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Background and Objectives: Sentinel lymph node (LN) biopsy (SLNB) remains to be the standard approach for surgical axillary staging of breast cancer (BC) patients. The aim of this study was to investigate the factors that affect axillary LN involvement in early BC patients. Materials and Methods: Clinically node negative early stage (cT1-2N0) BC patients having undergone breast conserving surgery (BCS) between February 2021 and January 2024 were included. During axillary exploration of all cases, sentinel LNs were excised and reserved for permanent section pathological examination (PS) only. Historical records of patients including clinicopathological features, surgical outcomes as well as pathological results were recorded and analyzed retrospectively. p < 0.05 indicated statistically significant results. Results: The study group consisted of 150 women with cT1-2N0 BC having undergone BCS with a median age of 59 (range: 25–81) years. According to the PS results of the sentinel LNs, the need for reoperation to complete axillary lymph node dissection was present in three (2%) patients. Tumors of the Luminal B subtype were significantly associated with increased sentinel LN positivity (p = 0.014). The risk of sentinel LN metastasis was found to be 5.2 times greater in patients with a Ki-67 ≥ %14 [OR: 5.224 (%95 CI:1.73–15.82, p = 0.003)] and the Ki-67 proliferation index was determined as an independent risk factor. Conclusions: In early-stage BC patients, PS of the excised sentinel LN offers sufficient axillary LN staging. On the other hand, a more careful clinical assessment is necessary for early BC patients harboring tumors with an elevated Ki-67 index and/or tumors of the Luminal B subtype.

Aim. Endoscopic retrograde cholangiopancreatography (ERCP) is frequently used for the diagnosis and treatment of hepatic, biliary tract, and pancreatic disorders. However, failure during cannulation necessitates other interventions. The aim of this study was to establish parameters that can be used to predict failure during ERCP. Methods. A total of 5884 ERCP procedures performed on 5079 patients, between 1991 and 2006, were retrospectively evaluated. Results. Cannulation was possible in 4482 (88.2%) patients. For each one-year increase in age, the cannulation failure rate increased by 1.01-fold (P=0.002). A history of previous hepatic biliary tract surgery caused the cannulation failure rate to decrease by 0.487-fold (P<0.001). A tumor infiltrating the ampulla, the presence of pathology obstructing the gastrointestinal passage, and peptic ulcer increased the failure rate by 78-, 28-, and 3.47-fold, respectively (P<0.001). Conclusions.Patient gender and duodenal diverticula do not influence the success of cannulation during ERCP. Billroth II and Roux-en-Y gastrojejunostomy surgeries, a benign or malignant obstruction of the gastrointestinal system, and duodenal ulcers decrease the cannulation success rate, whereas a history of previous hepatic biliary tract surgery increases it. Although all endoscopists had equal levels of experience, statistically significant differences were detected among them.

A 78-year-old male patient with a history of the right hemicolectomy due to the adenocarcinoma was admitted by the complaint of epigastric discomfort. Laboratory data showed an increase in liver biochemistries (aspartate aminotransferase (AST): 159 IU/L, alanine aminotransferase (ALT): 235 IU/L, alkaline phosphatase (ALP): 350 IU/L, gamma-glutamyl transferase (GGT): 911 IU/L, total bilirubin: 1.55 mg/dl and direct bilirubin: 0.82 mg/dl). Endoscopic retrograde cholangiopancreatiography (ERCP) administered after the gastrointestinal (GI) upper endoscopy was compatible with the tumoral lesion, and biopsy confirmed ‘neuroendocrine carcinoma’. Pylorus-preserving pancreaticoduodenectomy (PPPD) was performed with R0 resection. Pathologic evaluation revealed a 1,5 cm tumor of large cell neuroendocrine carcinoma (LCNEC). Five months later, biopsy of suspicious lesions in the liver was documented as ‘high-grade neuroendocrine carcinoma metastasis’. He was referred to the oncology for chemotherapy, but, unfortunately, he expired three months later. Large cell neuroendocrine carcinoma (LCNECs) of the ampulla of Vater might have an aggressive clinical course despite radical resections involving lymph node dissections. Small tumor size and lymph node negativity are not reliable factors for this tumor type.

Introduction:Malignant melanoma (MM) is a tumor that develops from skin-derived melanocytes and has a poor prognosis. Extracutaneous involvement of MM is also known, and one of these localizations is in the gastrointestinal tract. The study investigated gastrointestinal MM cases diagnosed as primary or metastatic in terms of their clinicopathological findings and survival rates.Methods:Patients diagnosed with gastrointestinal MM in our clinic between August 2013 and December 2022 were retrospectively evaluated. Data including demographics, physical examination, laboratory and imaging findings, surgical procedures, oncological treatment status, presence of metastasis, histopathological features, and mortality were recorded and analyzed.Results:The study group consisted of 9 patients: 4 (44.5%) women and 5 (55.5%) men with a mean age of 57.8±13.5 (median: 61, range: 40-75). Surgery could not be performed in four patients because of locally advanced or metastatic disease. Radical surgical interventions were performed in 4 (44.4%) patients who were operable. A second surgical intervention was performed in one patient. The mean duration of hospital stay of surgically treated patients was 6.4±4.3 (median: 5, range: 2-13) days. The mean overall survival in these patients was 40.0±25.7 (median: 40, range: 12-74) months. Three (33.3%) patients who underwent surgery are still being followed up.Conclusion:In operable cases of histopathologically proven primary or metastatic MM disease, surgical treatment has an important impact on terms of providing local control and improving survival.

Peutz-Jeghers syndrome may be presented with gastrointestinal and extra-intestinal malignancies. Herein, we report a case of Peutz-Jeghers syndrome with a malignant intestinal polyp accompanied by synchronous multiple hamartomatous gastrointestinal polyps that was treated with simultaneous surgical and endoscopic polypectomies.

Background: Gastroenteropancreatic neuroendocrine tumors (GEP-NETs) are rare entities. Generally, they can be localized anywhere in the gastrointestinal or hepatobiliary tract. The purpose of our study is to evaluate the effect of tumor location on prognosis in patients with GEP-NET undergoing surgery. Our secondary objective is to examine other factors affecting the prognosis of patients with GEP-NET. Methods: We retrospectively analyzed data from 30 patients with GEP-NET who underwent surgery in the General Surgery Clinic between 2012 and 2022. The gNET group (n=18) included tumors located in the gastrointestinal tract, while the pNET group (n=12) included tumors located in the hepatopancreatobiliary system. Surgical, laboratory, radiological, and pathological findings of the patients, as well as follow-up outcomes were recorded and statistically analyzed. Results: In subgroup comparison, tumor size was found to be larger in the pNET group (P=0.002). The statistical analysis of recurrence (16.7% versus 33.3%) and mortality rates (16.7% versus 41.7%) between the subgroups (P=0.329 and P=0.210, respectively) did not reveal a significant difference. When all patients were evaluated, it was observed that advanced age, presence of carcinoma diagnosis, higher tumor grade, advanced TNM stage, larger tumor size, presence of lymphovascular or perineural invasion, elevated mitotic index, higher Ki-67 index, and having received adjuvant therapy increased the rates of recurrence and mortality. Conclusion: There was no statistically significant difference in survival outcomes between the GEP-NET groups located in the gastrointestinal tract and the hepatopancreatobiliary system.

Foreign bodies in the breast are rarely encountered and may infrequently lead to complications such as persistent breast pain, abscess, and/or granuloma formation, pneumothorax, or cardiac tamponade. We aimed to present a case with a foreign body in her right breast, which was diagnostically missed in previous screenings. A 44-year-old asymptomatic woman, who was included in the national breast cancer screening program, was found to have a 2 cm-sized metallic foreign body in the upper-outer quadrant of her right breast via mammographic imaging. Retrospective clinical evaluations revealed that the foreign body had been present in her breast for at least five years. She was successfully treated via wire-assisted surgery. Although they may remain asymptomatic for long periods, foreign bodies detected in the breast are suggested to be surgically removed due to the possibility of considerable subsequent local or thoracic complications.

We aimed to present a case of appendiceal mucocele who was admitted with abdominal pain, operated under elective conditions and found to have been spontaneously drained from the root of the appendix to the colon in surgical exploration. A 41-year-old male patient was admitted to the emergency department with abdominal pain. In clinical examination; tenderness, rebound and defense in the lower right quadrant of abdomen and leucocytosis were detected. Computerized tomography scan showed the appearance of a cystic dilated appendix. After resolution of the physical examination findings based on the antibiotic treatment, we decided to perform elective surgery. In surgical exploration, ileocecal resection was performed by determining the mucocele of the appendix that had been spontaneously drained from the root of the appendix into the cecum lumen. On the sixth day after the operation, he was discharged without complications. Histopathological examination revealed high-grade appendiceal mucinous neoplasia. Our patient’s follow-up in the first year after the surgery revealed no recurrence. The patient is disease-free at the end of his first postoperative year. The mucocele of the appendix is a cystic neoplasia containing mucin and its perforation during surgery may result in the development of pseudomyxoma peritonei in the late period. In our case, the fact that the lesion was spontaneously drained into the lumen of the colon reduced the risk of the mucocele rupturing and spreading into the abdomen during surgery.

Glasgow prognostic score (GPS) has been found to be a useful tool in various cancer types. Our aim was to evaluate the significance of GPS in patients operated on for colorectal cancer (CRC). Patients with CRC who underwent radical resections between April 2010 and January 2015 were retrospectively evaluated. GPS was estimated based on the preoperative measurement of C-reactive protein and serum albumin levels. Data including demographics, laboratory and pathological parameters, surgical outcomes, and late-term follow-up results were analyzed. The study group of 115 patients consisted of 51 (44 %) women and 64 (56 %) men with a median age of 66 (range 32–91) years. The mean follow-up period was 20 (range 7–41) months. Tumor size and wound infection rates were significantly increased in patients with higher GPS ( p  = 0.019 and p  = 0.003, respectively). According to multivariate analyses, CEA and GPS were found to be independent risk factors significantly effecting mortality ( p  = 0.001 and p  = 0.009, respectively). At the end of the late-term follow-up period, it was detected that cancer-specific survival significantly decreased as the GPS increased ( p  = 0.016). The GPS is a significant prognostic factor in CRC and should be included in the routine preoperative assessment of all surgically treated CRC patients.

The prognostic importance of breast cancer axillary micrometastases is still controversial. This study aims to investigate the features of the micrometastases on recurrence and survival. Surgically treated breast cancer patients who were detected to harbor axillary micrometastasis were divided into subgroups as sinusoidal and intranodal and 0.2–1 mm and 1–2 mm according to the localization and size of the micrometastases, respectively. The association of micrometastasic features on overall survival (OS) and disease-free survival (DFS) was statistically analyzed. Thirty-three women with a mean age of 58.2 SD13.3 (range: 20–95) years were included. The median follow-up period was 50 (interquartile range: 30–62) months. Sentinel lymph node biopsy was performed in 27 (81.8%) and axillary dissection in 6 (18.2%) patients. The rate of intranodal micrometastasis of 1–2 mm diameter was higher than the other subgroups. Although the patients with a 1–2 mm diameter micrometastasis had an increased risk of distant metastasis development (hazard ratio (HR), 95% CI: 12.3, 1.2–126.0; p =0.035), tumor localization was not found to affect DFS (HR, 95% CI: 5.60, 0.55–57.10; p =0.15). The DFS of the group with a 0.2–1 mm diameter micrometastasis was found to be longer than the group with a micrometastasis of 1–2 mm diameter. Survival analysis revaled that OS was not affected by either the localization or the size of the micrometastases according to the comparisons of the study subgroups. We consider that the size of axillary micrometastasis poses importance during the follow-up of surgically treated breast cancer patients in terms of distant metastasis development.