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Öğe Comparison of clinical indications and postoperative histopathological diagnoses of hysterectomy specimens with benign preliminary diagnoses(2019) Bozdag, Zehra; Dizibuyuk, Omer Faruk; Bayramoglu Tepe, NeslihanAim: Hysterectomy specimens constitute a large section of routine pathology practice as hysterectomy operations widely performed all over the world to manage benign gynecological disorders by the gynecologists. In this study, we aimed to evaluate hysterectomy specimens obtained due to benign preliminary diagnoses by comparing them with regard to clinical indications and postoperative histopathological diagnoses. Material and Methods: Nine hundred and forty-seven cases who underwent hysterectomy at Gaziantep University Medical Faculty Hospital between January 2012 and December 2016 were retrospectively re-evaluated with regard to clinical indications and postoperative histopathologic diagnoses. Results: Leiomyoma was the most common hysterectomy indication and accounted for 34.1% (n:323). Other indications in descending order of prevalence were as follows; abnormal uterine bleeding (n:290, 30.6%), endometrial hyperplasia (n:113, 11.9%), uterine prolapse (n:107, 11.3%), adenomyosis (n:75, 7.9%) and abnormal placentation (n:39, 4.1%). According to the final histopathological results of the hysterectomy specimens, leiomyomas (n:325, 34.3%) were the most common postoperative diagnosis followed by adenomyosis (n:150, 15.8%) and endometrial hyperplasia (n:113, 11.9%). Abnormal placentation was found in 39 cases (4.1%). Squamous intraepithelial lesions of the uterine cervix were found in 39 cases (4.1%), endometrial adenocarcinomas in 10 cases (0.9%), smooth muscle tumor with uncertain malignant potential, leiomyosarcoma and granulosa cell tumor in one patient each (0.09%). We found more than one pathology in 280 cases. The most common pathology was leiomyomas coexisting with adenomyosis (n:170, 17.9%), while others included leiomyoma coexisting with endometrial polyp (n:56, 5.9%), and leiomyoma coexisting with endometrial polyp and adenomyosis (n:54, 5.7%). Conclusion: Incidental detection of conditions such as cervical squamous intraepithelial lesions and endometrial adenocarcinomas in hysterectomy materials obtained for benign preliminary diagnoses support the importance of cervical screening test and endometrial sampling as routine processes in preoperative surgical examinations. This also stresses the importance of macroscopic examination and increased sampling in suspicious cases for pathologistsÖğe A COMPARISON OF SATB2 EXPRESSION RESULTS WITH CK20 AND CDX2 IN METASTATIC COLORECTAL CARCINOMA CASES(Carbone Editore, 2019) Bozdag, Zehra; Akatli, Ayse NurIntroduction: SATB2 (The special AT-rich sequence-binding protein 2) is the new DNA binding protein and nuclear transcrip-tion factor. In normal epithelial tissues, the SATB2 protein is specifically expressed in the nuclei of the lower gastrointestinal (GI) tract epithelial cells. The elective expression of SATB2 in the lower GI tract implies that it can be used as a diagnostic marker for metastatic colorectal carcinoma (CRC). Materials and methods: Immunohistochemical (IHC) analysis was performed by applying SATB2, CK20 and CDX2 in 96 meta-static CRC cases (51 liver, 22 lung, 19 ovarian, 3 skin and 1 uterine myometrial tissue) with various origins. The aim is to evaluate the diagnostic value of SATB2 alone, and the double and triple combinations of SATB2 with CK20 and CDX2. Results: Out of 96 metastatic colon carcinoma cases, 94 (97.9%) had positive SATB2 expressions. It was found that 93.7% (90/96) of the cases had expression with CK 20 and CDX2. The sensitivity of SATB2 alone was 97.92%, and the sensitivity of CK20 and CDX2 alone was the same, i.e. 93.75%. This rate was also higher in the double combination of SATB2 with CDX2 and CK20 in comparison to the double combination of CK20 and CDX2. The sensitivity of SATB2 and CK20 combination was 98.8%, which was higher than that of CK20 and CDX2 combination. Conclusions: Our results support the requirement of including SATB2 in the IHC panel for metastatic CRC cases.Öğe Cytological and cytomorphometric characteristics of buccal mucosa cells from smokeless tobacco users(Wiley, 2017) Dagli, Adile Ferda; Sahin, Nurhan; Bozdag, Zehra; Ucer, Ozlem; Akatli, Ayse Nur; Artas, Gokhan; Sahin, IbrahimBackgroundUse of smokeless tobacco (ST) is increasing in many communities. We investigated whether ST alters the cytological and cytomorphometric features of buccal mucosa cells. MethodsTwenty male participants who had used Nicotiana rustica Linn.-containing ST (Maras powder) for at least 10 years, and 20 healthy male controls who did not use ST, were included in this study. After rinsing the mouth with water, samples were taken using a toothbrush from the buccal mucosa of subjects in both groups. Samples were gently spread over a glass slide. After applying a cytofixative spray, the Papanicolaou method was used to stain the slides. The presence of dysplasia, dyskeratosis, parakeratosis, hyperkeratosis, hypergranulosis, karyorrhexis, and pyknosis was evaluated by light microscopy, as were the increment amount of candida, cocco-bacillus, and Leptotrichia buccalis. Cytomorphometric analysis was performed and at least 20 cells with well-defined borders were evaluated from each slide, and the cellular diameter (CD), nuclear diameter (ND), and nucleus/cytoplasm (N/C) ratio of the cells were analyzed using a 60x objective. ResultsOther than the presence of dysplasia and candida, all measured cytological parameters were significantly higher in the ST users than in the non-ST users. Furthermore, CD was lower while nuclear/cytoplasmic ratio was higher in the ST users than in those non-ST users. ConclusionCytological changes associated with the use of ST, include dyskeratosis, parakeratosis, hyperkeratosis, hypergranulosis, karyorrhexis, pyknosis together with increase in the bacterial population of cocco-bacillus and L. buccalis. There were no significant differences in patients with dysplasia in spite of reduction of CD, increased nuclear size and N/C ratio.Öğe Gastrointestinal Kaposi Sarcoma Involving Stomach and Colon: Diagnostic Pitfall for Pathologists with Expression of CD117(Springer, 2023) Bozdag, Zehra; Toprak, Serhat; Karadag, Nese; Akbulut, SamiKaposi sarcoma (KS) is a low-grade vascular tumor caused by human herpes virus type 8 (HHV8). Gastrointestinal involvement of KS is rare and most commonly clinically silent. Gastrointestinal KS may mimic gastrointestinal stromal tumors (GISTs) histologically as the tumor formed by morphologically spindle-shaped cells, which is mostly located in the mucosa and submucosa. In the present study, we describe a case of Kaposi sarcoma that was first diagnosed in the gastrointestinal tract of a 73-year-old female patient who presented to the clinic with nausea and diarrhea. Immunohistochemical staining showed cytoplasmic CD117 expression both in stomach and colon biopsies. Although involvement of KS is rarely seen in the gastrointestinal tract (GIT), the differential diagnosis of low-grade spindle cell lesions without significant pleomorphism, KS should definitely be considered, and it should be known that CD117 positivity is also present in these neoplasms.Öğe Gastrointestinal system-derived secondary gynecologic tumors: 10 years experience at a single center(2019) Bayramoglu Tepe, Neslihan; Bozdag, Zehra; Balat, OzcanAim: To perform a retrospective review of gynecologic malignancies originating from gastrointestinal system (GİS).Material and Methods: The study included 35 patients who underwent surgery at Gaziantep University, Faculty of Medicine, Department of Gynecology and Obstetrics from January 2007 to December 2017 and were diagnosed with secondary gynecological malignancies originating from GİS. The patients’ age, primary tumor, metastatic tumor localization and size were recorded. The malignancies were classified based on origin, as those arising from the colon, appendix, pancreas, stomach, peritoneum, and those of an unknown origin. Results: The mean age of the patients was 50.8 years (min: 24, max: 98) and the mean tumor diameter was 9.8 cm (min: 2 cm, max: 23 cm). Malignancies originating from the colon were most common secondary gynecologic malignancies. The primary tumor was localized at the colon in 21 patients (60%), stomach in eight (22.8%), and in the pancreas in one patient, appendix in one patient, peritoneum in one patient (2.8%). The origin of the primary tumor could not be determined in three patients (8.5%). Of the malignancies originating from the colon (n=21), 16 (76.1%) metastasized to the ovaries, four (19%) to the vagina, one (4.7%) to the cervix, while all tumors originating from the stomach, peritoneum, pancreas, appendix and those derived from the GIS without specific origin metastasized to the ovaries. Of the ovarian metastases, 26 (86.6%) were bilateral while four (13.3%) were unilateral. Conclusion: Female genital system is among the substantial targets of metastasis of GIS-derived tumors. Metastatic tumors have a more aggressive behavior. Metastatic tumors must be distinguished from primary tumors as treatment modalities differ in these tumors. A multidisciplinary approach should be employed in the diagnosis, management and follow-up of cases, and the genital system should be screened carefully during both preoperative assessment and postoperative follow-up in patients with primary GIS malignancies.Keywords: Metastatic Tumor; Gynecologic Tumor; Gastrointestinal System.Öğe Histopathological Effects of Teriparatide in Medication-Related Osteonecrosis of the Jaw: An Animal Study(W B Saunders Co-Elsevier Inc, 2016) Keskinruzgar, Aydin; Bozdag, Zehra; Aras, Mutan Hamdi; Demir, Tuncer; Yolcu, Umit; Cetiner, SedatPurpose: Osteonecrosis of the jaw after tooth extraction is a major complication in patients using bisphosphonates (BPs) for bone lesions, such as for the treatment of osteoporosis. The purpose of this study was to investigate the histopathologic effects of teriparatide (a synthetic parathyroid hormone) on rats developing osteonecrosis with BP use. Materials and Methods: Rats (n = 80) that had been injected intraperitoneally with zoledronic acid for 7 weeks were used. Maxillary first molar extractions and bone defects were established in the same region in the eighth week. Teriparatidewas administered subcutaneously to prevent osteonecrosis. Animals were sacrificed and histopathologic changes were examined. Osteoblasts, osteoclasts, inflammatory phase of bone healing, and osteonecrotic areas were evaluated. Results: The osteoclast numbers were larger in the experimental groups (teriparatide administered before and immediately after tooth extraction) than in the control group (administered zoledronic acid). The inflammatory phase of bone healing was more pronounced in the experimental group (teriparatide administered before tooth extraction) than in the control group. There were significant differences in osteoclast numbers and in the inflammatory phase of bone healing between the experimental and control groups (P < .05). The osteoblast numbers and osteonecrotic areas were similar in size between the experimental and control groups. There were no significant differences (P > .05). Conclusions: BPs have negative effects on osteoclasts and the inflammatory phase of bone healing, whereas teriparatide was found to be effective in eliminating the negative effects of BPs. Teriparatide had positive effects in preventing osteonecrosis; therefore, teriparatide could be an effective agent for MRONJ. (C) 2016 American Association of Oral and Maxillofacial SurgeonsÖğe Histopathological subtyping of actinic keratosis and it's coexistence with nonmelanotic skin cancers in Gaziantep and Malatya regions(Deri Zuhrevi Hastaliklar Dernegi, 2016) Sahin, Nurhan; Bozdag, Zehra; Erkilic, Suna; Aydin, Nasuhi Engin; Sener, SerpilBackground and Design: Actinic (solar) keratosis (AK) is a precancerous, epidermal lesion, which develops in sensitive skin exposed to sun for a long period. AKs are divided into different histopathological subtypes. There is a link between the clinical progression of the histopathological subtypes, the degree of cellular atypia, and the precancerous nature of the lesion. Different series have reported that the rate of transformation of AK to squamous cell carcinoma (SCC) ranges between 12% and 20%. Materials and Methods: In this study, we reevaluated patients who were diagnosed with AK in the Pathology Departments of the Medical Faculties of Inonu and Gaziantep Universities over an eight-year period, and divided the patients into different histopathological subtypes. In addition, we investigated the association between the lesions, and basal cell carcinoma (BCC), SCC and both carcinomas. Results: 29,6% of cases were proliferative AK, 27% of cases were hypertrophic AK. 19% and 13% of all lesions was associated with BCC and SCC, respectively. Conclusion: In this study, we found that the most frequent subtype was proliferative AK and the most frequent nonmelanotic skin cancer was BCC associated with AK.Öğe Laparoscopic Trocar Port Site Endometriosis: A Case Report and Brief Literature Review(Int College Of Surgeons, 2012) Emre, Arif; Akbulut, Sami; Yilmaz, Mehmet; Bozdag, ZehraEndometriosis is defined as the presence of ectopic endometrial tissue outside the lining of the uterine cavity. It occurs most commonly in pelvic sites such as ovaries, cul-de-sac, and fallopian tubes but also can be found associated with the lungs, bowel, ureter, brain, and abdominal wall. Abdominal wall endometriosis, also known as scar endometriosis, is extremely rare and mainly occurs at surgical scar sites. Although many cases of scar endometriosis have been reported after a cesarean section, some cases of scar endometriosis have been reported after an episiotomy, hysterectomy, appendectomy, and laparoscopic trocar port tracts. To our knowledge, 14 case reports related to trocar site endometriosis have been published in the English language literature to date. Herein, we present the case of a 20-year-old woman (who had been previously operated on for left ovarian endometrioma 1.5 years ago by laparoscopy) with the complaint of a painful mass at the periumbilical trocar site with cyclic pattern. Consequently, although rare, if a painful mass in the surgical scar, such as the trocar site, is found in women of reproductive age with a history of pelvic or obstetric surgery, the physician should consider endometriosis.Öğe PAP smear test in the diagnosis of endometrial carcinoma: How useful is it, what does it indicate?(2019) Bozdag, Zehra; Eronat, OmerAim: Endometrial carcinoma constitutes the most common gynecological malignancy. Although early diagnosis is important as in all other malignancies, there still exists no screening-imaging modality that can be used effectively in the 517diagnosis of endometrial carcinomas. This study investigated the role of the cervical Papanicolaou (PAP) smear test in the diagnosis of endometrial carcinoma and evaluated the correlation of the results with histological and prognostic data.Material and Methods: Data obtained from 367 patients who underwent hysterectomy and lymph node dissections due to endometrial carcinoma at Gaziantep University Medical Faculty Hospital between 2010 January-2018 June were retrospectively evaluated. PAP smear results of 75 of these patients, who had undergone cervical PAP smear screening preoperatively (in a 1-36 month period), were evaluated independently by two pathologists. The relationship of the results with diagnosis and prognostic data was investigated.Results: Of the 75 cases included in the study; 58 were endometrioid endometrial carcinomas, 9 were serous carcinomas, 6 were malignant mixed Mullerian tumours, 1 was clear cell carcinoma, and 1 was adenosquamous carcinoma. Atypical glandular cells were detected in 29 cases (38.6%). While the evaluation of the relationship of positive cases with histological and prognostic data revealed no relationship with histological tumor type or cervical and lymph node involvement, depth of myometrial invasion presented a significant result.Conclusion: Although rates of endometrial carcinoma detection with PAP smear screening are not very high, they are also not negligible. The detection of an increase in smear positivity rate in correlation with an increase in myometrial invasion depth in our study is quite significant as it represents an important parameter with implications for the surgical procedure.Öğe Pyramidal Nonlocal Network for Histopathological Image of Breast Lymph Node Segmentation(Springernature, 2021) Bozdag, Zehra; Talu, Fatih M.The convolutional neural networks (CNNs) are frequently used in the segmentation of histopathological whole slide image-(WSI) acquired breast lymph nodes. The first layers in deep network architectures generally encode the geometric and color properties of objects in the training set, while the last layers encode the distinctive and detailed properties between classes. Modern segmentation approaches (DeepLabV3+, SegNet, PSPNet) are realized by evaluating these layers together. However, having a high parameter space of all these networks increases the calculation costs and prevents the researchers from working more effectively. In this study, we present a new pyramid-structured segmentation network (NonLocalSeg). Although the proposed network has low parameter space, its segmentation performance is similar to current architectures. The integration of the Non-local Module (NLM-a form of attention mechanism) or Asymmetric Pyramid Nonlocal block (APNB) into classical pyramid-built architectures has led to the reduction of network depth and narrowing of the parameter space while enabling coding of low and high image features. These mechanisms suppressed the unfocused background image, emphasizing the focused foreground object. As a result of a series of ablation experiments carried out, it is seen that the NLM and APNL mechanisms give the succeeded results. Although the network architectures adapting these mechanisms contain fewer parameters than current networks, it is observed that they have a similar accuracy (mean intersection over union [IoU]) range. (C) 2021 The Authors. Published by Atlantis Press B.V.Öğe Pyramidal position attention model for histopathological image segmentation(Elsevier Sci Ltd, 2023) Bozdag, Zehra; Talu, Muhammed FatihThe level of performance achieved in the classification of histopathological images has not yet been reached in the segmentation area. This is because the global context information sufficient for classification is not sufficient for segmentation. Especially, high tissue diversity in histopathological images and the fact that tissues in the same class have quite different colors, patterns and geometries make the segmentation problem difficult. In this study, a novel hybrid architecture (PAMSegNet) is presented that provides high segmentation accuracy in histopathological images. This architecture, which has a pyramid data processing strategy, has been provided with the Position Attention Module (PAM) and Boundary aware Module (BM) to extract global and local attri-butes more accurately. In addition, with the deep supervised technique used, both contents (global and local) were evaluated together in the segmentation decision. Segmentation architectures (Deeplabv3 +, SegNet, U-Net) with a strong backbone in the literature are used for performance comparison. The proposed architecture has been found to provide high segmentation accuracy (71.6% mIoU and 86.4% PA).Öğe Routine Histopathologic Examination of Appendectomy Specimens: Retrospective Analysis of 1255 Patients(Int College Of Surgeons, 2013) Emre, Arif; Akbulut, Sami; Bozdag, Zehra; Yilmaz, Mehmet; Kanlioz, Murat; Emre, Rabia; Sahin, NurhanThe objective of this study was to analyze the clinical benefit of histopathologic analysis of appendectomy specimens from patients with an initial diagnosis of acute appendicitis. We retrospectively analyzed the demographic and histopathologic data of 1255 patients (712 males, 543 females; age range, 17-85 years) who underwent appendectomy to treat an initial diagnosis of acute appendicitis. Patients who underwent incidental appendectomy during other surgeries were excluded from the study. Histopathologic findings of the appendectomy specimens were used to confirm the initial diagnosis. Ninety-four percent of the appendectomy specimens were positive for appendicitis. Of those, 880 were phlegmonous appendicitis, 148 were gangrenous appendicitis with perforation, and the remaining 88 showed unusual histopathologic findings. In the 88 specimens with unusual pathology, fibrous obliteration was observed in 57 specimens, carcinoid tumor in 11, Encheliophis vermicularis parasite infection in 8, granulatomous inflammation in 6, appendiceal endometriosis in 2, and 1 specimen each showed mucocele, eosinophilic infiltration, Taenia saginata parasite infection, and appendicular diverticulitis. All carcinoid tumors were located in the distal appendix. Six of the 11 carcinoid tumors were defined by histopathology as involving tubular cells, and the other 5 as involving enterochromaffin cells. Six patients had muscularis propria invasion, 2 patients had submucosa invasion, 2 patients had mesoappendix invasion, and 1 patient had serosal invasion. All patients with tumors remained disease free during the follow-up (range, 127 months). We conclude that when the ratio of unusual pathologic findings for appendectomy specimens is considered, it is evident that all surgical specimens should be subjected to careful histologic examination.Öğe Spindle Variant Primary Diffuse Large B Cell Lymphoma of the Colon: Case Report and Literature Review(Springer, 2023) Toprak, Serhat; Bozdag, Zehra; Karadag, Nese; Akbulut, SamiDiffuse large B cell lymphoma (DLBCL) with spindle cell morphology is a rare variant that can be seen in extranodal regions. Because the spindle cell dominant morphology in lymphoma is extremely unusual, the diagnosis can easily be missed in many organ systems. We present a case of an 82-year-old male patient with complaints of abdominal pain and swelling. He operated with the preliminary diagnosis of cecum tumor and ileum perforation. Tumoral proliferation was observed originating from the submucosa and infiltrating the muscularis propria, with the features of mostly spindle-shaped, having round-shaped nuclei in some of the cells, and having relatively narrow cytoplasm. A panel of immunohistochemical stains were performed to rule out the possibilities of sarcoma, carcinoma, or melanoma. Diffuse strong positive reaction was observed for CD45, CD20, CD19, CD22, Pax5, and CD30. The case was reported as spindle cell variant of DLBCL based on the present findings. As far as we know, this is the first case described in the colon. We emphasize that pathologists should be reminded of lymphoma as a differential diagnosis of spindle cell tumors.Öğe Therapeutic effect of alendronate in an experimental temporomandibular joint osteoarthritis(Wiley, 2023) Acibadem, Elif; Keskinruzgar, Aydin; Bozdag, Zehra; Yavuz, Gunay YapiciBackgroundTemporomandibular joint osteoarthritis is a common degenerative joint disease. This disease negatively affects the daily life, speech and chewing functions of patients. ObjectiveThis study aimed to evaluate the effects of intra-articular injection of alendronate to osteoarthritis, which has a protective effect on bone and cartilage tissue and helps reduce inflammation in temporomandibular joint osteoarthritis. MethodsA total of 24 Wistar albino rats were used in the study. Rats were divided into four groups: study, saline, control and sham. In both saline and control groups, monosodium iodoacetate was injected intra-articularly to induce osteoarthritis. Alendronate was administered intra-articularly to the study group weekly for 4 weeks. In the saline group, saline was administered by intra-articular injection. At the end of the 12th week, all groups were sacrificed. Mandibular condyle tissues were examined histopathologically. ResultsAccording to the results, osteoarthritic changes in the control group were higher than those in the study group (p < .05). No significant reduction in osteoarthritic changes was observed in the saline group (p > .05). Significant osteoarthritis findings were observed in all groups compared with the sham group (p < .05). ConclusionIntra-articular injection of alendronate was found to have positive results on TMJ osteoarthritis. In addition, it was seen that alendronate has effects on reducing cartilage tissue degeneration and loss of matrix proteins.Öğe An unusual cause of acute appendicitis: Appendiceal endometriosis(Elsevier Sci Ltd, 2013) Emre, Arif; Akbulut, Sami; Yilmaz, Mehmet; Bozdag, ZehraINTRODUCTION: While endometriosis is a common disorder in women of reproductive age, appendiceal endometriosis accounts for less than 1% of all pelvic endometriotic lesions. Appendiceal involvement may present as acute appendicitis and definitive diagnosis is made by only postoperative histological examination. PRESENTATION OF CASE: In this study, we present two cases of female patients who underwent an appendectomy presumed diagnosis as acute appendicitis, and a histopathological examination of the retrieved specimen revealed appendiceal endometriosis. DISCUSSION: Endometriosis is defined as the presence of ectopic endometrial tissue outside the lining of the uterine cavity. Gastrointestinal endometriosis is observed in 3-37% of all endometriosis cases, whereas appendiceal endometriosis accounts for only about 3% of gastrointestinal endometriosis. Appendiceal endometriosis is usually asymptomatic, although it sometimes causes abdominal cramps, nausea, chronic pelvic pain, lower gastrointestinal hemorrhage, intussusception, perforation, or acute appendicitis. CONCLUSION: Appendiceal endometriosis is an unusual histopathological finding. A preoperative diagnosis is difficult, but this condition should be considered when women of childbearing age present with clinical symptoms of acute appendicitis. (C) 2012 Surgical Associates Ltd. Published by Elsevier Ltd.Open access under CC BY-NC-ND license.
