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    A new technique for closure of pericardial defects: pericardial rug weave
    (Bmc, 2024) Findik, Gokturk; Cetin, Mehmet; Nomenoglu, Hakan; Turk, Ilteris; Acemoglu, Serdar; Solak, Necati; Can, Mehmet Ali
    Background Pericardial defect that occurs after intrapericardial pneumonectomy can cause many fatal complications, and closing the defect with mesh is a widely used surgical method to prevent these complications.Methods Data of patients who underwent intrapericardial pneumonectomy and pericardial resection in our clinic between October 2010 and June 2022 were retrospectively reviewed. Patients were divided into two groups, those who had prolene mesh used to close the pericardial defect and those who underwent the Rug Weave technique we proposed as an alternative, and the results were compared.Results The study included 23 patients, one of whom was female. All patients underwent surgery due to malignancy. The vast majority of the patients had a diagnosis of squamous cell lung carcinoma (86.9%). Atrium was added to three patients and rib resection was added to one patient during intrapericardial pneumonectomy and pericardial resection. There was no significant difference between the two groups in terms of average age, gender, and length of hospital stay. There was no significant difference between the two groups in terms of complications, including atrial fibrillation, which is commonly seen in these patients (p = 0.795). The Rug Weave group had an average defect width of 23.96 cm2 and was found to be advantageous in terms of overall survival compared to the mesh group (p = 0.017).Conclusions The Rug Weave technique we proposed for closing pericardial defects after pneumonectomy can be used as a cheaper method safely and effectively that reduces complications as much as the traditional method of using mesh.
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    Efficiency of Outsourcing Reporting in Thorax Computed Tomography Evaluation: Retrospective Analysis of 350 Thoracic Surgery Cases
    (Aves, 2023) Cetin, Mehmet; Solak, Necati; Turk, Ilteris; Guresci, Kursat
    OBJECTIVE: External reporting is frequently used due to the significant increase in computed tomography examinations in recent years and the insufficient number of personnel in internal reporting. We aimed to evaluate the adequacy of outsourcing reporting.MATERIAL AND METHODS: Patients who were seen or hospitalized as a consultation by thoracic surgeons with thoracic computed tomography between January 2021 and January 2022 were included in the study retrospectively. Computed tomography results reported by radiologists working in our hospital were grouped as internal reports, and the results reported externally by a company were grouped as outsourcing reports. The total number of computed tomography examinations taken during the same period and the number of examinations reported by a daily average radiologist were also determined. False-negative findings in internal and outsourcing reports were evaluated and statistically compared between groups.RESULTS: A total of 84 702 computed tomography scans were taken in 2021. In external reporting, 1 physician reported an average of 202.83 computed tomography scans per day (74 033 per year). A total of 350 thorax computed tomography reports were evaluated. A total of 304 (86.9%) thorax computed tomography examinations were reported with external reporting and 46 (13.1%) with internal reporting. False-negative findings other than those reported were found in 81 reports (23.1%). A significantly higher deficiency was observed in external reporting (77/304) compared to internal reporting (4/46). (P = .013).CONCLUSION: The effectiveness of external reporting was found to be lower than internal reporting due to a possible lack of com-munication and audit problems. In order to minimize the errors and related liability arising from external reporting, primarily a legal standardization is required with realistic reporting numbers of external reporting.
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    Endobronchial Primary Pulmonary Angiomatoid Fibrous Histiocytoma in a Patient with Testicular Germ Cell Tumor: An Evidence Against Somatic Transformation
    (Sage Publications Inc, 2022) Cetin, Mehmet; Katipoglu, Kubra; Turk, Ilteris; Ozkara, Seref; Kosemehmetoglu, Kemal; Bicakcioglu, Pinar
    Primary Pulmonary Angiomatoid Fibrous Histiocytoma is a recently described soft tissue tumor with challenging differential diagnosis both clinically and pathologically due to its rarity in this location. It may also occur as a secondary malignancy and its occurrence either as a somatic malignancy arising in the germ cell tumor or as a secondary malignancy after chemotherapy is questionable. In this report, we present a 29-year-old male patient with a mass in the lower lobe of the left lung, who underwent orchiectomy and received adjuvant chemotherapy due to a mixed germ cell tumor 8 years ago. Morphology, immunophenotype, and molecular findings were consistent with the diagnosis of primary pulmonary angiomatoid fibrous histiocytoma. Fluorescent in situ hybridization was unable to demonstrate the presence of 12p amplification or isochromosome 12p, which is known as the key event in the development of testicular germ cell neoplasia even present in somatic malignancies arising in germ cell tumors. Our results support that angiomatoid fibrous histiocytoma arising as a secondary malignancy does not represent the somatic transformation of germ cell tumors.
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    Importance of Histopathological Grading for Treatment Selection in Malignant Mesothelioma
    (Georg Thieme Verlag Kg, 2023) Turk, Ilteris; Findik, Gokturk; cetin, Mehmet; Bicakcioglu, Pinar; Gulhan, Selim Sakir Erkmen; Aydogdu, Koray; Yilmaz, Ulku
    Background Complexities in TNM staging in epithelioid malignant pleural mesothelioma (MPM) may lead to errors in treatment selection, leading to major surgical interventions in patients with low survival expectations.Methods Sixty-nine stage I epithelioid MPM patients, including 27 patients treated with pleurectomy/decortication (P/D) and multimodal therapy (MMT) (the P/D [MMT] group), and 42 patients treated with chemotherapy or chemoradiotherapy (the CRT group), were included in the study. After an initial evaluation of overall survival, all patients were grouped in terms of histopathological parameters and treatment types, and then, a secondary survival evaluation was performed for the groups.Results Forty-one patients were male, the mean age was 61.8 years. The median survival time was 26 months in the P/D (MMT) group, and 19.6 months in the CRT group, but the difference was not statistically significant. After grouping according to pathological criteria, a median survival time of 32.4 +/- 2.9 months in the P/D (MMT) group and 21.9 +/- 13.2 months in the CRT group was obtained among patients with histopathological low-grade tumors. Among patients with high-grade tumors, the median survival time was 18.3 +/- 2.6 months in the P/D (MMT) group and 17 +/- 4.4 months in the CRT group. Among patients with low-grade tumors, the P/D (MMT) group had longer survival. Median survival times were similar among patients with high-grade tumors.Conclusion In epithelioid MPM, histopathological grading by video-assisted thoracic surgery pleural biopsy can prove accurate in selecting patients for P/D and MMT.
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    Pneumomediastinum: retrospective analysis of 19 cases and an innovation proposal in classification
    (Springer, 2022) Cetin, Mehmet; Turk, Ilteris; Findik, Gokturk; Aydogdu, Koray; Gulhan, Selim Sakir Erkmen; Bicakcioglu, Pinar; Kaya, Sadi
    Background Guidelines to standardize treatment and follow-up strategies in pneumomediastinum cases are lacking. The aim of the study was to evaluate the etiology in pneumomediastinum cases and the results of treatment and follow-up. Results Nineteen patients with pneumomediastinum who were followed up in our clinic between 2015 and 2020 comprised the study population. Among the patients, 16 (84.2%) were male, and the mean age was 31.15 years. The chief presenting complaints were chest pain and dyspnea. Pneumomediastinum was spontaneous in 15/19 patients (including spontaneous pneumomediastinum with an underlying pathology in 3/15), traumatic in 3/19, and iatrogenic in 1/19. Spontaneous pneumomediastinum without underlying pathology was seen in younger adults (mean age: 23 years). Surgical intervention in traumatic and iatrogenic pneumomediastinum cases was compared with spontaneous cases and no statistically significant difference was observed (p=0.178). The mean hospital stay of all patients was 3.15 days. Only one patient had a recurrence and died, which was later determined to be a secondary spontaneous pneumomediastinum case. Conclusion Pneumomediastinum often occurs with an underlying pathology in advancing age and as spontaneous in younger patients. Therefore, secondary spontaneous pneumomediastinum subclass should be evaluated in the classification to facilitate to create a standard guideline and prevent overdiagnosis and overtreatment.
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    Role of orthopedia homebox protein in subclassification of pulmonary carcinoid tumors: Retrospective analysis of 110 cases
    (Wolters Kluwer Medknow Publications, 2023) Cetin, Mehmet; Findik, Gokturk; Demirag, Funda; Turk, Ilteris; Aydogdu, Koray
    Background: Orthopedia homeobox protein (OTP), highlighted as a sensitive and specific marker for pulmonary carcinoids, may provide a more objective criterion for subclassification. Materials and Methods: A total of 110 patients who underwent surgery for pulmonary carcinoids (2009-2019) were included. Gender, age, application complaint, tumor diameter and location, typical and atypical tumor type, lymph node involvement, stage, recurrence, and survival data were evaluated retrospectively with OTP nuclear staining. Results: The sensitivity of OTP was 66.4%. OTP in subclassifying pulmonary carcinoids was not significant. There was no significant relationship between OTP and lymph node involvement, recurrence, and survival. Conclusion: OTP does not provide significant results in the subclassification of typical and atypical carcinoid tumors and the evaluation of recurrence and survival of carcinoid tumor cases.
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    The importance of coordination in preventing overdiagnosis: a retrospective analysis of unabsorbed oxidized regenerated cellulose
    (Springer-Verlag Italia Srl, 2024) Turk, Ilteris; Cetin, Mehmet; Babacan, Fatma; Solak, Necati; Agackiran, Yetkin; Ozturk, Ayperi; Acar, Leyla Nesrin
    BackgroundOxidized regenerated cellulose (ORC) is commonly used to control small intraoperative bleedings in lung cancer surgery. However, difficulties in its absorption may lead to complications that can mimic malignancy recurrence in the affected areas, and may require further examination.MethodsBetween 2015 and 2022, patients who underwent malignant tumour resection and lymph node dissection and were subsequently evaluated for suspected lymph node recurrence and underwent EBUS-guided needle biopsy were included in the study. Pathology reports of these patients showed an ORC-related foreign body type granulomatous reaction. Such reactions, caused by delayed absorption of ORC, can mimic malignancy recurrence and result in unnecessary biopsies.ResultsIn a total of 13 patients (10 males), pathology was observed in 18 lymph node areas after malignant resection and lymph node dissection, and ORC was detected in subcarinal and inferior paratracheal lymph node areas in all patients. The average age of the patients was calculated as 63.1 years (range 51-74). The mean SUVmax value observed in these lymph node areas on PET/CT was 5.22 (range 0-14.36). Although the SUVmax value decreased as the time between surgery and EBUS increased, no statistically significant difference was observed (p = 0.100).ConclusionThe study suggests that in cases of suspected unexpected lymph node recurrence in postoperative follow-up of lung cancer, it is important for clinicians to communicate with the surgeon and re-evaluate the use of ORC by reviewing the operative notes. This may help in determining an appropriate further investigation strategy.