No abstract

Intranodal palisaded myofibroblastoma (IPM) is a benign mesenchymal neoplasm originating from smooth muscle cells and myofibroblasts. The inguinal region is the most common site of this rare tumor. As there are only about 89 such cases reported in the literature, the precise etiology and pathogenesis have yet to be explained adequately. It is characterized by spindle cells, amianthoid fibers, and by the proliferation of hemosiderin-containing histiocytes in the lymph node. A nodular lesion was excised from the inguinal region of a 47-year-old female patient with the clinical diagnosis of lymphoma and/or metastase. Macroscopic examination of a section of the lesion demonstrated a solid appearance. Microscopic examination revealed spindle-cell proliferation, amianthoid fibers, hemosiderin pigment, and extravasated erythrocytes. Nuclei of the spindle cells displayed a palisaded appearance. Compressed lymphoid tissue was observed around the lesion. Neoplastic cells were identified by the presence of vimentin, SMA, Cyclin D1, and beta-catenin. The Ki67 index was less than 1%. Histological examination confirmed the diagnosis of IPM. Although IPM is benign, it is frequently confused with metastatic lesions and lymphomas.

A careful assessment is a key point for the correct diagnosis and treatment of AFBs. Clinical conditions of patients and type of AFBs are important in the choice of treatment strategy. If the AFBs are large, proximally migrated or the patients with an AFB have acute abdomen due to perforation, pelvic abscess, obstruction, or bleeding, surgery is needed as soon as possible. There are different types of surgical approaches such as less invasive transanal extraction under anesthesia and more invasive abdominal routes such as laparotomy or laparoscopy. The stoma can be done if there is colonic perforation. In the management of AFBs, the priority must be less invasive methods as possible.

Dieulafoy lezyonu nadir görülmesine rağmen alt gastrointestinal sistem kanamalarının hayatı tehdit eden nedenlerindendir. Masif alt gastrointestinal kanamaya ve mortaliteye neden olan anal kanaldaki Dieulafoy lezyonunu sunmayı amaçladık. Yetmiş iki yaşındaki erkek hasta masif kanama nedeniyle hastaneye başvurmuştur. Kolonoskopi ve sintigrafide odak saptanamadığından, unstabil durumda olan hastaya acil olarak laparotomi yapılmıştır. İntraoperatif olarak yapılan kolonoskopide anal kanal proksimalinde lezyon saptanarak klipslenmiştir. Kanama tekrarlamamasına rağmen, masif transfüzyona bağlı solunum problemleri nedeniyle postoperatif sekizinci günde hasta eksitus olmuştur. Bu tür lezyonlarda %80'e kadar varan oranlarda lezyon ilişkili mortalite oranları bildirilmiştir. Acil şartlarda yapılan bu değerlendirmelerde lezyon görülememiştir. Nadir karşılaşılsa da masif gastrointestinal kanamalarda Dieulafoy lezyonunun akılda tutulması gerekmektedir. Tedavide selektif arteriyel embolizasyon, skleroterapi, epinefrin enjeksiyonu, termokoagülasyon ve klipsleme gibi konservatif yöntemler kullanılabilir. Kanama odağının preoperatif dönemde bulunamadığı durumlarda lokalizasyon için cerrahi sırasında kolonoskopiden faydalanılabilir. Tanıda gecikme olan durumlarda kanama kontrol altına alınsa da masif transfüzyonlara bağlı morbiditenin ve mortalitenin artabileceği unutulmamalıdır. Anahtar Kelimeler: Anal kanal, kan transfüzyonu, kolonoskopi, Dieulafoy lezyonu, kanama, cerrahi ÖZ ABSTRACTDieulafoy's lesion is rare but life-threatening cause of lower gastrointestinal hemorrhage. In this study it is aimed to present a case of Dieulafoy lesion in anal canal which causes massive lower gastrointestinal hemorrhage and mortality. A 72 year-old male patient with massive lower gastrointestinal bleeding applied to the hospital. Since no lesion was detected on colonoscopy and scintigraphy, emergency laparotomy was performed for the unstable patient. On the intraoperative colonoscopy, a lesion was located proximal to anal canal and clipped. Despite the absence of rebleeding, the patient died due to respiratory complications associated with massive transfusion at the eighth day of his postoperation. For this kind of lesions, mortality rates were reported as up to 80%. In this case, the lesion was not found on evaluation performed under emergency setting. Although it is rare, Dieulafoy lesion should be kept in mind in patients with massive lower gastrointestinal hemorrhage. For treatment, conservative methods such as selective arterial embolisation, sclerotherapy, epinephrine injection, thermocoagulation and clips application can be used. When the location of bleeding was not revealed in preoperative evaluation, colonoscopy can be used during surgery. In case of delayed diagnosis the hemorrhage may be kept under control; however, morbidity and mortality may increase with massive transfusion.

We aimed to evaluate the effect of different parameters on survival in patients with gastric adenocarcinoma who underwent D2 lymph node dissection with more than 15 lymph nodes. Methods: A total of 161 patients with gastric adenocarcinoma, who underwent curative gastrectomy and had more than 15 lymph nodes dissected between January 2001 and January 2015, were retrospectively evaluated. A hundred and forty-six patients were included in the study. Results: The mean follow-up period was 24 (12-102) months and the mean survival time was 818.80±692.42 (66-3065) days. Gender, age, lymphovascular invasion and perineural invasion, tumor differentiation and histology were not found to have a statistically significant effect on overall survival. Length of hospital stay, tumor location, extent of surgery, chemotherapy, tumor stage (T category), total number of harvested lymph nodes, number of metastatic lymph nodes, lymph node status (N status), percentage of lymph node positivity, metastatic lymph node ratio and stage were found to have a statistically significant effect on overall survival. Conclusion: Having distally located tumor, having chemotherapy, higher total number of harvested lymph node and lower N category were better prognostic factor for overall survival in gastric cancer patients having curative resection with more than 15 lymph nodes harvested.