Nİ, Keser SH, Çelik B, Bulut T, Abdullazade S, Erden E, Savaş B, Bostan T, Sağol Ö, Ağalar AA, Kepil N, Karslıoğlu Y, Günal A, Markoç F, Saka B, Özgün G, Özdamar ŞO, Bahadır B, Kaymaz E, Işık E, Ayhan S, Tunçel D, Yılmaz BÖ, Çelik S, Karabacak T, Seven İE, Çelikel ÇA, Gücin Z, Ekinci Ö, Akyol G. A Retrospective Evaluation of the Epithelial Changes/Lesions and Neoplasms of the Gallbladder in Turkey and a Review of the Existing Sampling Methods: A Multicentre Study. Turk Patoloji Derg 2018; 34:41-48. [PMID: 28984336 DOI: 10.5146/tjpath.2017.01404] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Abstract
OBJECTIVE As there is continuing disagreement among the observers on the differential diagnosis between the epithelial changes/lesions and neoplasms of the gallbladder, this multicentre study was planned in order to assess the rate of the epithelial gallbladder lesions in Turkey and to propose microscopy and macroscopy protocols. MATERIAL AND METHOD With the participation of 22 institutions around Turkey that were included in the Hepato-Pancreato-Biliary Study Group, 89,324 cholecystectomy specimens sampled from 2003 to 2016 were retrospectively evaluated. The numbers of adenocarcinomas, dysplasias, intracholecystic neoplasms/adenomas, intestinal metaplasias and reactive atypia were identified with the review of pathology reports and the regional and countrywide incidence rates were presented in percentages. RESULTS Epithelial changes/lesions were reported in 6% of cholecystectomy materials. Of these epithelial lesions, 7% were reported as adenocarcinoma, 0.9% as high-grade dysplasia, 4% as low-grade dysplasia, 7.8% as reactive/regenerative atypia, 1.7% as neoplastic polyp, and 15.6% as intestinal metaplasia. The remaining lesions (63%) primarily included non-neoplastic polypoids/hyperplastic lesions and antral/pyloric metaplasia. There were also differences between pathology laboratories. CONCLUSION The major causes of the difference in reporting these epithelial changes/lesions and neoplasms include the differences related to the institute's oncological surgery frequency, sampling protocols, geographical dissimilarities, and differences in the diagnoses/interpretations of the pathologists. It seems that the diagnosis may change if new sections are taken from the specimen when any epithelial abnormality is seen during microscopic examination of the cholecystectomy materials.
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Affiliation(s)
- Güldal Esendağlı
- Department of Medical Pathology, Gazi University School of Medicine, Ankara, Turkey
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Baysal B, İnce AT, Gültepe B, Gücin Z, Malya FÜ, Tozlu M, Şentürk H, Bağcı P, Çelikel ÇA, Aker F, Özkara S, Paşaoğlu E, Dursun N, Özgüven BY, Tunçel D. Helicobacter pylori is undetectable in intraductal papillary mucinous neoplasm. Pancreatology 2016; 16:865-8. [PMID: 27320723 DOI: 10.1016/j.pan.2016.06.005] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/28/2016] [Revised: 06/08/2016] [Accepted: 06/09/2016] [Indexed: 12/11/2022]
Abstract
BACKGROUND About half of the world population is infected with Helicobacter pylori (H. pylori), a bacterium associated with gastric cancer and considered to be a risk factor for pancreatic ductal adenocarcinoma. Whether the bacterium is associated with intraductal papillary mucinous neoplasm, believed to be a precursor of pancreatic ductal adenocarcinoma, is unknown. The aim of this study was to investigate the presence of H. pylori DNA in tissue sections of intraductal papillary mucinous neoplasm. METHODS The presence of H. pylori DNA was tested in a retrospective controlled study of formalin-fixed, paraffin-embedded pancreatic tissues from 24 patients who underwent surgery for intraductal papillary mucinous neoplasm. Histologically normal tissues surrounding neoplasms were used as control. H. pylori DNA was evaluated after deparaffinization, DNA extraction, and purification, and results were evaluated statistically. RESULTS Samples were collected from 13 males and 11 females with mean age 59 years (range 44-77), and consisted of 19 cases of main-duct and three cases of branched-duct intraductal papillary mucinous neoplasm. Two patients were diagnosed with pancreatic cancer and main-duct intraductal papillary mucinous neoplasm. H. pylori DNA was not detected either in intraductal papillary mucinous neoplasm tissue, or in surrounding normal tissue. CONCLUSIONS Although H. pylori has been implicated in pancreatic ductal adenocarcinoma, it may not play a key role in the development of intraductal papillary mucinous neoplasm.
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Affiliation(s)
- Birol Baysal
- Gastroenterology Department, Bezmialem Vakıf University, Istanbul, Turkey
| | - Ali Tüzün İnce
- Gastroenterology Department, Bezmialem Vakıf University, Istanbul, Turkey.
| | - Bilge Gültepe
- Microbiology Division, Bezmialem Vakıf University, Istanbul, Turkey
| | - Zuhal Gücin
- Pathology Division, Bezmialem Vakıf University, Istanbul, Turkey
| | - Fatma Ümit Malya
- Surgery Department, Bezmialem Vakıf University, Istanbul, Turkey
| | - Mukaddes Tozlu
- Gastroenterology Department, Bezmialem Vakıf University, Istanbul, Turkey
| | - Hakan Şentürk
- Gastroenterology Department, Bezmialem Vakıf University, Istanbul, Turkey
| | - Pelin Bağcı
- Pathology Division, Marmara University, Istanbul, Turkey
| | | | - Fügen Aker
- Pathology Division, Haydarpaşa Numune Education and Research Hospital, Istanbul, Turkey
| | - Selvinaz Özkara
- Pathology Division, Haydarpaşa Numune Education and Research Hospital, Istanbul, Turkey
| | - Esra Paşaoğlu
- Pathology Division, İstanbul Education and Research Hospital, Istanbul, Turkey
| | - Nevra Dursun
- Pathology Division, İstanbul Education and Research Hospital, Istanbul, Turkey
| | - Banu Yılmaz Özgüven
- Pathology Division, Şişli Etfal Education and Research Hospital, Istanbul, Turkey
| | - Deniz Tunçel
- Pathology Division, Şişli Etfal Education and Research Hospital, Istanbul, Turkey
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Duman DG, Biçakci E, Çelikel ÇA, Akbal C. Nonalcoholic Fatty Liver Disease is Associated With Erectile Dysfunction: A Prospective Pilot Study. J Sex Med 2016; 13:383-8. [DOI: 10.1016/j.jsxm.2015.12.030] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2015] [Revised: 12/20/2015] [Accepted: 12/25/2015] [Indexed: 02/07/2023]
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Uprak TK, Attaallah W, Çelikel ÇA, Ayrancı G, Yeğen C. HER-2 incidence in gastric cancer, its association with prognosis and clinicopathological parameters. Ulus Cerrahi Derg 2015; 31:207-13. [PMID: 26668528 DOI: 10.5152/ucd.2015.2964] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/03/2014] [Accepted: 05/25/2015] [Indexed: 12/22/2022]
Abstract
OBJECTIVE Human epidermal growth factor-2 (HER-2) overexpression has prognostic value in breast cancer. However, the significance of HER-2 positivity in gastric cancer is controversial. In this study, we investigated the frequency of overexpression of HER-2 and its relationship with clinicopathological findings and impact on survival in gastric cancer. MATERIAL AND METHODS Gastric cancer patients, operated in Marmara University Faculty of Medicine, Pendik Training and Research Hospital, General Surgery Department, between January 2012-December 2013 were enrolled in this study. Medical records were retrospectively evaluated. Tissue samples were stained by immunohistochemistry (IHC) method, and were followed by fluorescence in situ hybridization (FISH) in those with positive results. HER-2 expression rates and its association with other histopathological features and survival have been analyzed. RESULTS 135 patients were enrolled in the study, with 88 (65%) male and 47 (35%) female patients. The median age was 61 (29-84) years. Only 11 patients (8%) were positive for HER-2. HER-2 positive patients were similar to negative patients in terms of age, gender, tumor size, tumor location, tumor T stage, lymph node metastasis, histological type, differentiation, lymphovascular invasion, perinodal, perineural invasion and stage. No significant difference was detected on 1 and 2-year overall and disease-free survival rates between receptor positive and negative groups. CONCLUSION Consistent with the literature data, HER-2 positivity rate in this study was approximately 8%, but this positivity has not been found to be associated with either clinical and pathological parameters or overall and disease-free survival.
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Affiliation(s)
- Tevfik Kıvılcım Uprak
- Department of General Surgery, Marmara University Faculty of Medicine, İstanbul, Turkey
| | - Wafi Attaallah
- Department of General Surgery, Marmara University Faculty of Medicine, İstanbul, Turkey
| | | | - Gülçiçek Ayrancı
- Department of Pathology, Marmara University Faculty of Medicine, İstanbul, Turkey
| | - Cumhur Yeğen
- Department of General Surgery, Marmara University Faculty of Medicine, İstanbul, Turkey
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