1
|
Köseoğlu E, Kulaç İ, Armutlu A, Gürses B, Seymen H, Vural M, Aykanat İC, Tarım K, Sarıkaya AF, Kılıç M, Baydar DE, Demirkol MO, Balbay MD, Kordan Y, Canda AE, Esen T. Intraoperative Frozen Section via Neurosafe During Robotic Radical Prostatectomy in the Era of Preoperative Risk Stratifications and Primary Staging With mpMRI and PSMA-PET CT: Is There a Perfect Candidate? Clin Genitourin Cancer 2023; 21:602-611. [PMID: 37451883 DOI: 10.1016/j.clgc.2023.06.014] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2023] [Revised: 06/01/2023] [Accepted: 06/25/2023] [Indexed: 07/18/2023]
Abstract
BACKGROUND We aimed to analyze the effect of preoperative risk assessment including Ga-68 PSMA PET and multiparametric magnetic resonance imaging (mpMRI) on nerve sparing practices, positive surgical margin (PSM) rates and oncological outcomes based on a comparison between patients underwent RARP with and without Neurosafe (NS). METHODS Patients underwent RARP with NS (RARP-NS) or without (RARP-only) NS retrospectively evaluated. Suspicion for extracapsular extension on mpMRI and/or Ga-68 PSMA PET was recorded as i(imaging)T3. NS was performed according to the Martini-Klinik technique. PSM at preserved bundle side were called PSM at region of interest (ROI) while the others were elsewhere. RESULTS A total of 208 patients (90 in RARP-NS, 118 in RARP-only groups) were included. Preoperatively the RARP-only group showed significantly higher mean PSA (p = .01) and PIRADS 5 (p = .002) findings and had more D'Amico high risk (DAHR) patients (p = .08). The overall PSM rates for pT2 versus pT3 disease were 7.5% versus 21.6 and 15.6% versus 55% in RARP-NS and RARP-only groups, respectively. NS resulted in more bilaterally preserved bundles (81.1% vs. 66.3%) and less PSM at the ROI (3.3% vs. 23.4%) than RARP-only group. NS outperformed RARP-only in all clinical settings had its highest differential benefit in more bilateral nerve sparing and less PSM at ROI in patients with both DAHR and iT3 disease. BCR rates were 2.2% and 2.5% for RARP-NS and RARP only groups, respectively (p = .4). One patient in RARP-NS and 9 in RARP-only groups had PSA persistence (p = .02). CONCLUSION RARP-NS led to more preserved bundles with less PSM. It was especially useful in DAHR patients with preoperative extracapsular extension suspicion in imaging simultaneously.
Collapse
Affiliation(s)
- Ersin Köseoğlu
- Department of Urology, Koç University School of Medicine, Istanbul, Turkey.
| | - İbrahim Kulaç
- Department of Pathology, Koç University School of Medicine, Istanbul, Turkey
| | - Ayşe Armutlu
- Department of Pathology, Koç University School of Medicine, Istanbul, Turkey
| | - Bengi Gürses
- Department of Radiology, Koç University School of Medicine, Istanbul, Turkey
| | - Hülya Seymen
- Department of Nuclear Medicine, Koç University School of Medicine, Istanbul, Turkey
| | - Metin Vural
- Radiology Clinic, VKF American Hospital, Istanbul, Turkey
| | | | - Kayhan Tarım
- Department of Urology, Koç University School of Medicine, Istanbul, Turkey
| | | | - Mert Kılıç
- Urology Clinic, VKF American Hospital, Istanbul, Turkey
| | - Dilek Ertoy Baydar
- Department of Pathology, Koç University School of Medicine, Istanbul, Turkey
| | - Mehmet Onur Demirkol
- Department of Nuclear Medicine, Koç University School of Medicine, Istanbul, Turkey
| | - Mevlana Derya Balbay
- Department of Urology, Koç University School of Medicine, Istanbul, Turkey; Urology Clinic, VKF American Hospital, Istanbul, Turkey
| | - Yakup Kordan
- Department of Urology, Koç University School of Medicine, Istanbul, Turkey
| | | | - Tarık Esen
- Department of Urology, Koç University School of Medicine, Istanbul, Turkey; Urology Clinic, VKF American Hospital, Istanbul, Turkey
| |
Collapse
|
2
|
Saeed OAM, Armutlu A, Cheng L, Longe HO, Saxena R. Tumor Genomic Profiling to Determine Tissue Origin of Cancers of Unknown Primary: A Single Institute Experience With its Utility and Impact on Patient Management. Appl Immunohistochem Mol Morphol 2022; 30:592-599. [PMID: 36083154 DOI: 10.1097/pai.0000000000001057] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2022] [Accepted: 08/10/2022] [Indexed: 11/26/2022]
Abstract
Tumor genomic profiling represents a promising tool in diagnosis and management of cancer of unknown primary. We report our experience on the impact of genomic profiling in elucidating primary tumor site, correlation with pathologic findings and patient management. Tissue or cytology specimens from 22 cancers of unknown primary were referred for genomic profiling. Reports were available to review in 18 cases; 3 samples were inadequate for analysis. Of the remaining 15 cases, primary tumor site was suggested in 12 cases (80%), whereas it remained indeterminate in 3 (20%). Of the 12 cases, molecular profiling was concordant with light microscopy findings in 3 patients, whereas in 2 cases molecular testing identified a sarcoma, contradicting light microscopy and immunohistochemistry findings. The suggested primary was confirmed by additional immunohistochemistry in 1 case and by endoscopic biopsy in another. In 5 cases, follow-up biopsy or additional testing were not considered necessary for patient management. Three patients received palliative care and 12 received various chemotherapy regimens. Five patients died within a year, whereas 9 were alive more than a year after diagnosis, 3 of who were alive >3 years after diagnosis. In conclusion, genomic profiling helped confirm the original diagnosis and suggested primary sites in two third of our cases. Although many patients may be at a disease stage too advanced to withstand further investigations or underg aggressive therapy, molecular testing improves diagnostic accuracy and may thus assist in selection of the most appropriate therapy.
Collapse
Affiliation(s)
| | - Ayşe Armutlu
- Department of Pathology, Koç University, Istanbul, Turkey
| | - Liang Cheng
- Departments of Pathology and Laboratory Medicine
| | - Harold O Longe
- Hematology and Oncology, Indiana University School of Medicine, Indianapolis, IN
| | - Romil Saxena
- Departments of Pathology and Laboratory Medicine
| |
Collapse
|
3
|
Köseoğlu E, Canda A, Özkan A, Kordan Y, Ertoy Baydar D, Kulaç İ, Armutlu A, Kiremit M, Aykanat İ, Tarım K, Sarıkaya A, Balbay M, Esen T. Outcomes of NeuroSAFE application of in robotic radical prostatectomy: Initial experience. EUR UROL SUPPL 2022. [DOI: 10.1016/s2666-1683(22)02152-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
|
4
|
Armutlu A, Saeed O, Saxena R. Metastatic Liver Tumors in Surgical Pathology: Impact of Contemporary Diagnostic and Therapeutic Paradigms in a Tertiary Care Center. Int J Surg Pathol 2021; 30:138-144. [PMID: 34125627 DOI: 10.1177/10668969211022708] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
We analyzed metastatic liver tumors received in the department of pathology in a tertiary care center over a 3-year period. There were 509 metastatic liver tumors; counterintuitively, there were as many resections (235 cases) as biopsies (274 cases). This unexpected finding reflects contemporaneous organ-specific paradigms for diagnosis and management of metastatic liver disease in oncologic practice, and the association of our practice with a National Cancer Institute-designated comprehensive cancer center with expertise and specialization in liver surgery. We receive a large number of resections for metastatic liver tumors because metastasectomy from a variety of primary tumors is associated with improved overall, and in many instances, disease-free, long-term survival. Metastatic colorectal carcinomas, metastatic neuroendocrine tumors, and metastatic gastrointestinal stromal tumors constituted 78% of resections because the largest body of literature and cumulative experience exists for these lesions. In contrast, breast carcinomas and pancreatic carcinomas, which are the next common metastatic liver tumors were biopsied but rarely resected, because metastasectomy is not the standard of care for these tumors. Immunohistochemistry was performed in less than a quarter of the total number of cases (23%), because the primary tumor site was known in the vast majority of cases. Of the 42 cases with unknown primary tumor, it was elucidated in 50% of the cases by immunohistochemical and clinical work-up. Of the cases with known primary tumor, immunohistochemistry was performed mostly in metastatic breast, colon, and lung carcinomas. In these cases, biomarker analyses provided additional information relevant to clinical management.
Collapse
Affiliation(s)
| | - Omer Saeed
- 12250Indiana University School of Medicine, Indianapolis, IN, USA
| | - Romil Saxena
- 12250Indiana University School of Medicine, Indianapolis, IN, USA
| |
Collapse
|
5
|
Taşkın OÇ, Armutlu A, Ağcaoğlu O, Peker Ö, Terzioğlu T, Demirkol MO, Tezelman S, Kapran Y. Tumor border pattern and size help predict lymph node status in papillary microcarcinoma: A clinicopathologic study. Ann Diagn Pathol 2020; 48:151592. [PMID: 32871504 DOI: 10.1016/j.anndiagpath.2020.151592] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2020] [Accepted: 07/30/2020] [Indexed: 10/23/2022]
Abstract
OBJECTIVE Lymph node metastasis occurs in a subset of papillary microcarcinoma patients. We aimed to analyze the differences between metastatic and non-metastatic papillary microcarcinomas in order to identify a high-risk subgroup that is likely to require more aggressive treatment. MATERIALS AND METHODS 126 thyroidectomies with lymph node dissections (central ± lateral), diagnosed as papillary microcarcinoma, were reviewed. RESULTS Mean age of 126 patients (F/M = 3.3) was 42 years. Mean size of the largest tumor was 7 mm. Classical was the most frequently (89%) encountered subtype. Multiple histologic subtypes co-occurred in 19%. Lymphovascular invasion was present in 16% (n = 20). 55 (44%) and 71 (56%) cases were unifocal and multifocal, respectively. 90 cases (71%) were non-encapsulated with overall infiltrative tumor borders, whereas in 36 cases (29%), the tumor had a well-defined capsule. Among those, 23 (64%) had tumor capsule invasion. 47 (37%) cases had metastasis in lymph nodes. In univariate analysis, metastasis was associated with tumor size of >5 mm (p = 0.02), tumor burden of >5 mm (p = 0.03), lymphovascular invasion (p = 0.02) and non-encapsulation (p = 0.01). No associations were found regarding sex, age, histologic subtype, lymphocytic thyroiditis, tumor capsule invasion (in capsulated tumors), laterality and multifocality (p > 0.05). In multivariate analysis, lymphovascular invasion (p = 0.01, OR = 3.97, 95% CI 1.35-11.67), tumor size >0.5 cm (p = 0.031, OR = 2.92, 95% CI 1.10-7.71) and non-encapsulation (p = 0.033, OR = 2.85, 95% CI 1.08-7.51) were independent risk factors. CONCLUSION Size (largest tumor or sum of all foci) of >5 mm, non-encapsulation and lymphovascular invasion were independent predictors of LNM in PMs. Unifocal tumors metastasize the same as multifocal tumors, suggestive of the contribution of other factors. Patients with sporadically resected microcarcinomas should be carefully followed-up, especially those that harbor risk factors in histology.
Collapse
Affiliation(s)
| | - Ayşe Armutlu
- Department of Pathology, Koç University Hospital, Turkey
| | | | - Önder Peker
- Department of Pathology, VKV American Hospital, Turkey
| | | | | | | | - Yersu Kapran
- Department of Pathology, Koç University Hospital, Turkey
| |
Collapse
|
6
|
Mut T, Acar Ö, Armutlu A, Incir S, Uhlig A, Ertuglu L, Özel M, Ertoy Baydar D, Kanbay M, Esen T. Can remote ischemic preconditioning counteract the renal functional deterioration attributable to partial nephrectomy under warm-ischemia? Results of an animal study. EUR UROL SUPPL 2020. [DOI: 10.1016/s2666-1683(20)33298-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
|
7
|
Koseoglu E, Kordan Y, Kilic M, Kiremit M, Tarim K, Armutlu A, Falay O, Altinmakas E, Esen T. Could mpMR and Ga-68 PSMA PET predict pT3 – pT4 disease? EUR UROL SUPPL 2020. [DOI: 10.1016/s2666-1683(20)32981-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
|
8
|
Taşkın OÇ, Armutlu A, Adsay V, Aslan F, Kapran Y. Clinicopathologic and immunohistochemical characteristics of upper gastrointestinal leiomyomas harboring interstitial cells of Cajal: A potential mimicker of gastrointestinal stromal tumor. Ann Diagn Pathol 2020; 45:151476. [PMID: 32062475 DOI: 10.1016/j.anndiagpath.2020.151476] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2020] [Accepted: 01/31/2020] [Indexed: 12/11/2022]
Abstract
OBJECTIVE To analyze clinicopathologic characteristics of upper gastrointestinal leiomyomas and to determine the distribution and immunohistochemical features of interstitial cells of Cajal, in order to designate whether they can cause diagnostic challenges. MATERIALS AND METHODS Twenty-four upper gastrointestinal leiomyomas (14 esophagus, 10 stomach) were retrieved. CD117, DOG-1 and muscle markers were performed. The staining was analyzed based on the distribution and percentage. Interstitial cells of Cajal were distinguished based on their positivity for both CD117 and DOG-1 immunohistochemistry, along with their morphological features. RESULTS Mean age of patients was 49 years, M/F ratio was 2.4. Patients with gastric leiomyomas were significantly younger than those with esophageal leiomyomas (41.5 vs. 54.3, p = 0.012). Histologically, leiomyomas were similar to their endometrial counterpart. Immunohistochemically, all tumors had strong/diffuse positivity for muscle markers. CD117 highlighted mast cells in all cases. Three cases had prominently increased mast cells. Both CD117 and DOG-1 also highlighted interstitial cells of Cajal in 24/24 (100%) of cases. Interstitial cells of Cajal were distributed in variable proportions, from focal to homogenous. In one case, they constituted 50% of tumor cells. In 16 cases, the distribution was homogenous. Superficial leiomyomas (n = 3) had only focal CD117 and DOG-1 positivity. CONCLUSION Upper gastrointestinal leiomyomas harbor expression of CD117 and DOG-1 in entrapped/colonized interstitial cells of Cajal, which can cause a potential pitfall in the differential diagnosis, especially in cases that show prominent immunohistochemical positivity. Evaluation of the immunohistochemistry can be exceptionally challenging in small biopsy/cytology specimens. Careful histologic evaluation of the tumor as well as the recognition of interstitial cells of Cajal will help the pathologist render the accurate diagnosis.
Collapse
Affiliation(s)
| | - Ayşe Armutlu
- Koç University Hospital, Department of Pathology, Turkey
| | - Volkan Adsay
- Koç University Hospital, Department of Pathology, Turkey
| | - Fatih Aslan
- Koç University Hospital, Department of Gastroenterology, Turkey
| | - Yersu Kapran
- Koç University Hospital, Department of Pathology, Turkey
| |
Collapse
|
9
|
Imam A, Karatas C, Imam R, Armutlu A, Mecit N, Karakaya A, Kalayoglu M, Kanmaz T. Three Consequent Pediatric Liver Transplant Deaths in the COVID-19 Era. Int J Organ Transplant Med 2020; 11:202-206. [PMID: 33335701 PMCID: PMC7726841] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/12/2023] Open
Abstract
The effect of COVID-19 on the transplant recipients is not well-established. Many reports underestimate the effect of COVID-19 on the immunosuppressed population. Herein, we report on 3 pediatric liver transplant recipients who were transplanted at our center between February 11 and March 10, 2020-during the COVID-19 pandemic era. The 3 patients aged between 5 and 10 months, had a rapid and aggressive respiratory deterioration that necessitated mechanical ventilation and extracorporeal life support; and eventually died. The clinical and pathological pictures likely represent COVID-19 pneumonia. Chest x-rays showed progressive infiltrates. Lung autopsies showed diffuse alveolar damage in two cases. We concluded that COVID-19 is very likely to have catastrophic effects on transplant recipients.
Collapse
Affiliation(s)
- A Imam
- Liver Transplantation Department, Koc University Hospital, Istanbul, Turkey
| | - C Karatas
- Liver Transplantation Department, Koc University Hospital, Istanbul, Turkey
| | - R Imam
- Liver Transplantation Department, Koc University Hospital, Istanbul, Turkey
| | - A Armutlu
- Pathology Department, Koc University Hospital, Istanbul, Turkey
| | - N Mecit
- Liver Transplantation Department, Koc University Hospital, Istanbul, Turkey
| | - A Karakaya
- Radiology Department, Koc University Hospital, Istanbul, Turkey
| | - M Kalayoglu
- Liver Transplantation Department, Koc University Hospital, Istanbul, Turkey
| | - T Kanmaz
- Liver Transplantation Department, Koc University Hospital, Istanbul, Turkey
| |
Collapse
|
10
|
Gökler O, Karanfil I, Koçak İ, Altuntaş MO, Armutlu A, Ünal ÖF. Nasopharyngeal Glial Heterotopia with Intracranial Extension: A Case Report. Turk Arch Otorhinolaryngol 2018; 56:177-179. [PMID: 30319877 DOI: 10.5152/tao.2018.3204] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2018] [Accepted: 04/20/2018] [Indexed: 11/22/2022] Open
Abstract
Nasopharyngeal glial heterotopia is a mass composed of mature neural tissue occurring outside the central nervous system and is extremely rare. The preoperative diagnosis of such a mass in the head and neck region is challenging. In this study, we report a case of a 16-month-old patient presenting with respiratory distress and snoring caused by nasopharyngeal glial heterotopia. Radiologic imaging and histopathology are obligatory for the definitive diagnosis of glial heterotopia. Preoperative evaluation of an intracranial connection is one of the most essential issues in the presence of pediatric nasopharyngeal masses. The gold standard of treatment is surgical excision. Early recognition and early surgical excision by endoscopic or external approach are crucial to relieve respiratory distress and to maintain healthy growth and development.
Collapse
Affiliation(s)
- Ozan Gökler
- Department of Otorhinolaryngology, Koç University Hospital, İstanbul, Turkey
| | - Işıl Karanfil
- Department of Otorhinolaryngology, Koç University Hospital, İstanbul, Turkey
| | - İlker Koçak
- Department of Otorhinolaryngology, Koç University Hospital, İstanbul, Turkey
| | | | - Ayşe Armutlu
- Department of Pathology, Koç University Hospital, İstanbul, Turkey
| | - Ömer Faruk Ünal
- Department of Otorhinolaryngology, Koç University Hospital, İstanbul, Turkey
| |
Collapse
|
11
|
Sezer H, Aygün MS, Armutlu A, Acar Ö, Falay FO, Yazici D, Deyneli O, Alagöl F. Erdheim-chester disease: Case report with testes involvement and review of literature. Urol Case Rep 2018; 18:19-21. [PMID: 29686965 PMCID: PMC5910526 DOI: 10.1016/j.eucr.2018.02.007] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2018] [Revised: 02/08/2018] [Accepted: 02/14/2018] [Indexed: 11/29/2022] Open
Affiliation(s)
- Havva Sezer
- Koç University School of Medicine, Division of Endocrinology and Metabolism, Turkey
| | | | - Ayşe Armutlu
- Koç University School of Medicine, Department of Pathology, Turkey
| | - Ömer Acar
- Koç University School of Medicine, Department of Urology, Turkey
| | - Fikri Okan Falay
- Koç University School of Medicine, Department of Nuclear Medicine, Turkey
| | - Dilek Yazici
- Koç University School of Medicine, Division of Endocrinology and Metabolism, Turkey
| | - Oğuzhan Deyneli
- Koç University School of Medicine, Division of Endocrinology and Metabolism, Turkey
| | - Faruk Alagöl
- Koç University School of Medicine, Division of Endocrinology and Metabolism, Turkey
| |
Collapse
|