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Öğe Akromegali ve pankreas adenokarsinomunun insidental birlikteliği olan nadir bir vaka: olgu sunumu(2017) Güngüneş, Aşkın; Arıkan, Şenay Durmaz; Oğuz, Dilek; Yalçın, Selim; Turhan, Nesrin; Çifci, AydınAkromegali nadir bir endokrin hastalıktır. Akromegali, premalign tübüler adenom ve kolorektal kanser stiroid gibi ı Elli iki ya ında erkek hasta, yakla ık 2 yıl önce akromegali tanısı aldı. Tanı sonrası transsfenoidal cerrahi uygulandı. Cerrahi sonrası büyüme hormonu ve insülin benzeri büyüme faktörü (IGF-1) düzeyleri normale dönmeyen hastaya bu nedenle somatostatinanalog tedavisi ba landı. Bu tedaviyi takiben IGF-1değeri yaş ve cinsiyete göre normale döndü. Aynı hasta ay önce karın ağrısı şikayeti ile polikliniğimize başvurdu. Abdomen bilgisayarh tomografide pankreas kuyruk kesiminde 44x26 mm boyutlarında kitle lezyonu ve karaciğerde çok sayıda metastatik lezyon saptandı. Üst gastrointestinalsistem endoskopisi ve kolonoskopide sırasıyla eroziv gastrit ve kolonda polipler gözlendi. Pankreas kuy-- ruğundaki kitle lezyonundan endoskopik ultrasonografi eşliğinde ince iğne aspirasyon biyopsisi yapıldı. Patolojik inceleme pankreas kaynaklı duktal adenokarsinom ile uyumlu id. Akromegalisi olan hastalarda benign ve malign neoplazm riskinde artış olup bu durum dolaşımdaki artmış IGF-l düzeyleri ile ilişkili olabilir. IGF-l, proliferatif ve anti-apoptotik etkinliğe sahiptir. Akromegali ve metastatik pankreatik tümör birlikteliği literatürde yer almakla birlikte 01- dukça nadirdir Akromegali hastalarında pankreas adenokasinomu ve diğer malign hastalıklann olabileceğini dikkate almak gerekir.Öğe Is Gastric Xanthelasma an Alarming Endoscopic Marker for Advanced Atrophic Gastritis and Intestinal Metaplasia?(Mosby-Elsevier, 2016) Koksal, Aydin; Suna, Nuretdin; Kalkan, Ismail; Eminler, Ahmet T.; Sakaogullari, Sukran; Turhan, Nesrin; Parlak, ErkanÖğe Is Gastric Xanthelasma an Alarming Endoscopic Marker for Advanced Atrophic Gastritis and Intestinal Metaplasia?(Springer, 2016) Koksal, Aydin Seref; Suna, Nuretdin; Kalkan, Ismail Hakki; Eminler, Ahmet Tarik; Sakaogullari, Sukran Ziysan; Turhan, Nesrin; Parlak, ErkanThe clinical significance of gastric xanthelasmas is unknown. We conducted a case-control study in order to evaluate whether gastric xanthelasma is an indicator of advanced atrophic gastritis and intestinal metaplasia. The study was conducted among 1400 patients who underwent elective upper endoscopy. Patients with gastric xanthelasma and atrophy and/or intestinal metaplasia constituted the study group (n = 55). The control group involved patients with only atrophic gastritis and/or intestinal metaplasia (n = 50). Histopathologic findings of the groups including the distribution of atrophic gastritis and/or intestinal metaplasia, operative link on gastritis assessment score, operative link on gastritis intestinal metaplasia assessment (OLGIM) score, and presence of dysplasia and malignancy were compared. Subgroup analysis was performed in order to establish the relation between the characteristics (size, number, and localization) of xanthelasmas, atrophy, and intestinal metaplasia. Multifocal atrophic gastritis was significantly more common in patients with a gastric xanthelasma (41.8 vs. 26.0 %, p = 0.03). Patients with multiple xanthelasmas had a significantly higher rate of intestinal metaplasia (p = 0.02) and a higher OLGIM score (p = 0.02) compared to those with a single xanthelasma. Dysplasia was detected in 8 (14.5 %) patients with a xanthelasma and 4 (8.0 %) patients without a xanthelasma (p = 0.2). Gastric xanthelasma(s) is a warning endoscopic sign for the presence of multifocal atrophic gastritis and advanced intestinal metaplasia.Öğe Noninvasive assesment in differentiating benign and malign pancreatic lesions with endosonographic elastography score and strain ratio(2020) Utku, Özlem Gül; Ergül, Bilal; Karatay, Eylem; Efe, Cumali; Turhan, Nesrin; Oğuz, DilekBackground: We aimed to evaluate the diagnostic capability of endoscopic ultrasound elastography (EUS-EG) score and strain ratio (SR) for differentiating benign pancreatic lesions from the malign lesions Material and Method: We retrospectively evaluated well collected data of patients who undergone EUS-EG in a single center during the period of January 2016-June 2019. Patients who had pancreatic disorders were further evaluated for the study. The final diagnosis of solid pancreatic lesions (SPL) was made by histopathologic examination. Control group consisted of patients with chronic pancreatitis (CP) who diagnosed according to Rosemont criteria. Elastography was evaluated by a qualitative (elastography scores) and a quantitative method SR. Results: A total of 66 patients (42 (63.6%)female/24(63.6%)male) with mean age of 58.88±15.32 (19- 80) were included in the study. Thirty-eight patients had SLP, remain 28 patients were CP. In SPL group, 32 (84.2%) had adenocarcinomas and 6 (15.8%) had neuroendocrine tumors. Among 28 patients with benign pancreatic lesions, 23 (82.1%) had CP while five (17.9%) had autoimmune pancreatitis. Median SR values were significantly higher in patients with SPL than those with CP (44.0 (10.0-110.0) vs 7.0 (2.6- 14.6), p<0.001). Elasticity scores were also significantly different between patients with SLP and CP (p<0.001). Elasticity scores were significantly different between adenocarcinomas and CP (p<0.001). A 14 cut-off value of SR had 97% sensitive and 100% specificity for SPL and receiver-operating characteristic curves showed an area under the curve of 0.99.6. Likelihood Ratio test revealed that SR appears as the best parameter in discrimination of lesion type either as benign or malignant (X2 = 54.031, p<0.001). Conclusion: Our study suggested that EUS-elastography and SR scores are highly effective in differentiating malign-benign pancreatitis lesions.Öğe STRONGYLOIDES STERCORALIS: A RARE CASE DIAGNOSED WITH ESOPHAGEAL SWAB SAMPLE(Kırıkkale Üniversitesi, 2023) Aydın, Arzu Hazal; Bayazıt Gözüküçük, Buse; Turhan, NesrinStrongyloides stercoralis is an opportunistic parasite that may cause severe and fatal disease in immunocompromised hosts. A 70-year-old man with a nonspecific history except pneumoconiosis had diffuse ulcers on the esophagus. Hence, only a swab sample could be performed. On microscopic examination of the swab sample, larvae and soils were observed in necrotic and inflammatory background. It was evaluated as compatible with S. stercoralis. At repeated endoscopic examination multiple biopsies were taken from the stomach. Larvae and soils were detected in crypt lumens with chronic inflammation in gastric mucosa. We presented this case with gastric involvement as a rare presentation that has not been reported in the literature before and was diagnosed by esophageal swab sample. Although infection is usually asymptomatic in the chronic phase, it carries a high mortality risk in immunocompromised hosts. So, it is important to scan the risk group. Swab sampling is an easy method for cytological examination.
