Merve Cin

Background: Pathological complete response (pCR) to neoadjuvant chemotherapy (NACT) in breast cancer is influenced by multiple tumor- and host-related factors, and readily available pretreatment biomarkers of response are still limited. This study aimed to evaluate the association between pretreatment systemic inflammatory and nutritional parameters and pCR assessed by the Miller–Payne grading system, with a specific focus on the independent predictive value of pretreatment serum albumin compared with established inflammatory ratios. Methods: A total of 226 patients with breast carcinoma who received NACT between May 2017 and September 2023 were retrospectively evaluated. Pretreatment laboratory parameters—including neutrophil-to-lymphocyte ratio (NLR), platelet-to-lymphocyte ratio (PLR), C-reactive protein (CRP), serum albumin, and the CRP/albumin ratio (CAR)—were recorded. Pathological response was assessed using the Miller–Payne grading system by two breast pathologists blinded to laboratory data. Univariable and multivariable logistic regression and receiver operating characteristic (ROC) curve analyses were performed, complemented by bootstrap validation of the optimal cut-off, a sensitivity analysis using the contemporary ypT0/is ypN0 definition of pCR, and a subgroup analysis by molecular subtype. Results: pCR was observed in 41 patients (18.1%). Pretreatment serum albumin levels were significantly lower in responders than in non-responders (p = 0.027), whereas NLR, PLR, CRP, and CAR were not significantly associated with response. In multivariable analysis, pretreatment serum albumin, Ki-67, and HER2 status emerged as independent predictors of pCR. ROC analysis demonstrated moderate discriminatory ability for albumin (AUC = 0.64); the optimal cut-off was 4.22 g/dL (bootstrap 95% CI 3.50–4.53 g/dL), with values below this threshold associated with a higher likelihood of pCR. The association between low pretreatment albumin and pCR was particularly pronounced in the triple-negative subgroup (3.30 vs. 4.02 g/dL, p = 0.027). The albumin signal remained significant under the stricter ypT0/is ypN0 definition of pCR in univariable analysis (OR 0.47, p = 0.045). Conclusions: Pretreatment serum albumin, independent of systemic inflammatory ratios, is associated with pCR to NACT in breast cancer and may serve as a candidate biomarker for pretreatment risk stratification, particularly when interpreted alongside established tumor-related predictors such as Ki-67 and HER2 status. The association appears especially relevant in the triple-negative subgroup, suggesting that patients with TNBC and low pretreatment serum albumin may warrant heightened multidisciplinary attention during NACT. Validation in larger, prospective, multicenter cohorts is needed before routine clinical implementation.

Aim: Nasopharyngeal carcinomas (NPCs) are often diagnosed through fine-needle aspiration biopsy (FNAB) samples from metastatic lymph nodes. The differential diagnosis of cervical mass lesions includes a broad spectrum of lesions, which can complicate the diagnostic process. This study aims to analyze the clinical and cytological features of 12 cases of undifferentiated nonkeratinizing NPC diagnosed from metastases and identify key morphological findings that may aid diagnosis. Method: This retrospective study included 12 cases of nasopharyngeal carcinoma diagnosed via fine-needle aspiration (FNA) in our department between 2021 and 2024. All cases were histologically classified as undifferentiated-type nasopharyngeal carcinoma. Clinical data of the cases were retrieved from the hospital information management system. Cytology smears were retrieved from the archives and re-evaluated in terms of cytomorphological characteristics. Results: Eight of the cases were male, and four were female. Their ages ranged from 23 to 80 years. All smears were cellular. In half of the cases (6 cases), the tumor cells formed cohesive clusters, whereas in 5 cases, the cells displayed loose cohesion. In 7 cases, the tumor cells exhibited large nuclei, with pleomorphism in 10 cases. In half of the cases, the nuclei were oval-shaped, followed by oval-to-round nuclei in four cases. Naked nuclei were observed in most cases (9/12). Nucleoli were prominent in 8 cases. In 10 cases, the cytoplasm was scant with indistinct borders. Conclusions: The cytologic diagnosis of NPC is complex and requires a multifaceted approach. FNA of cervical lymph nodes is a valuable diagnostic tool, but careful interpretation is crucial. The presence of cells exhibiting a mixed pattern—forming clusters as well as appearing isolated cells—characterized by large pleomorphic nuclei, prominent nucleoli, and scant cytoplasm, particularly in samples obtained from cervical lymph nodes, constitutes a significant clue in cytological diagnosis.

Background/Objectives: Both benign and malignant thyroid lesions present as nodules. While thyroid nodules are less common in the pediatric population than in adults, their malignancy rates are considerably higher. Although the 10 mm cut-off for fine-needle aspiration cytology (FNAC) is commonly used for both adults and children, there is limited information regarding subcentimeter thyroid nodules in the pediatric population. The majority of published studies have focused on nodules measuring 1 cm or greater. This study aimed to compare the cytological diagnosis, ultrasonographic features, and histopathological outcomes of thyroid nodules in pediatric patients (under 21 years old), stratified by size (≤10 mm vs. >10 mm). Methods: We conducted a retrospective, single-center cohort study, evaluating 108 thyroid nodules from 98 patients. Nodule sizes were categorized into two groups, and their features were correlated with findings from FNAC using the Bethesda System for Reporting Thyroid Cytopathology and subsequent surgical histopathology. The risk of malignancy (ROM) was calculated for each Bethesda category. Results: A total of 108 nodules were evaluated, with 35 (32.4%) measuring ≤ 10 mm. The overall malignancy rate was 12%, with 14.3% in the ≤10 mm group and 11% in the >10 mm group. The difference was not statistically significant, and this finding indicates that small nodules can also harbor malignancy. Notably, all cases categorized as suspicious for malignancy or malignant by FNAC were confirmed to be malignant on histopathology (ROM = 100%). The Atypia of Undetermined Significance (AUS) category exhibited a malignancy rate of 60%, which is significantly higher than the rates reported in previous studies. Ultrasonographic features such as hypoechogenicity and microcalcifications were more prevalent in malignant nodules but lacked statistical significance. Conclusions: Our findings demonstrate that pediatric thyroid nodules, including those ≤10 mm, have a notable risk of malignancy. The high rate of malignancy in the AUS category suggests that the current Bethesda criteria, primarily designed for adults, may require re-evaluation for pediatric cases due to known differences in genetic profiles and disease behavior. Consequently, these pathological findings clearly demonstrate that FNAC indications in children should not be based solely on nodule size, and that a multidisciplinary approach guided by pediatric-specific guidelines should inform clinical management.

Can INSM1 and Phox2B be an Alternative to Conventional Neuroendocrine Markers in the Diagnosis of Pancreatic Solid Pseudopapillary Neoplasia and Neuroendocrine Tumors? - Istanbul Medical Journal

Is There a Relationship between the Staining Pattern of Classical Neuroendocrine Markers and Clinicopathological Findings in Neuroendocrine Tumors of the Appendix? - Bezmialem Science

Background/Objectives: Bladder cancer, predominantly urothelial carcinoma, is an important malignancy of the urinary system. Despite the same histologic grade and stage, some patients seem to have a worse prognosis. In this context, the epithelial–mesenchymal transition (EMT), characterized by the loss of E-cadherin and gain of vimentin expression, is an important process in tumor progression. Galectin-3, a lactose-binding protein involved in various cellular processes, has been associated with increased tumor cell migration, invasion, and treatment resistance. Methods: In this study, 223 bladder cancer cases were examined, and E-cadherin, vimentin, and galectin-3 expression was evaluated by immunohistochemical staining in tumor budding areas and invasive components. These markers were also correlated with clinicopathological parameters, including tumor grade and stage. Results: The results indicated a significant decrease in E-cadherin expression and an increase in vimentin staining in higher-grade and higher-stage tumors, supporting EMT involvement. Galectin-3 expression was notably higher in T1 high-grade tumors but decreased in T2 stage tumors. Despite this, no significant correlation was found between galectin-3 and E-cadherin or vimentin, suggesting a complex role of galectin-3 in EMT. Conclusions: High galectin-3 expression in T1 high-grade tumors highlights its potential role in early tumor progression and as a therapeutic target. However, the decrease in its expression in advanced stages underscores the need for further research to understand its multifaceted involvement in bladder cancer. These findings suggest that while galectin-3 may contribute to the EMT and early tumor progression, its exact role and potential as a therapeutic target require more detailed investigation.