Nesrin Turhan

CORRECTION NOTE A correction has been made to the original version of this article, published as Suppl. 1 in 2019 (Ref: KLM-2890): In Table 25, the information ‘200 mg/day, single dose, oral’ for Doxycycline has been corrected to: ‘200 mg/day, 2 doses, oral’. Corrected article: https://doi.org/10.5152/kd.2019.51

Primary hepatic T-cell lymphoma (PHTCL) is a rare, aggressive extranodal non-Hodgkin lymphoma confined to the liver, often presenting with non-specific symptoms and leading to delayed diagnosis. A 37-year-old female presented with progressive jaundice, pruritus, and abdominal discomfort, accompanied by markedly elevated transaminases and mixed-pattern cholestasis. Extensive serological, infectious, and autoimmune work-up was non-contributory. Despite the introduction of a gluten-free diet following the incidental diagnosis of celiac disease, the patient’s liver function deteriorated, accompanied by persistent cytopenia. Initial liver biopsy demonstrated non-specific inflammatory changes. A repeat biopsy, prompted by worsening clinical status, revealed extensive infiltration of atypical T-lymphocytes with a high proliferative index and diffuse CD3 positivity, consistent with high-grade peripheral T-cell lymphoma. Rapid hepatic decompensation ensued, and the patient died before receiving oncologic treatment. PHTCL should be considered in patients with unexplained liver dysfunction and cytopenia, even without classic risk factors or imaging abnormalities, to enable timely diagnosis and management.

Background/Aims: The International Autoimmune Hepatitis (AIH) Group recommends the new histological criteria (HC) (2022) and modified immunoserological testing for diagnosing AIH. The diagnostic utility of the 2022 HC was evaluated. The simplified criteria were also updated with the 2022 HC and immunoserological testing and assessed the diagnostic performance. Materials and Methods: The data of 207 patients (111 AIH, 33 primary biliary cholangitis, 35 drug-induced liver injury, and 28 metabolic dysfunction–associated fatty liver disease) were evaluated. Results: The 2022 HC and the 2008 simplified HC showed 95% vs. 88% sensitivity and 82% vs. 49% specificity for possible/compatible AIH. For likely/typical AIH, sensitivity was 60% vs. 42% and specificity was 98% vs. 95% for the 2022 HC and the 2008 HC, respectively. The area under the curve (AUC) was better for the 2022 HC than for the 2008 simplified HC (0.932 vs. 0.771, P < .001). The updated simplified criteria had a sensitivity comparable with the simplified criteria (88% vs. 87%) but a better specificity (94% vs. 80%) for prob able AIH. The sensitivity was slightly lower (57% vs. 63%), but the specificity was greater (97% vs. 89%) for definitive AIH. The AUC was higher in the updated simplified criteria than in the simplified criteria (0.959 vs. 0.894, P = .016). Conclusion: The 2022 HC showed better sensitivity and specificity than the 2008 simplified HC for AIH. The updated simplified criteria worked well with improved accuracy of AIH diagnosis. Our results suggest that the diagnostic algorithm of AIH should be modified based on recent recommendations. Cite this article as: Moral K, Efe C, Sert A, et al. Evaluation of histological criteria and immunoserological testing of simplified criteria for the diagnosis of autoimmune hepatitis. Turk J Gastroenterol. Published online September 18, 2025. doi: 10.5152/ tjg.2025.25402.

We investigated expressions of PD-L1, LAG-3, TIM-3, and OX40L as immune checkpoint proteins, and MSI (repetitive short-DNA-sequences due to defective DNA-repair system) status were analyzed with immunohistochemistry from tissue blocks. Of 83 patients, PD-L1 expression was observed in 18.1% (n = 15) of the patients. None of the patients exhibited LAG-3 expression. TIM-3 expression was 4.9% (n = 4), OX40L was 22.9% (n = 19), and 8.4% (n = 7) of the patients had MSI tumor. A low-to-intermediate positive correlation was observed between PD-L1 and TIM-3 expressions (rho: 0.333, p < 0.01). Although PD-L1 expression was higher in grade 3 NET/NEC, MSI status was prominent in grade 1/2 NET.

Pancreatic metastases account for 2% of pancreatic malignancies and are rare. Metastases to the pancreas originate from many organ systems in the body but occur more frequently from the lung, breast, kidney, and gastrointestinal tract. It may occur years after the treatment of the primary tumor. Symptoms such as abdominal pain, weight loss, and jaundice are present at presentation, but it can also be detected on radiologic imaging without any symptoms. In this article, we present a case of RCC metastasis to the pancreas detected 16 years after renal cell carcinoma (RCC) treatment that was found to be incidental and detected by EUS FNAB.

Strongyloides 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.

Autoimmune hepatitis (AIH) is a rare, immune-mediated liver disease. It has a heterogeneous nature with varied clinical presentations. The management of patients with AIH is challenging in many ways. The main difficulties are inexperience due to the rarity of the disease, diagnostic confusion in controversial areas such as variant/overlap cases, acute presentations, the presence of non-alcoholic fatty liver disease or drug-induced liver injury features, and the long and complex course of treatment. Here, we provide a clear, concise, and visualized review regarding the diagnosis and treatment of AIH, including illustrative cases.

Hepatoportal sclerosis (HPS) is an idiopathic non-cirrhotic portal hypertension (INCPH) characterized by hypersplenism, portal hypertension, and splenomegaly. Hepatocellular carcinoma (HCC) is the most common form of liver cancer. Non-cirrhotic portal hypertension is an extremely rare cause of HCC. A 36-year-old woman was referred to our hospital with esophageal varices. All serologic tests for etiology were negative. Serum ceruloplasmin and serum Ig A-M-G were normal. In the follow-up, two liver lesions were identified on a triple-phase computer. The lesions had arterial enhancement but no washout in the venous phase. In the magnetic resonance imaging examination, differentiation in favor of HCC was considered at one of the lessions. Radiofrequency ablation therapy was first applied to a patient who had no signs of metastasis. Within 2 months, the patient underwent a living donor liver transplant. In explant pathology, well-differentiated HCC and HPS were considered the cause of non-cirrhotic portal hypertension. The patient has been followed without relapse for 3 years. The development of HCC in INCPH patients is still debatable. Despite the presence of liver cell atypia and pleomorphism in nodular regenerative hyperplasia liver specimens, a causal link between HCC and INCPH is yet to be established.

Amaç: Transfüzyon bağımlı talasemi hastalarında aşırı demir yüklenmesi, sürekli şelasyon tedavisi ve demir düzeyi izlemini gerektiren bir durumdur. Serum ferritin düzeyinin tayini, demir yükünü takip etmek için basit bir yöntem olarak kabul edilmektedir. Bununla birlikte, karaciğer demir düzeyi tayininde manyetik rezonans görüntüleme (MRG) gibi yöntemlerin daha kesin olduğunu vurgulamaktadır. Gereç ve Yöntem: Talasemide demir yükünün anlaşılmasına katkıda bulunmak amacıyla, kök hücre transfüzyonuna hazırlık amacıyla karaciğer biyopsisi yapılan 14 transfüzyon bağımlı talasemi hastasının karaciğer demir düzeyi sonuçlarını karaciğer T2 MRG ve serum ferritin sonuçları ile karşılaştırıldı. Bulgular: Serum ferritin değeri ortalaması 2488,43±1520,18 mg/L idi. T2*MRG sonuçlarına göre karaciğer demir yükü değerlendirildiğinde sekiz hastada hafif düzey, beş hastada orta düzey, bir hastada ileri düzey demir birikimi saptandı. Modifiye Scheuer sınıflamasına göre biyopsilerde demir düzeyi iki hastada derece 1; yedi hastada derece 2; üç hastada derece 3 ve iki hastada derece 4 olarak değerlendirildi. Ferritin düzeyi arttıkça karaciğer demir biyopsi skoru da istatistiksel anlamlı olarak artmaktaydı (r=0,544 ve p=0,044). Karaciğer T2 MRG düzeyi ile karaciğer demir biyopsi skoru arasında ise istatistiksel olarak anlamlı ve ters yönlü korelasyon mevcuttu (r=-0,724 ve p=0,003). Karaciğer biyopsi demir skoruna göre demir düzeyini ayırt etmede ferritin düzeyi istatistiksel olarak anlamlı bulunmazken (p=0,096); T2*MRG ölçümlerine ilişkin ROC eğrisi altında kalan alan istatistiksel olarak anlamlı bulundu (AUC=0,967; 95% CI: 0,880-1,000 ve p=0,005). Sonuç: Çalışmamızda serum ferritin ve T2 MRG sonuçlarının karaciğer biyopsisi demir düzeyi ile korele olduğunu saptadık. Ancak ferritin düzeyinin karaciğer biyopsisi demir düzeyini göstermede sensitivite ve spesifitesinin düşük olduğu, T2 MRG ise sensitivite ve spesifitesinin yüksek olduğunu saptadık.

Background: We aimed to evaluate the diagnostic capability of endoscopic ultrasound elastography (EUS-EG) 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 centre 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/42 (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 lessions, 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