Tıp Fakültesi / Faculty of Medicine
Permanent URI for this collectionhttps://hdl.handle.net/11727/1403
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Item Kikuchi-Fujimoto Disease as A Rare Cause of Benign Lymphadenopathy and 18F-FDG PET/CT Findings(2014) Erhamamci, Seval; Reyhan, Mehmet; Kocer, Nazim Emrah; https://orcid.org/0000-0001-8550-3368; https://orcid.org/0000-0002-5943-9283; 24563878; AAJ-5242-2021; AAM-5436-2021Kikuchi-Fujimoto disease (KFD) is an uncommon benign and self-limited disease, characterized by cervical lymphadenopathy. This disease is generally diagnosed on the basis of an excisional biopsy of affected lymph nodes. However, clinical presentation and histopathological findings of KFD could lead to a wrong initial diagnosis, of tuberculosis, systemic lupus erythymatosus or malignant lymphoma. Laboratory tests are not specific. Imaging modalitites give confusing results. Affected lymph nodes of patients; with KFD can exibit F-18-FDG uptake on PET/CT imaging similar to malignant lymphoma. Therefore, the differential diagnosis of KFD should be considered in patients with cervical and/or generalized lymphadenopathy. Accurate diagnosis of KFD by histology is essential in avoiding unnecessary emotional and mental distress associated with the diagnosis of lymphoma.Item Prognostic Value of 18F-Fluorodeoxyglucose Uptake in Pelvic Lymph Nodes in Patients with Cervical Cancer Treated with Definitive Chemoradiotherapy(2015) Onal, Cem; Guler, Ozan C.; Reyhan, Mehmet; Yapar, Ali Fuat; 0000-0001-6908-3412; 0000-0003-1715-4180; 0000-0002-2742-9021; 0000-0001-8550-3368; 25641567; AAC-5654-2020; AAI-8973-2021; D-5195-2014; AAJ-5242-2021; HOC-5611-2023Purpose. To evaluate the prognostic significance of the maximum standardized uptake (SUVmax) value for pelvic lymph nodes in patients with cervical cancer and its impact on treatment response, disease control, and survival. Methods. Ninety-three patients with pelvic or para-aortic metastasis detected by PET/CT and treated with definitive chemoradiotherapy were evaluated. The impact of pelvic lymph node SUVmax on prognostic factors and treatment outcomes was assessed. Results. The size and SUVmax of pelvic lymph nodes were significantly correlated (r = 0.859; p < 0.001). Patients with pelvic and para-aortic lymph node metastases had significantly higher SUVmax values for both primary tumor (23.4 +/- 9.2 vs. 18.5 +/- 73; p = 0.01) and pelvic lymph nodes (11.4 +/- 4.6 vs. 7.4 +/- 3.8; p = 0.001). Patients with pelvic lymph node SUVmax >= 7.5 had significantly higher primary tumor SUVmax, larger pelvic lymph nodes, higher rates of para-aortic lymph node metastasis, and lower post-therapy complete response rates. Overall survival (OS) and disease-free survival (DFS) rates were significantly higher in patients with SUVmax < 7.5 compared to patients with SUVmax >= 7.5. In a multivariate analysis, pelvic lymph node SUVmax and post-therapy metabolic response were significant prognostic factors for both OS and DFS for all patients, but no significant prognostic factors were found in pelvic lymph node metastasis only. Conclusions. Patients with highly FDG-avid pelvic lymph nodes have a higher risk of disease recurrence with worse survival. Identification of these patients may assist in the evaluation of the clinical benefits of additional treatments. (C) 2015 Elsevier Inc. All rights reserved.Item Treatment Outcomes of Patients with Cervical Cancer with Complete Metabolic Responses After Definitive Chemoradiotherapy(2014) Onal, Cem; Reyhan, Mehmet; Guler, Ozan C.; Yapar, Ali Fuat; https://orcid.org/0000-0002-2742-9021; https://orcid.org/0000-0001-8550-3368; https://orcid.org/0000-0001-6908-3412; https://orcid.org/0000-0003-1715-4180; 24562649; HOC-5611-2023; AAJ-5242-2021; AAC-5654-2020; AAI-8973-2021Purpose We sought to evaluate failure patterns and prognostic factors predictive of recurrences and survival in cervical cancer patients who are treated with definitive chemoradiotherapy (ChRT), who have a subsequent complete metabolic response (CMR) with (18) F-fluorodeoxyglucose positron-emission tomography (FDG-PET) after treatment. Methods The records of 152 cervical cancer patients who were treated with definitive chemoradiotherapy were evaluated. All patients underwent pre-treatment positron emission tomography (PET-CT), and post-treatment PET-CT was performed within a median of 3.9 months (range, 3.0-9.8 months) after the completion of ChRT. The prognoses of partial response/progressive disease (PR/PD) cases (30 patients, 18 %) and CMR cases (122 patients, %82) were evaluated. Univariate and multivariate analysis effecting the treatment outcome was performed in CMR cases. Results The median follow-ups for all patients and surviving patients were 28.7 (range, 3.3-78.7 months) and 33.2 months (range, 6.23-78.7 months), respectively. Four-year overall survival (OS) rate was significantly better in patients with CMR compared to patients with PR/PD (66.9 % vs. 12.4 %, p < 0.001, respectively). Patients with PR/PD had higher maximum standardized uptake value (SUVmax) of primary cervical tumor (26.4 +/- 10.1 vs. 15.9 +/- 6.3; p < 0.001) and larger tumor (6.4 cm +/- 2.3 cm vs. 5.0 cm +/- 1.4 cm; p < 0.001) compared to patients with CMR. Of the 122 patients with post-treatment CMRs, 25 (21 %) developed local, locoregional, or distant failure. In univariate analysis, tumor size a parts per thousand yen 5 cm, 'International Federation of Obstetricians and Gynecologists' (FIGO) stage a parts per thousand yenaEuro parts per thousand IIB, and pelvic and/or para-aortic lymph node metastasis were predictive of both overall survival (OS) and disease-free survival (DFS), while histology was predictive of only OS. In multivariate analysis, tumor size, stage and lymph node metastasis were predictive of OS and DFS. Conclusion Although CMR is associated with better outcomes, relapses remain problematic, especially in patients with bulky tumors (a parts per thousand yen 5 cm), extensive stage (a parts per thousand yen IIB) or pelvic and/or para-aortic lymph node metastasis. These findings could support the need for more aggressive treatment or adjuvant chemotherapy regimens.Item Elastofibroma Dorsi Incidentally Detected by 18F-FDG PET/CT Imaging(2015) Erhamamci, Seval; Reyhan, Mehmet; Nursal, Gul Nihal; Torun, Nese; Yapar, Ali Fuat; Findikcioglu, Alper; Canpolat, Tuba; 0000-0003-1715-4180; 0000-0002-5597-676X; 0000-0002-5302-4386; 0000-0001-8550-3368; 25666569; AAI-8973-2021; AAE-2718-2021; R-3735-2016; AFT-2303-2022; AAK-8107-2021; AAJ-5242-2021Elastofibroma dorsi (ED) is a rare pseudotumor of the soft tissues that can also show 18F-fluorodeoxyglucose (F-18-FDG) uptake on positron emission tomography combined with computed tomography (PET/CT) imaging. The aim of this retrospectively study was to describe the metabolic characteristics of ED incidentally detected by F-18-FDG PET/CT imaging. Between November 2009 and August 2013 at our institution, 10,350 consecutive PET/CT examinations were retrospectively investigated. In 176 of these patients, ED was recorded as an incidental finding. Fifty-five of 176 patients also had follow-up scans after chemoradiotherapy. A total of 231 scans with ED in 176 patients were identified. To determine the metabolic activity of ED, the maximum standardized uptake value (SUVmax) was calculated semiquantitatively. For measurement size of ED, the longest axis of transaxial CT images was used. Seven of the 176 patients underwent surgery due to suspected metastases and/or invasion of primary malignancy and/or symptoms or incidental during surgery. The prevalence of ED in our series was 1.7 %. The lesions were located in the subscapular region in all patients, except in one case with a lesion in the infrascapular region. A total of 419 ED lesions in 231 scan of 176 patients were evaluated. Mean +/- A SD SUVmax and long axis values for these 419 lesions were 2.31 +/- A 0.61 (range 1.0-4.30) and 56.78 +/- A 17.01 mm (range 19-112 mm), respectively. Of these 176 patients, 141 (80.1 %) had bilateral lesions and 35 (19.9 %) had unilateral lesions. There were statistically significant differences in the SUVmax and long axis values between the right and left side in the bilateral lesions (p = 0.001). No significant differences in the SUVmax and long axis values of the lesion were found between pre- and posttreatment in the patients with follow-up scans. Elastofibroma dorsi located in the scapular region is usually bilateral, asymmetric and with mild or moderate metabolic activity on PET/CT imaging. In addition, the metabolic activity and size of ED remained stable after chemoradiotherapy. Awareness of these metabolic characteristics of ED is important for preventing misinterpretation during F-18-FDG PET/CT studies.Item Simultaneous Occurrence of Medullary and Differentiated Thyroid Carcinomas. Report of 4 Cases and Brief Review of The Literature(2014) Erhamamci, Seval; Reyhan, Mehmet; Kocer, Nazim Emrah; Nursal, Gul Nihal; Torun, Nese; Yapar, Ali Fuat; https://orcid.org/0000-0001-8550-3368; https://orcid.org/0000-0002-5943-9283; https://orcid.org/0000-0002-5302-4386; https://orcid.org/0000-0002-5597-676X; https://orcid.org/0000-0003-1715-4180; 24997082; AAJ-5242-2021; AAM-5436-2021; R-3735-2016; AAE-2718-2021; AAI-8973-2021Simultaneous occurence of medullary thyroid carcinoma (MTC) and papillary thyroid carcinoma (PTC) in a single patient is an unusual event. The incidence, cell origin, histopathology features and prognosis of these two carcinomas are considered completely different. The aim of this retrospective study was to describe clinical, pathologic characteristics and the prevalence of diagnosing such patients in our clinic. Between October 2003 and December 2013, 1.420 consecutive patients diagnosed by histology as having differentiated thyroid carcinoma (DTC) and treated with radioactive iodide (RAI) were retrospectively investigated. Of these, 4 patients were diagnosed by histology as having simultaneous MTC and PTC. The clinical and pathology characteristics of these patients are described. The prevalence of simultaneous MTC and PTC of these 4 patients in our clinic was 0.28% of all patients with DTC.The age of the 4 patients ranged from 44 to 63 years and were three females and one male.These patients are currently alive without disease from either of the two types of cancer. In two of these patients, MTC was located in the left and PTC in the right thyroid lobe. One patient had MTC in the right lobe and PTC in both lobes. The remaining patient had both cancers in the left lobe as a mixed tumor. We are able to present the pathology of only 2 of these 4 patients. In these 2 patients MTC was located in the left and PTC in the right thyroid lobe, one of them was female and the other was male, aged 44 and 49, respectively. In conclusion, our results suggested that simultaneous occurrence of MTC and PTC had a prevalence in our clinic of 0.28% among 1420 consecutive patients with DTC or 0.14%, if only the 2 patients in whom we are able to present their pathology slides are considered. Our cases suggest that these two tumors are usually independent and coincidental events in patients.Item Multifocal Soft Tissue Langerhans' Cell Histiocytosis Treated with PET-CT Based Conformal Radiotherapy(2015) Onal, Cem; Oymak, Ezgi; Reyhan, Mehmet; Canpolat, Tuba; Ozyilkan, Ozgur; 0000-0002-2742-9021; 0000-0001-8550-3368; 0000-0001-8825-4918; 26211006; AGG-9214-2022; HOC-5611-2023; D-5195-2014; AAJ-5242-2021; AAD-2817-2021; AAK-8107-2021Langerhans' cell histiocytosis (LCH) is a proliferative disorder of Langerhans cells, which is seen extremely rarely in adults. Conventional imaging modalities, such as skeletal surveys and bone scans, were accepted to be standard methods for diagnosis; however, 18-fluorodeoxyglucose positron emission tomography (PET-CT) has been increasingly used. We report on a 33-year-old female patient with disseminated LCH treated with radiotherapy and systemic chemotherapy where PET-CT has been used for defining the extent of the disease, RT planning and assessment of treatment response during follow-up. The patient was treated with 24 Gy 3-dimensional conformal radiotherapy (RT), given as 2 Gy a day, 5 days a week. The patient was also treated with systemic prednisolone 20 mg/m(2), concurrently. The chemotherapeutic regimen switched to cytosine-arabinoside with a dose of 100 mg/m(2) subcutaneously daily for 4 days, vincristine 1.5 mg/m(2) given on the 1st day and prednisolone 20 mg/m(2) for 4 cycles. After local RT with adjuvant chemotherapy, the patient was alive for 54 months and remained disease-free at last visit. RT is a treatment choice in multi-system LCH as well as solitary lesions. Low-dose RT is adequate to control large masses of LCH including soft tissue and lymph nodes.Item Focal 99mTc-DMSA Uptake in Lung Parenchyma Without Structural Alterations on SPECT/CT(2015) Nursal, Gul Nihal; Reyhan, Mehmet; Yapar, Ali Fuat; 0000-0003-1715-4180; 0000-0001-8550-3368; 0000-0002-5302-4386; 26053717; AAI-8973-2021; AAJ-5242-2021; R-3735-2016Static renal scintigraphy with Tc-99m-DMSA is commonly used for the evaluation of renal morphology and function. Extrarenal uptake of Tc-99m-DMSA is a rare finding described previously on sites such as bone metastasis, hemangioma, and splenic amyloidosis. We report a case with Tc-99m-DMSA activity in the lungs.Item Is PET/CT Necessary in the Management of Early Breast Cancer?(2016) Nursal, Gul Nihal; Nursal, Tarik Zafer; Aytac, Huseyin Ozgur; Hasbay, Bermal; Torun, Nese; Reyhan, Mehmet; Yapar, Ali Fuat; https://orcid.org/0000-0002-5302-4386; https://orcid.org/0000-0002-3583-9282; https://orcid.org/0000-0002-5597-676X; https://orcid.org/0000-0001-8550-3368; https://orcid.org/0000-0003-1715-4180; 26914560; R-3735-2016; IQV-1169-2023; AAJ-7913-2021; AAE-2718-2021; AAJ-5242-2021; AAI-8973-2021Purpose Advanced imaging methods in early breast cancers are not recommended before surgery. In contrast to the accepted guidelines, some recent studies have shown some benefits with the use of PET/CT in early-stage breast cancer. In this study, we aimed to document the efficacy of PET/CT in detection of distant metastasis as well as other primary cancers. Patients and Methods In this retrospective study, we reviewed the records of all women patients diagnosed with early breast cancer between March 2012 and December 2014. Besides demographics, we recorded the clinical TNM stage, histology of the tumor, and hormone receptor status. As PET/CT imaging is a routine procedure in our center for early breast cancer, tumor size, lymph node status, distant metastasis, and possible other primary malignancies detected by PET/CT were also recorded. Results Of the 419 women included in the study, 24.8% were clinically staged as stage I while the rest were stage II. Distant metastases were detected in 42 patients (10%). The yield of PET/CT in detecting metastasis was significant in stage II patients compared with stage I patients (12.4% vs 2.9%). In subgroup analysis of stage II patients, the performance of PET/CT in detecting metastasis was still evident in stage IIA patients (9.5%). In logistic regression analysis of the significant and near-significant factors (as detected by univariate analysis) effecting PET/CT detected distant metastasis, only nodal status (P = 0.053) was found to be significant. Conclusions We suggest the use of PET/CT in investigating metastasis in axilla positive and clinically stage II early breast cancer patients.Item Choroidal Metastasis of Papillary Thyroid Carcinoma Demonstrated on SPECT-CT(2016) Torun, Nese; Reyhan, Mehmet; Yapar, Ali Fuat; Karatas, Muge; https://orcid.org/0000-0002-5597-676X; https://orcid.org/0000-0001-8550-3368; https://orcid.org/0000-0003-1715-4180; 26825205; AAE-2718-2021; AAJ-5242-2021; AAI-8973-2021We report a 68-year-old woman with papillary thyroid carcinoma metastasizing to choroid. The choroid metastasis was diagnosed with SPECT-CT and then was treated with high-dose radioactive iodine therapy.Item A Case of a Man With Isolated Breast Metastasis From Lung Adenocarcinoma Incidentally Detected by FDG PET/CT(2016) Erhamamci, Seval; Reyhan, Mehmet; Canpolat, Tuba; Nursal, Gul Nihal; Yapar, Ali Fuat; https://orcid.org/0000-0001-8550-3368; https://orcid.org/0000-0002-5302-4386; https://orcid.org/0000-0003-1715-4180; 26562574; AAJ-5242-2021; AAK-8107-2021; R-3735-2016; AAI-8973-2021Breast metastases from an extramammary primary tumor are very rare, particularly in men. In this study, we present a case of a 74-year-old man with isolated breast metastasis from lung adenocarcinoma as an incidental finding on PET/CT and diagnosed concomitantly with the primary tumor. Detection of isolated incidental metastatic lesions in the breast on PET/CT imaging has a significant clinical impact on patients with known malignant disease due to change of disease stage, management, and also treatment method.