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IntroductionIdiopathic granulomatous mastitis (IGM) is a rare, chronic inflammatory benign breast disease. Although the etiology of this disease is unknown, it has been suggested that hormonal disorders, autoimmunity, smoking, and α1-antitrypsin deficiency may play a role in the etiopathogenesis. The aim is to investigate the changes in cytokine profiles including interleukin (IL)-4, -8, -10, -17, and tumor necrosis factor (TNF)-alpha in patients with IGM.MethodsForty-seven patients with pathologically diagnosed IGM and 30 healthy women were included. The cytokines including IL-4, -8, 10, -17, and TNF-alpha were measured by human enzyme-linked immunosorbent assay.ResultsThe IL-8, IL-10, and IL-17 levels were higher in IGM patients than control group (p = .002; p = .008; and p = .018, respectively). The IL-8 levels of patients with active lesions and in remission were statistically higher than the control group (p = .027 and p = .015, respectively). IL-10 levels of patients in remission were higher than the control group (p = .024). There was no difference in IL-4 and TNF-ɑ levels between all groups.ConclusionThese results showed that proinflammatory cytokines including IL-8 and IL-17 have role in pathogenesis of IGM. However, the increased levels of IL-10 in especially patients in remission suggest that it reduces the release of proinflamatory cytokines as well as suppressing their function and activation for controlling IGM. Although IGM is thought to be a surgical disease, these cytokine changes indicate the presence of serious immune dysregulation. This suggests that in the treatment of IGM, treatment needs to evolve from surgery to medical treatment.Key points• The IL-8, IL-10, and IL-17 levels were higher in IGM patients than in control group.• The IL-8 levels of both patients with active lesions and in remission were high.• There was no difference in IL-4 and TNF-ɑ levels between all groups.

BackgroundMore evidence shows that primary surgery for de novo metastatic breast cancer (BC) prolongs overall survival (OS) in selected cases. The aim of this study was to evaluate the role of locoregional treatment (LRT) in BC patients with de novo stage IV bone only metastasis (BOM).MethodsThe prospective, multicenter registry study BOMET MF14-01 was initiated in May 2014. Patients with de novo stage IV BOM BC were divided into two groups: those receiving systemic treatment (ST group) and those receiving LRT (LRT group). Patients who received LRT were further divided into two groups: ST after LRT (LRT + ST group) and ST before LRT (ST + LRT group).ResultsWe included 505 patients in this study; 240 (47.5%) patients in the ST group and 265 (52.5%) in the LRT group. One hundred and thirteen patients (26.3%) died in the 34-month median follow-up, 85 (35.4%) in the ST group and 28 (10.5%) in LRT group. Local progression was observed in 39 (16.2%) of the patients in the ST group and 18 (6.7%) in the LRT group (p = 0.001). Hazard of death was 60% lower in the LRT group compared with the ST group (HR 0.40, 95% CI 0.30–0.54, p < 0.0001).ConclusionIn this prospectively maintained registry study, we found that LRT prolonged survival and decreased locoregional recurrence in the median 3-year follow-up. Timing of primary breast surgery either at diagnosis or after ST provided a survival benefit similar to ST alone in de novo stage IV BOM BC patients.

To determine the distribution of human leukocyte antigens (HLA) in patients with idiopathic granulomatous mastitis (IGM). The study included 48 patients diagnosed with IGM and 50 controls consisting of healthy donor candidates. The frequencies of HLA-A*10, HLA-A*2403, HLA-B*18 and HLA-DR*17 antigens were significantly higher in the patient group than control group (p = 0.012, p = 0.012, p = 0.0001 and p = 0.005, respectively). However, the frequencies of HLA-A*29, HLA-B*14 and HLA-DR*1 were lower in the patient group than control group (p = 0.027, p = 0.013 and p = 0.015, respectively). When patients without/with relapse were compared, there was a significant difference in HLA-A*3 (p = 0.048) and HLA-A*32 (p = 0.011). Also, the patients with relapse and control group were compared in respects of HLA-A*10 (p = 0.0006), HLA-A*24 (p = 0.035), HLA-A*32 (p = 0.011), HLA-B*18 (p = 0.035), HLA-B*103 (p = 0.035) and HLA-DR*17 (p = 0.006). These findings may help to explain etiopathogenesis but still, further studies on this subject with more patients in different geographic regions are needed. •The prevalence of HLA-A*10, HLA-A*2403, HLA-B*18 and HLA-DR*17 in patients is higher than the healthy control group.•HLA-A*29, HLA-B*14 and HLA-DR*1 were lower in patient group than the healthy controls.•When patients without/with relapse were compared, there was a significant difference in HLA-A*3 and HLA-A*32.•Relapse and control group were compared in respects of HLA-A*10, HLA-A*24, HLA-A*32, HLA-B*18, HLA-B*103 and HLA-DR*17.

The aim of this study was to evaluate the clinical importance of fibulin-5, which has been shown to display tumour-promoting and tumour-protective functions in breast lesions. Sixty-two breast cancer patients, 19 patients with fibroadenoma, and 15 healthy breast tissues were enrolled. Forty-seven patients had invasive ductal carcinoma (IDC) (12 of them also had in situ carcinoma DCIS), and 15 had invasive lobular carcinoma (ILC). A scoring system from 0 to 4 was used to evaluate the fibulin-5 staining according to the percentage of stained cells. The median values of fibulin-5 staining scores of the breast cancer, fibroadenoma, and healthy breast tissues were 2 (range: 0-4), 3 (range: 3-4), and 4 (range: 1-4), respectively, and the difference is statistically significant (p = 0.0001). There was no significant difference between the fibulin-5 scores of IDC, ILC, and DCIS. Fifteen patients with triple-negative breast cancer (TNBC) had the lowest fibulin-5 score (p < 0.0001). The median fibulin-5 scores of the patients according to Ki-67 index ≥ 14% and < 14% were 2 (range: 1-5) and 4 (range: 1-5), respectively, and the difference is statistically significant (p = 0.001). These data can be explained by the inhibitory effect of fibulin-5 on epithelial cell proliferation, which is closely related to differentiation and prognosis.

ObjectiveThis study aimed to evaluate whether the A, B and 0 blood groups (AB0) subgroup distribution of patients with idiopathic granulomatous mastitis (IGM) is different or notdiffers from that of the general population.MethodsThe patients with IGM who were followed up in the breast unit and applied for routine control between July 2021 and October 2021 were included in the study.ResultsDuring this period, 101 IGM patients were enrolled. The patients’ age ranged between 21 and 61 years (median, 33 years). The most common AB0 blood subgroup in both the patient and control groups was Group A (48.5% and 44.7%, respectively). Between the groups, the difference in AB0 subgroups was not statistically significant (p=0.122). Eight patients had erythema nodosum. In 75% of patients with erythema nodosum, the most common AB0 subgroup was Group A. Eight patients developed relapses. The AB0 subgroup was A in five of the patients who had a relapse. However, the comparison of AB0 subgroups according to both erythema nodosum and relapse status could not be performed because there were few such cases, and the data did not satisfy the necessary assumptions for the chi-square test.ConclusionIn our study, the AB0 blood group distributions in both patient and control groups were similar, and our data did not support a relationship between IGM and AB0 blood groups.

Extrahepatic bile duct tumors are uncommon, with the majority being adenocarcinomas. Primary neuroendocrine tumors of the extrahepatic bile ducts are extremely rare. Herein, we report a case of the extrahepatic biliary duct primary well-differentiated neuroendocrine carcinoma in a 45-year-old woman.

The extrahepatic vascular and biliary anatomy of Calot’s triangle is well known to be highly variable and this provides a surgical challenge. The liver has a dual blood supply consisting of the portal vein and the hepatic artery. The hepatic artery which delivers 25% of the blood supply, arises from the celiac trunk. The celiac trunk gives off the left gastric, splenic and common hepatic arteries. The common hepatic artery then divides into gastroduodenal artery and hepatic artery proper which diverts in right and left hepatic arteries. The systic artery usually originates from the right hepatic artery. The “classic” arterial anatomy is present in approximately 75% of cases. The remaining 25% of the cases have many anatomical variants. Here in we present a patient with multiple anatomic variants in celiac trunk which were determined incidentally during laparoscopic cholecystectomy. Being aware of the arterial variations in the liver is really important in surgical procedures in order to avoid bleeding and ischemia.

We discuss the operative challenges posed by the advanced laparoscopic approach for a patient with situs inversus totalis. The patient was a morbidly obese woman with multiple co-morbidities related to her weight. The modifications in the surgical technique include the insertion of trocars according to the mirror image anatomy of the intra-abdominal organs under laparoscopic visualization. We suggest preoperative abdominal ultrasound in order to diagnose both gallbladder stones and also the reverse location of intra-abdominal organs that is rarely seen. A laparoscopic gastric banding, not a contradiction for situs inversus totalis, was performed successfully.

Introduction: Breast cancer and thyroid disorders are both important health problems that are common in women. The relationship between both diseases is not fully known. In this study, the frequency of thyroid diseases was investigated in patients with breast cancer. Materials and Methods: Eighty women with breast cancer and age-matched 63 women without cancer, as the control group, were included into the study. Thyroid stimulating hormone (TSH), free T4, Anti-TPO, Anti-Tg, glucose and insülin levels were measured and all cases underwent thyroid ultrasonography (USG). Patients who had undergone thyroid surgery and who used drugs that affect glucose metabolism were excluded. Results: The results are given in Table 1 and Table 2. Waist and hip circumferences, glucose, insulin and HOMA-IR levels were higher in patients with breast cancer. Waist hip ratio, body mass index (BMI), TSH, free T4, anti-TPO and anti-thyroglobulin levels and thyroid volumes were similar in both groups. Rates of autoantibody positivity, the presence of nodules and thyroiditis in USG were similar in both groups. The frequency of hypothyroidism was similar in both groups. Thyrotoxicosis was not detected in the breast cancer group, whereas in the control group, thyrotoxicosis was detected in 4(6.3%) patients (p= 0.022). Discussion: Thyrotoxicosis was found to be less frequent in patients with breast cancer, although nodular goiter, autoimmune thyroid disease, and hypothyroidism frequencies were similar. We believe that prospective studies involving more cases should be appropriate to remove the suspicion of the relationship between breast cancer and thyroid diseases.