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Comba C, Aslan E, Vatankulu B, Tatar Z, Demir AA, Demir O. An Extraordinary Location of Sentinel Lymph Nodes in a Patient with Endometrial Cancer. J Minim Invasive Gynecol 2023; 30:613-614. [PMID: 37137423 DOI: 10.1016/j.jmig.2023.04.012] [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: 01/27/2023] [Revised: 04/22/2023] [Accepted: 04/24/2023] [Indexed: 05/05/2023]
Abstract
OBJECTIVE To show dissection of sentinel lymph nodes. DESIGN A step-by-step demonstration of the technique with narration. SETTING Endometrial cancer (EC) is the most common gynecologic malignancy worldwide. Sentinel lymph node biopsy with indocyanine green (ICG) has become more widely used and has been featured in recently published guidelines for EC [1]. Minimally invasive approaches with the sentinel lymph node concept (conventional laparoscopy, laparoscopic-assisted vaginal surgeries or robotic) to EC staging have resulted in lower rates of peri- and postoperative complications than conventional staging procedures [2]. INTERVENTIONS No video article has been published in the literature about high pelvic, para-aortic sentinel lymph node dissection. An informed consent form was obtained from the patient. An institutional review board approval was not required. A 45-year-old female with gravidity 0, parity 0, and body mass index of 23.4 kg/m2 presented with complaints of abnormal uterine bleeding (spotting). Increased endometrial thickness was detected on transvaginal ultrasound (10 mm) in the postmenstrual period. Endometrioid-type endometrial adenocancer with focal squamous differentiation International Federation of Gynecology and Obstetrics grade I was detected on endometrial biopsy. The patient had hepatitis B virus positivity and no other chronic disease. A laparotomic myomectomy had been performed in 2016. Laparoscopic high pelvic, low para-aortic sentinel lymph node dissection with ICG and hysterectomy (without uterine manipulator) + bilateral salpingo-oophorectomy were performed (Supplemental Video 1). The operation time for the procedure was 110 minutes and the estimated blood loss was <20 mL. No major complications occurred during or after the surgery. The patient stayed in the hospital for 1 day. The final pathology result showed an International Federation of Gynecology and Obstetrics grade I, endometrioid-type endometrial adenocancer with focal squamous differentiation, as a 1.5 × 1 cm tumorous mass invading less than one-half of the myometrium. Neither lymphovascular invasion nor sentinel lymph node metastasis was detected. A multicenter, prospective study showed that sentinel lymph node dissection with ICG in clinical stage 1 EC is feasible and has a high degree of diagnostic accuracy in detecting EC metastases. In that study, isolated para-aortic sentinel lymph node was detected in 3 of 340 patients (<1%) [2]. Another study reported the detection rate of isolated para-aortic sentinel lymph node to be 1.1% in patients with intermediate- and high-risk EC [3]. CONCLUSION There are in some cases 2 distinct channels emanating from one side, and it is important to follow each and to acknowledge there may be more than one sentinel, one of which is lower in a typical location and one higher as in this case. This video article is the first video demonstration of bilateral isolated high pelvic, para-aortic sentinel lymph node dissection in EC.
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Affiliation(s)
- Cihan Comba
- Department of Gynecologic Oncology (Dr. Comba).
| | - Erkan Aslan
- Department of Obstetrics and Gynecology (Dr. Aslan)
| | | | - Zeynep Tatar
- Department of Pathology (Dr. Tatar), Patomer Pathology Laboratory, Istanbul, Turkey
| | - Ali Aslan Demir
- Department of Diagnostic Radiology (Dr. A. Demir), VM Medical Park Florya Hospital, Istanbul Aydin University, Istanbul, Turkey
| | - Omer Demir
- Department of Obstetrics and Gynecology (Dr. O. Demir), Karadeniz Technical University, Trabzon, Turkey
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Atici A, Asoglu R, Demirkiran A, Demir AA, Barman HA, Cevik E, Dursun M, Bugra MZ. Impact of Multimodality Imaging on the Diagnosis of Left Ventricular Apical Thrombus in Patients after Anterior Myocardial Infarction. Am J Med Sci 2021; 363:130-139. [PMID: 34848187 DOI: 10.1016/j.amjms.2021.06.028] [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] [Received: 07/22/2020] [Revised: 03/12/2021] [Accepted: 06/17/2021] [Indexed: 11/25/2022]
Abstract
BACKGROUND The presence of the left ventricle (LV) apical thrombus is one of the most critical complications of anterior myocardial infarction (MI). Due to the high risk of systemic embolization, the determination of LV apical thrombus (LVAT) is essential. We aimed to compare the two-dimensional echocardiography (2DE), contrast-2DE and real-time three-dimensional echocardiography (RT-3DE) in the diagnosis of LVAT and determine which imaging modality is superior. METHODS The study was designed as a prospective cohort study, and 161 patients were included. Patients with low ejection fraction (<40%) and LV apical wall motion abnormality (severe hypokinetic, akinetic or dyskinetic) were included. 2DE, contrast-2DE, RT-3DE, and magnetic resonance imaging (MRI) were performed on all patients within one month after anterior MI. RESULTS Transthoracic 2DE detected thrombi in 29 patients, contrast-2DE detected thrombi in 33 patients, RT-3DE detected thrombi in 32 patients, and MRI detected thrombi in 28 patients. While MRI is accepted as the gold standard for non-invasive imaging, the specificity of detecting thrombus with 2DE is 90%, and the sensitivity is 57%, contrast-2DE had 82% sensitivity and 92% specificity for the detection of LVAT. The specificity for detecting thrombus with RT-3DE is 93%, and the sensitivity is 85%. Accuracy was 84%, 90% and 92% with 2DE, contrast-2DE and RT-3DE, respectively. CONCLUSIONS We found that RT-3DE was more sensitive and more specific than 2DE and contrast-2DE in the diagnosis of LVAT. The diagnostic accuracy of RT-3DE was higher than 2DE and contrast-2DE for LVAT.
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Affiliation(s)
- Adem Atici
- Cardiology Department, Istanbul Medeniyet University, Goztepe Training and Research Hospital, Istanbul, Turkey.
| | - Ramazan Asoglu
- Adiyaman Health Education and Research Hospital, Department of Cardiology, Adiyaman, Turkey
| | - Ahmet Demirkiran
- Cardiology Department, Istanbul Faculty of Medicine, Istanbul, Turkey
| | - Ali Aslan Demir
- Radiology Department, Istanbul Faculty of Medicine, Istanbul, Turkey
| | - Hasan Ali Barman
- Istanbul University - Cerrahpasa, Institute of Cardiology, Department of Cardiology, Istanbul, Turkey
| | - Erdem Cevik
- Cardiology Department, Istanbul Faculty of Medicine, Istanbul, Turkey
| | - Memduh Dursun
- Radiology Department, Istanbul Faculty of Medicine, Istanbul, Turkey
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Soydan L, Demir AA, Torun M, Cikrikcioglu MA. Use of Diffusion-Weighted Magnetic Resonance Imaging and Apparent Diffusion Coefficient in Gastric Cancer Staging. Curr Med Imaging 2021; 16:1278-1289. [PMID: 32108000 DOI: 10.2174/1573405616666200218124926] [Citation(s) in RCA: 3] [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: 08/06/2019] [Revised: 01/08/2020] [Accepted: 01/23/2020] [Indexed: 11/22/2022]
Abstract
BACKGROUND The apparent diffusion coefficient (ADC), the quantitative parameter of diffusion-weighted magnetic resonance imaging (DW-MRI), is a measure for this restricted diffusion, and its role in gastric cancer (GC) including distinguishing malignant segments from healthy gastric wall, metastatic perigastric lymph nodes from benign nodes and evaluating response of GC to neoadjuvant chemotherapy has been investigated in previous studies. Evidence suggests that ADC may also be of help in assessment of aggressiveness and preoperative staging of gastric cancer, which needs to be explored in further studies. OBJECTIVE To investigate the role of DW-MRI and its quantitative parameter, ADC in staging of gastric cancer. METHODS Forty-six patients (28 male, 18 female, mean age 62 years) with non-metastatic biopsy- proven GC who underwent abdominal DW-MRI before surgery were included in this retrospective study. Tumor invasion depth (T-stage) and nodal involvement (N-stage) were evaluated using signal increase on DW-MRI, and tumor ADC was measured. Diagnostic performance of these results was assessed by comparing them with postsurgical histopathology based on 8th TNM classification. RESULTS Sensitivity, specificity, and accuracy of DW-MRI in T-staging were 92.1%, 75%, 89.1% for ≤T2 vs. ≥T3; and 75%, 88.5%, 82.6% for ≤T3 vs. T4. However, sensitivity, specificity, and accuracy of DW-MRI in N-staging were 89.3%, 88.9%, 89.1% for ≤N1 vs. ≥N2; and 73.7%, 96.3%, 86.9% for ≤N2 vs. N3, respectively. Relative preoperative ADC values correlated with pT staging (r=-0.397, p=0.006). There was also a statistically significant difference of relative ADC values between ≤T3 and T4 stages, and a cut-off of 0.64 s/mm2 could differentiate these stages with an odds ratio of 7.714 (95% confidence interval, 1.479-40.243). The area under the receiver operating characteristic curve for differentiating ≤T3 and T4 stages was 0.725. CONCLUSION DW-MRI may contribute to the clinical staging of non-metastatic GC. In particular, relative ADC of DW-MRI can distinguish T4 gastric cancer from less advanced T-stages.
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Affiliation(s)
- Levent Soydan
- Department of Radiology, Haydarpasa Numune Education and Research Hospital, Istanbul, Turkey
| | - Ali Aslan Demir
- Department of Radiology, Fulya Imaging Center, Istanbul, Turkey
| | - Mehmet Torun
- Department of Surgery, Haydarpasa Numune Education and Research Hospital, Istanbul, Turkey
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Bayramoğlu Z, Yılmaz R, Demir AA, Ataizi-Çelikel Ç, Kombak FE, İkinci A, Yekeler E. Multimodality imaging findings of visceral myopathy in a child presenting with palpable abdominal mass. Turk J Pediatr 2019; 61:120-125. [PMID: 31559733 DOI: 10.24953/turkjped.2019.01.020] [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] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
Bayramoğlu Z, Yılmaz R, Demir AA, Ataizi-Çelikel Ç, Kombak FE, İkinci A, Yekeler E. Multimodality imaging findings of visceral myopathy in a child presenting with palpable abdominal mass. Turk J Pediatr 2019; 61: 120-125. Visceral myopathy is a rare cause of intestinal obstruction characterized by intestinal dysmotility and constipation. Patients often present with recurrent abdominal pain, vomiting and abdominal distension. We report a rare case of visceral myopathy in a child presenting with intraabdominal mass. We aimed to describe ultrasound, computed tomography and magnetic resonance enterography findings of this rare disease that has not been demonstrated before. Differential diagnosis of mural thickening with distinguishable layers in addition to intestinal dilatation in the absence of mesenteric inflammation includes visceral myopathy.
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Affiliation(s)
- Zuhal Bayramoğlu
- Department of Radiology, Istanbul University Istanbul Faculty of Medicine, , Istanbul, Turkey
| | - Ravza Yılmaz
- Department of Radiology, Istanbul University Istanbul Faculty of Medicine, , Istanbul, Turkey
| | - Ali Aslan Demir
- Department of Radiology, Istanbul University Istanbul Faculty of Medicine, , Istanbul, Turkey
| | | | - Faruk Erdem Kombak
- Department of Pathology, Marmara University Faculty of Medicine, Istanbul, Turkey
| | - Aygün İkinci
- Department of Pathology, Marmara University Faculty of Medicine, Istanbul, Turkey
| | - Ensar Yekeler
- Department of Radiology, Istanbul University Istanbul Faculty of Medicine, , Istanbul, Turkey
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Soydan L, Demir AA, Tunaci A. Frequency of abnormal pulmonary computed tomography findings in asylum seeking refugees in Turkey. Int Health 2017; 9:118-123. [PMID: 28100704 DOI: 10.1093/inthealth/ihw057] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [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: 06/27/2016] [Accepted: 12/14/2016] [Indexed: 11/13/2022] Open
Abstract
Background Lungs are particularly vulnerable to both acute infections, including TB, and chronic diseases such as chronic obstructive pulmonary disease, as well as to malignancies, all of which require particular attention during war times in which health conditions are far from optimal. Methods This retrospective cross-sectional study included 1149 refugees that underwent thoracic computed tomography (CT) for respiratory symptoms between March 2013 and February 2015 in Turkey. Results At least one positive CT finding was seen in 231 (20.1%) of the patients. The most common findings were chronic pulmonary changes (n=197, 17.2%), followed by findings suggestive of infections (n=39, 3.4%), and mass/nodular lesions (n=16, 1.4%). The rates of the lesions suggestive of active TB and malignancy were 1.0% (n=11) and 0.7% (n=8), respectively. Age 55-64 years was an independent significant predictor for any CT lesion, chronic changes, mass lesions, and lesions suggestive of malignancy. Age>65 years was predictive of any CT lesion and chronic changes. Conclusions The findings of this study indicate the need for implementation of cost-effective screening strategies in refugees, particularly during war times. Screening for TB would improve disease control among both refugees and the host populations. Middle aged and older individuals, in particular, would benefit from more proactive screening tools and strategies for the early diagnosis of pulmonary malignancies and chronic lung diseases.
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Affiliation(s)
- Levent Soydan
- Department of Radiology, Haydarpasa Numune Research and Training Hospital, 34668, Istanbul, Turkey
| | - Ali Aslan Demir
- Department of Radiology, Capa Medical Faculty, Istanbul University, 34093, Istanbul, Turkey
| | - Atadan Tunaci
- Department of Radiology, Capa Medical Faculty, Istanbul University, 34093, Istanbul, Turkey
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Abstract
PURPOSE We aimed to evaluate computed tomography (CT) and magnetic resonance imaging (MRI) findings of cardiac calcified amorphous tumors (CATs). METHODS CT and MRI findings of cardiac CATs in 12 patients were included. We retrospectively examined patient demographics, location, size, shape configuration, imaging features, calcification distribution of tumors, and accompanying medical problems. RESULTS There was a female predominance (75%), with a mean age at presentation of 65 years. Patients were mostly asymptomatic on presentation (58.3%). The left ventricle of the heart was mostly involved (91%). CT findings of CATs were classified as partial calcification with a hypodense mass in four patients or a diffuse calcified form in eight. Calcification was predominant with large foci appearance as in partially calcified masses. On T1- and T2-weighted magnetic resonance images, CATs appeared hypointense and showed no contrast enhancement. CONCLUSION The shape and configuration of cardiac CATs are variable with a narrow spectrum of CT and MRI findings, but large foci in a partially calcified mass or diffuse calcification of a mass on CT is very important in the diagnosis of cardiac CATs. Masses show a low signal intensity on T1- and T2-weighted images with no contrast enhancement on MRI.
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Affiliation(s)
- Ravza Yılmaz
- Department of Radiology, İstanbul University School of Medicine, İstanbul, Turkey.
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Bayramoglu Z, Yılmaz R, Demir AA, Yekeler E, Dursun M, Dindar A, Nisli K, Omeroglu R. Topsy-turvy heart and associated imaging findings. J Cardiovasc Comput Tomogr 2017; 11:417-418. [PMID: 28438441 DOI: 10.1016/j.jcct.2017.04.008] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/07/2017] [Accepted: 04/18/2017] [Indexed: 11/19/2022]
Affiliation(s)
- Zuhal Bayramoglu
- Department of Radiology, Istanbul Medical Faculty, Istanbul University, Istanbul, Turkey.
| | - Ravza Yılmaz
- Department of Radiology, Istanbul Medical Faculty, Istanbul University, Istanbul, Turkey
| | - Ali Aslan Demir
- Department of Radiology, Istanbul Medical Faculty, Istanbul University, Istanbul, Turkey
| | - Ensar Yekeler
- Department of Radiology, Istanbul Medical Faculty, Istanbul University, Istanbul, Turkey
| | - Memduh Dursun
- Department of Radiology, Istanbul Medical Faculty, Istanbul University, Istanbul, Turkey
| | - Aygun Dindar
- Department of Pediatric Cardiology, Istanbul Medical Faculty, Istanbul University, Istanbul, Turkey
| | - Kemal Nisli
- Department of Pediatric Cardiology, Istanbul Medical Faculty, Istanbul University, Istanbul, Turkey
| | - Rukiye Omeroglu
- Department of Pediatric Cardiology, Istanbul Medical Faculty, Istanbul University, Istanbul, Turkey
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Bayramoglu Z, Yılmaz R, Demir AA, Ozturk Sari S, Maulid P, Bozbey HU, Acunas G. Imaging Findings of A Rare Breast Malignancy: Bilateral Metachronous Primary Angiosarcoma of Breast. Breast J 2017; 23:596-599. [DOI: 10.1111/tbj.12804] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Affiliation(s)
- Zuhal Bayramoglu
- Department of Radiology; Istanbul Medical Faculty; Istanbul University; Istanbul Turkey
| | - Ravza Yılmaz
- Department of Radiology; Istanbul Medical Faculty; Istanbul University; Istanbul Turkey
| | - Ali Aslan Demir
- Department of Radiology; Istanbul Medical Faculty; Istanbul University; Istanbul Turkey
| | - Sule Ozturk Sari
- Pathology Department; Istanbul Medical Faculty; Istanbul University; Istanbul Turkey
| | - Payam Maulid
- Department of Radiology; Istanbul Medical Faculty; Istanbul University; Istanbul Turkey
| | - Hamza U. Bozbey
- Department of Medical Oncology; Istanbul Medical Faculty; Istanbul University; Istanbul Turkey
| | - Gulden Acunas
- Department of Radiology; Istanbul Medical Faculty; Istanbul University; Istanbul Turkey
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Bulakci M, Gocmez A, Demir AA, Salmaslioglu A, Tukenmez M, Yavuz E, Acunas G. Fibroadenomatosis involving bilateral breasts and axillary accessory breast tissues in a renal transplant recipient given cyclosporin A. J Clin Ultrasound 2014; 42:495-497. [PMID: 25131521 DOI: 10.1002/jcu.22220] [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] [Subscribe] [Scholar Register] [Received: 11/07/2013] [Revised: 07/04/2014] [Accepted: 07/21/2014] [Indexed: 06/03/2023]
Abstract
We present the mammographic and sonographic findings in a case of fibroadenomatosis involving both breasts and axillae in a renal transplant patient after 16 years of treatment with cyclosporin A. Awareness of the fact that cyclosporin A may induce the formation of fibroadenomas, including in accessory breast tissue, is important for correct diagnosis and preventing unnecessary intervention.
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Affiliation(s)
- Mesut Bulakci
- Department of Radiology, Istanbul University, Istanbul Faculty of Medicine, 34390, Capa, Istanbul, Turkey
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