Ahmet Serkan Ilgun

Introduction: Eosinophilic granulomatosis with polyangiitis (EGPA), formerly known as Churg–Strauss syndrome, is a rare small- to medium-vessel vasculitis characterized by asthma, eosinophilia, sinonasal disease, and variable systemic involvement. Gastrointestinal involvement is less common but clinically important, as it may indicate severe disease and can lead to complications such as bowel ischemia, perforation and fistula formation. Case Report: We report the case of a 46-year-old gentleman with a background of asthma and chronic sinusitis requiring functional endoscopic sinus surgery on two occasions, who initially presented with worsening shortness of breath, wheeze, productive cough, and lethargy. Initial investigations for pulmonary embolism were negative, and he was treated for an acute asthma exacerbation. During admission, he was found to have marked eosinophilia, raised inflammatory markers and positive antineutrophil cytoplasmic antibody (ANCA), supporting a diagnosis of EGPA. He improved following corticosteroid therapy and was discharged. One month later, after interruption of prednisolone therapy, he represented with severe abdominal pain and melaena. Computed tomography (CT) imaging demonstrated ischemic small bowel with portal and mesenteric venous gas. Laparotomy revealed diffuse dusky small bowel, most severe in the proximal jejunum, but no bowel resection was performed due to intraoperative improvement. He was managed in intensive care with high-dose corticosteroids, antibiotics, anticoagulation, nutritional support, and multidisciplinary input. Ongoing disease activity required cyclophosphamide, subsequently changed to rituximab. His course was complicated by bowel perforation, wound dehiscence, and enterocutaneous fistula, which were managed conservatively with bowel rest, total parenteral nutrition, antibiotics, intravenous immunoglobulin, and ongoing immunosuppression. Conclusion: This case highlights the importance of considering EGPA in patients with difficult-to-control asthma, sinonasal disease, and eosinophilia. Gastrointestinal involvement may be life-threatening and should prompt urgent multidisciplinary assessment and escalation of immunosuppressive therapy.

Introduction: Primary breast lymphoma (PBL) accounts for less than 0.5% of total breast cancers and 1–2% of extranodal non-Hodgkin lymphomas. It mainly affects women, with male presentations being exceedingly rare and underrepresented in the literature. Primary breast lymphoma presents similarly to primary breast carcinoma, posing diagnostic challenges and risks of delaying treatment. This case emphasizes the importance of maintaining a high index of suspicion when assessing male breast lumps. Case Report: A 68-year-old gentleman presented to his general practitioner with a new left breast lump, present for several weeks, associated with ipsilateral axillary lymphadenopathy. He was referred to the breast clinic, where examination revealed a palpable, solid lesion in the left lower outer quadrant with localized discomfort but no skin or nipple changes. The initial clinical suspicion was that of primary breast carcinoma. Triple assessment demonstrated a lobulated breast lesion measuring 16 × 8 × 14 mm with axillary lymphadenopathy. Sampling of the axillary node showed reactive changes. Core biopsy of the breast lesion revealed grade 3A classic follicular lymphoma. Following multidisciplinary team discussion, the patient was referred to a hematologist. Due to multiple comorbidities, treatment options were carefully considered. He received one cycle of bendamustine and rituximab but subsequently experienced clinical deterioration and elected for palliative care. Conclusion: Primary breast lymphoma in males is rare and can resemble breast carcinoma at presentation. A high index of suspicion and adherence to triple assessment are essential for accurate diagnosis. A proper multidisciplinary approach should be devised based on patient compliance and clinical condition.

Introduction: Achieving a pCR serves as a biomarker indicating enhanced overall survival for breast cancer patients undergoing NST. Vitamin D enhances the antitumor effect of chemotherapeutics as demonstrated in cancer cells and animal models. In this prospective randomized clinical study, we aim to investigate the effect of oral vitamin D supplementation during neoadjuvant systemic therapy (NST) on pathologic complete response (pCR). Methods: Between June 2019 and June 2023, an oral form of 50,000 IU vitamin D3 (cholecalciferol) replacement was administered once a week during NST for the study group. Results: There were 114 (50.2%) cases in the study group and 113 (49.8%) in the control group (totally 227 cases). Factors that positively influenced pCR were higher clinical T stage, higher AJCC clinical stage, Estrogen receptor negativity, progesterone receptor negativity, human epidermal growth factor receptor 2 positivity, high Ki‐67 expression (≥ 20%), hormone negative molecular subtypes, and vitamin D intake in univariate analysis. In the multivariate analysis, factors significantly affecting pCR were vitamin D intake (OR: 2.33, 95% CI 1.20–4.53; p = 0.013), hormone receptor negativity (OR: 2.22, 95% CI 1.11–4.43; p = 0.024), and Ki‐67 ≥ 20% (OR: 3.27, 95% CI 1.03–10.34; p = 0.044). Conclusions: This is the first and only study to compare the effect of oral vitamin D supplementation on pCR during NST. Vitamin D supplementation during NST has a significant effect on pCR in breast cancer patients. Although this effect is not significant for axillary pCR, there is an almost significant correlation. Trial Registration: ClinicalTrials.gov (Identifier: NCT03986268)

Cabıoğlu N, et al. J Breast Cancer. 2025 Aug;28:e26. https://doi.org/10.4048/jbc.2025.0052

Aim: Duodenal diverticulum is the second most common diverticulum section in the gastrointestinal system, but perforation is rare. It is frequently diagnosed incidentally and has little clinical evidence. There are no certain treatment strategies for duodenal diverticulum perforation. Our aim is to identify perforated duodenal diverticulum cases published in the last 10 years through our case report and to evaluate different approaches to treatment. Case Report: A 58-year-old male was diagnosed central nervous system (CNS) tumor with a perforated duodenal diverticulum. Our case presented with abdominal pain and pneumoperitoneum on imaging. The patient was treated surgically with an omental patch, pyloric exclusion, retrocolic gastrojejunostomy, and tube duodenostomy. The patient died on the 10th postoperative day. Conclusion: Duodenal diverticulum perforation is a rare but fatal condition. CT is useful in diagnosis. If the patient is not in a septic condition, it can be followed conservatively. However, if the patient is in a septic condition, surgery may be required. Surgical options should be determined based on the perforation site and characteristics.

Estradiol (E2), a follicle-stimulating hormone (FSH), AMH, and inhibin B levels, along with AFC and MOV, are used to determine ovarian reserve in pre-menopausal women. Studies have shown that AMH levels are more sensitive than those of E2, FSH, and inhibin B and that AFC and MOV can be used to evaluate ovarian reserve. AMH, AFC, and MOV measurements were performed before and after adjuvant SC in 3-month periods for one year. Patients were classified as experiencing chemotherapy-induced amenorrhea (CIA) if they did not have menstrual cycles for a period of six months or longer following the conclusion of their chemotherapy treatment. We aimed to evaluate the factors affecting chemotherapy-induced amenorrhea in breast cancer patients treated with adjuvant chemotherapy and the performance of baseline measurements of AMH, AFC, and MOV to predict chemotherapy-induced amenorrhea. The effects of different chemotherapy regimens on the AMH level, AFC, and MOV in CIA patients were investigated. Seventy-one patients were eligible for this study, and the median age was 38 years (range: 23–45). The median follow-up was 37 months (range: 20–51), and CIA developed in 62% of the patients. The AMH level and AFC were significantly decreased one year after SC (p < 0.0001), whereas MOV was not (p = 0.507). AMH levels before chemotherapy (median: 1.520 vs. 0.755, p = 0.001) and at the end of the first year (median: 0.073 vs. 0.010, p = 0.030) and pre-treatment AFC (median: 12 vs. 4.50, p = 0.026) were lower in patients with CIA compared to those without CIA. The AMH levels before SC were the most valuable and earliest factor for predicting CIA development. In addition, there was no difference between the chemotherapy regimens (including or not including taxane) in terms of CIA development.

The coronavirus disease-2019 (COVID-19) pandemic causes delays in the diagnosis and treatment of cancer patients due to fear of contagion and lockdown. This study aims to investigate the effects of the COVID-19 pandemic on breast cancer patients treated in our breast center. Patients who applied to our clinic with the diagnosis of invasive breast cancer in March 2020 and March 2021 (Study Group) when the COVID-19 pandemic was observed, and in March 2019 and March 2020 before the COVID-19 pandemic (Control Group) were compared in terms of demographic, clinical and pathological characteristics. Statistical analyses were performed using the SPSS software version 21. There were 176 (46%) patients in the study and 206 (54%) patients in the control group. Almost a 15% reduction was detected in patients admitted during the COVID-19 pandemic. The rate of pre-menopausal patients and patient-related delay time (PRDT) were significantly higher in SG (57.7% vs. %45, p=0.013, 2.58 vs. 1.82-month, p=0.001, respectively). There was a larger tumor size and more metastatic lymph nodes after NAC in the SG, but the differences were not significant. There was no difference regarding breast cancer stages and molecular subtypes between the two groups, but there was significantly more de novo stage IV breast cancer in the SG (p=0.009). The incidence of neo-adjuvant chemotherapy and type of surgical therapy was similar between the two groups. COVID-19 pandemic caused a decrease in the number of patients who applied to our clinic and increased patient-related delay time due to fear of transmission and lockdown. The rate of de novo stage IV breast cancer was also significantly increased.

Aim: This study investigated the effect of neoadjuvant chemotherapy (NAC) on stromal tumor-infiltrating lymphocytes (sTILs) and their treatment response. Materials & methods: One hundred fifteen pa... Plain language summary New studies have shown that the tumor microenvironment is critical in tumor behavior. Immune cells surrounding tumor cells are the main components of the tumor microenvironme...

The benefit of breast magnetic resonance imaging (MRI) in breast-conserving surgery (BCS) is unclear. Our study compared breast cancer patients with and without preoperative breast MRI and their long-term oncologic outcomes are reported. A total of...