Tıp Fakültesi / Faculty of Medicine
Permanent URI for this collectionhttps://hdl.handle.net/11727/1403
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Item Fine-Needle Aspiration Biopsy Findings of the Thyroid Gland in Renal Transplant Patients(2023) Akcay, Eda Yilmaz; Tepeoglu, Merih; Atilgan, Alev Ok; Yagci, Sergen; Ozdemir, Binnaz Handan; Haberal, Mehmet; 37885286Objectives: For patients with end-stage renal disease, thyroid diseases are common due to altered hormone excretion and transport, and for renal transplant recipients this is due to immunosuppressive drugs. We investigated the prevalence of thyroid disorders, including thyroid cancer, by fine-needle aspiration biopsy in kidney transplant candidates and recipients and estimated the outcomes. Materials and Methods: For 305 thyroid fine-needle aspiration biopsies performed from January 2000 to December 2020 in patients with end-stage renal disease, we recorded patient demographics, thyroid ultrasonography, and biopsy findings. Results: Of biopsy results from 305 patients, 272 (89.2%) were benign, 24 (7.9%) showed atypia of undetermined significance/follicular lesion of undetermined significance, 2 (0.7%) had suspicion for malignancy, and 7 (2.3%) were malignant. Thyroid surgery was performed for 13 patients with benign results, 6 with atypia of undetermined significance/follicular lesion of unde-termined significance, 2 with suspicion for malignancy, and 7 with malignancy. In 13 patients with benign cytology, the histopathology finding was also benign in lobectomy specimens. In 6 patients with atypia of undetermined significance/follicular lesion of undetermined significance, the final diagnosis was papillary thyroid carcinoma in 3 patients, adeno-matous hyperplasia in 2 patients, and Hurthle cell adenoma in 1 patient. For all 9 patients for whom fine-needle aspiration biopsy was suspicious for malignancy or malignant, histopathologic examination showed papillary thyroid carcinoma in total thyroidectomy materials. Among 12 papillary thyroid carcinoma patients, 4 underwent renal transplant after thyroidectomy, and survival for these 4 patients was 116.25 +/- 29.30 months after transplant without tumor recurrence or distant metastases. Conclusions: Thyroid diseases are more frequent in patients with end-stage renal disease or renal transplant versus the normal population and also affect morbidity and mortality at higher rates in these patients. Fine-needle aspiration biopsy is a useful diagnostic modality in evaluation and treatment of thyroid nodules in both kidney transplant candidates and recipients.Item Liver Transplant in a Child With an Uncommon Co-Occurrence of Biliary Atresia and Bilateral Vesicoureteral Reflux(2014) Deniz, Emine Ebru; Terzi, Aysen; Ozdemir, Binnaz Handan; Haberal, Nihan; Baskin, Esra; Haberal, Mehmet; https://orcid.org/0000-0002-1225-1320; https://orcid.org/0000-0002-7528-3557; https://orcid.org/0000-0001-9852-9911; https://orcid.org/0000-0003-4361-8508; https://orcid.org/0000-0002-3462-7632; 24635820; F-7546-2013; X-8540-2019; AAK-4587-2021; B-5785-2018; AAJ-8097-2021We report the clinicopathologic findings of a patient with biliary atresia associated with vesicoureteral reflux who underwent a liver transplant and nephroureterectomy simultaneously. The patient was a 22-month-old female infant born of a nonconsanguineous marriage, who was reported to be icteric from first day of life. Her antenatal history was significant for bilateral hydronephrosis. The results of a liver biopsy showed findings of biliary atresia, and the results of a radiograph showed bilateral vesicoureteral reflux. Therefore, the patient underwent a liver transplant and a right nephroureterectomy simultaneously. In the days after the operation, the patient died because of extrahepatic hematoma. In conclusion, a child having biliary atresia must remain for investigation of associated anomalies including vesicoureteral reflux.Item Clinicopathologic Study of Kidney Biopsies in Patients Before or After Liver Transplant(2014) Terzi, Aysen; Ozdemir, Binnaz Handan; Taslica, Firdevs Zeynep; Ozdemir, Fatma Nurhan; Kirnap, Mahir; Haberal, Mehmet; https://orcid.org/0000-0002-1225-1320; https://orcid.org/0000-0002-7528-3557; https://orcid.org/0000-0002-5682-0943; https://orcid.org/0000-0002-3462-7632; 24635810; F-7546-2013; X-8540-2019; AAK-1697-2021; AAH-9198-2019; AAJ-8097-2021Objectives: The purpose of this study was to evaluate the causes of kidney impairment associated with liver transplant in patients who had kidney biopsy before or after liver transplant. Materials and Methods: In 408 patients who had liver transplant from January 1990 to December 2012, there were 10 patients who had kidney biopsy (total, 19 kidney biopsies) for evaluation of kidney dysfunction. A retrospective review of clinical records and kidney biopsies was performed. Results: There were 7 male and 3 female patients (median age at liver transplant, 43 y; range, 10 to 62 y). The most frequent reason for liver transplant were hepatitis B virus cirrhosis (4 patients). There were 3 patients who had a kidney transplant before or concurrent with liver transplant. Increased serum creatinine level was the most common clinical finding at the time of kidney biopsy. The median interval from liver transplant to kidney biopsy was 495 days (mean, 1025 d; range, 10-4980 d). The most common pathology in the kidney biopsies was immune complex glomerulonephritis (total, 7 patients: IgA nephropathy, 4 patients; lupus nephritis, 2 patients; membranoproliferative glomerulonephritis, 1 patient). There were 4 patients who had allergic tubulointerstitial nephritis, 2 patients who had chronic calcineurin inhibitor nephrotoxicity, and 1 patient who had karyomegalic nephropathy. There were 7 patients who died at mean 34 months (range, 1-70 mo) after liver transplant. The other 3 patients were alive at mean 128 months (range, 67-193 mo) after liver transplant and had a functioning liver graft and chronic kidney disease. Conclusions: Chronic kidney disease after liver transplant has a major effect on mortality. The frequency of immune complex glomerulonephritis associated with liver transplant may be greater than previously recognized.Item Hepatic Angiosarcoma and Liver Transplant: A Report of 2 Cases With Diagnostic Difficulties(2014) Terzi, Aysen; Deniz, Emine Ebru; Haberal, Nihan; Moray, Gokhan; Ozdemir, Binnaz Handan; https://orcid.org/0000-0002-1225-1320; https://orcid.org/0000-0001-9852-9911; https://orcid.org/0000-0003-2498-7287; https://orcid.org/0000-0002-7528-3557; 24635809; F-7546-2013; AAK-4587-2021; AAE-1041-2021; X-8540-2019Angiosarcoma is a rare primary malignant mesenchymal tumor of the liver. The prognosis of hepatic angiosarcoma is poor with an average life expectancy of 6 months after diagnosis. Diagnosing hepatic angiosarcoma is challenging because of nondiagnostic liver biopsy or specious history and radiologic presentation. We report 2 cases with hepatic angiosarcoma which were diagnosed histopathologically in the native liver after liver transplant. One of 2 patients was lost to follow-up, and another patient died of relapsing hepatic angiosarcoma 18 months after the liver transplant.Item A Single-Center Retrospective Clinicopathologic Study of Endomyocardial Biopsies After Heart Transplant at Baskent University Hospital in Ankara, 1993-2014(2015) Terzi, Ayen; Sezgin, Atilla; Tunca, Zeynep; Deniz, Ebru; Ayva, Ebru Sebnem; Reyhan, Nihan Haberal; Mulderrisoglu, Haldun; Ozdemir, Binnaz Handan; 0000-0002-2280-8778; 0000-0002-7528-3557; 0000-0002-1225-1320; 0000-0001-9852-9911; 25894188; AAK-1967-2021; X-8540-2019; F-7546-2013; AAK-4587-2021Objectives: The purpose of this study was to investigate the frequency and prognostic importance of acute cellular rejection after heart transplant. Materials and Methods: All 84 heart transplant patients at our center from January 1993 to January 2014, including all 576 endomyocardial biopsies, were evaluated with retrospective review of clinical records and endomyocardial biopsies. Routine and clinically indicated endomyocardial biopsies after heart transplant were graded for acute cellular rejection (2005 International Society for Heart and Lung Transplantation Working Formulation). Survival analysis was performed using Kaplan-Meier method. Results: There were 61 male (73%) and 23 female recipients. Median age at heart transplant was 29 years (range, 1-62 y). Posttransplant early mortality rate was 17.9% (15 patients). In the other 69 patients, 23 patients died and 46 patients (66.7%) were alive at mean 69.3 +/- 7.2 months after heart transplant. Mean follow-up was 35.4 +/- 29.8 months (range, 0.07-117.5 mo). Mean 8.4 +/- 4.2 endomyocardial biopsies (range, 1-19 biopsies) were performed per patient. Median first biopsy time was 7 days (range, 1-78 d). The frequency of posttransplant acute cellular rejection was 63.8% (44 of 69 patients) by histopathology; 86% patients experienced the first episode of acute cellular rejection within 6 months after transplant. There were 18 patients with acute cellular rejection >= grade 2R on >= 1 endomyocardial biopsy in 44 patients with acute cellular rejection. No significant difference was observed between survival rates of patients with grade 1R or >= grade 2R acute cellular rejection, or between survival rates of patients with or without diagnosis of any grade of acute cellular rejection. Acute cellular rejection was not related to any prognostic risk factor. Conclusions: Acute cellular rejection had no negative effect on heart recipient long-term survival, but it was a frequent complication after heart transplant, especially within the first 6 months.Item The Relation Between The Inflamatory Cytokine Expression with Acute Rejection Episodes and Hepatitis Recurrence in Liver Allograft Recipients(2016) Ozgun, Gonca; Ozdemir, Binnaz Handan; Akcay, Eda Yilmaz; Borcek, Pelin; Moray, Gokhan; Haberal, Mehmet; https://orcid.org/0000-0002-7528-3557; https://orcid.org/0000-0001-6831-9585; https://orcid.org/0000-0003-2498-7287; https://orcid.org/0000-0002-3462-7632; X-8540-2019; AAK-1960-2021; AAE-1041-2021; AAJ-8097-2021Item Liver Transplant for Hepatocellular Carcinoma: Pathologic Point Of View(2017) Ozgun, Gonca; Reyhan, Nihan Haberal; Ozdemir, Binnaz Handan; Haberal, Mehmet; 0000-0001-9852-9911; 0000-0002-7528-3557; 0000-0002-3462-7632; 28301999; AAK-4587-2021; X-8540-2019; AAJ-8097-2021Primary liver cancer is the fifth most common cancer overall and the second most common cause of cancer mortality worldwide. Hepatocellular carcinoma accounts for up to 90% of all primary hepatic malignancies and represents a major international health problem. It is a complex and heterogeneous malignancy, frequently occurs in the setting of a chronically diseased organ, and has multiple confounding factors. Liver transplant for hepato cellular carcinoma has been established as a standard treatment in selected patients. Liver resection and locoregional therapies could be other options for treatment. Pathologic evaluation of hepatocellular carcinoma is a complicated process that includes tumor grading and evaluation of microvascular invasion. Although macrovascular invasion can be detected with imaging techniques, microvascular invasion is diagnosed pathologically. Pathologic evaluation provides additional information about the tumor biology, using immunohistochemical and molecular methods to predict patient outcomes. Hepatocellular carcinoma requires a multidisciplinary approach to determine the most appropriate treatment, as well as requires accurate timing of various treatments for optimal outcomes.Item Pediatric Liver Transplant For Hepatoblastoma: A Single-Center Experience(2017) Kirnap, Mahir; Soy, Ebru Ayvazoglu; Ozcay, Figen; Moray, Gokhan; Ozdemir, Binnaz Handan; Haberal, Mehmet; 0000-0002-3462-7632; 0000-0002-5214-516X; 0000-0003-2498-7287; 0000-0002-0993-9917; 0000-0002-7528-3557; 28260432; AAJ-8097-2021; ABG-5684-2020; AAH-9198-2019; AAE-1041-2021; AAC-5566-2019; X-8540-2019Item Traumatic Neuroma Causing Biliary Stricture After Orthotopic Liver Transplant, Treated With Hepaticojejunostomy: A Case Report(2017) Terzi, Aysen; Kirnap, Mahir; Sercan, Cigdem; Ozdemir, Gokce; Ozdemir, Binnaz Handan; Haberal, Mehmet; 0000-0002-1225-1320; 0000-0003-2545-0078; 0000-0002-7528-3557; 0000-0002-3462-7632; 28260461; F-7546-2013; AAL-4282-2020; X-8540-2019; AAJ-8097-2021Traumatic neuromas of the biliary tract have occasionally been reported to cause strictures at the cystic duct stump as a late complication of cho-lecystectomy with common bile duct exploration. The incidence of symptomatic traumatic biliary neuroma appears to be low after orthotopic liver transplant, as only 25 patients have been described previously in the English-language literature. Traumatic (amputation) neuroma is a reactive proliferation of pericholangial nerve fibers induced by injury, but it is not a true neoplasm. The diagnosis of traumatic neuroma is possible only by histopathologic examination; the diagnostic finding is a mass of hyperplastic nerve bundles. We report a patient with a traumatic neuroma causing an early biliary stricture with intrahepatic extension after an orthotopic liver transplant. The lesion failed to respond to repeated endoscopic stenting and eventually required hepaticojejunostomy. A biopsy of the liver graft, performed in the 13th month after transplant, showed chronic ductopenic rejection.Item Auxiliary Partial Orthotopic Living Liver Transplant for Wilson Disease(2017) Haberal, Mehmet; Akdur, Aydincan; Moray, Gokhan; Boyacioglu, Sedat; Torgay, Adnan; Arslan, Gulnaz; Ozdemir, Binnaz Handan; 0000-0002-6829-3300; 0000-0002-3462-7632; 0000-0003-2498-7287; 0000-0002-8726-3369; 0000-0002-7528-3557; 0000-0002-9370-1126; 28260463; AAJ-5221-2021; AAJ-8097-2021; AAE-1041-2021; AAA-3068-2021; X-8540-2019; AAE-7637-2021Wilson disease is a genetic disease involving copper metabolism disturbances that result in copper accumulations, especially in the liver and brain. Wilson disease can be treated with pharmacologic agents, such as chelators that induce urinary excretion of copper or zinc salts that inhibit copper absorption in the digestive tract. Liver transplant is the only treatment option for Wilson disease when liver failure has occurred. In some patients, that is, in those with Child-Pugh A score, neurologic disease can be seen without hepatic failure. Our recommendation is for these patients to have auxiliary partial orthotopic liver transplant. Here, we present a 36-year-old male patient with neurologic disease associated with Wilson disease who had successful related living-donor auxiliary partial orthotopic liver transplant using a left lobe. The patient, as a result of neurologic symptoms that included tremor walking and speaking problems and low serum ceruloplasmin level of 7 mg/dL, was diagnosed with Wilson disease, and a liver biopsy was performed. Chronic necroinflammatory disease activity was 4/18, and the patient received chelation treatment. His hepatic functions were normal. The donor was the patient's 57-year-old father whose liver function tests were also normal. The graft-to-recipient weight ratio was 1% using a left lobe graft. After transplant, serum ceruloplasmin levels on day 15 and month 1 were 14 and 19 mg/dL. At month 1, liver function tests were normal. Doppler ultrasonography showed normal vascular flow of the native liver and the graft. The patient's neurologic symptoms were progressively reduced. Progressive neurologic deterioration with no hepatic insufficiency is considered a suitable indication for auxiliary partial orthotopic liver transplant; this procedure is suggested before the neurologic and liver failure symptoms of Wilson disease occur.