Canan Kelten Talu

Background/Objectives: Adult granulosa cell tumors (AGCTs) of the ovary are rare sex cord-stromal malignancies characterized by an indolent clinical course and a persistent risk of late recurrence. Although adjuvant chemotherapy is considered for selected patients with higher-risk disease, the optimal platinum-based regimen remains uncertain because comparative evidence is limited. This study compared disease-free survival (DFS), treatment delivery, and toxicity between bleomycin–etoposide–cisplatin/etoposide–cisplatin (BEP/EP) and carboplatin–paclitaxel (CP) in the postoperative adjuvant setting. Methods: This retrospective, multicenter, nonrandomized comparative cohort study included 58 patients with AGCTs who underwent primary surgery and received adjuvant platinum-based chemotherapy at five tertiary oncology centers in Türkiye between 2010 and 2024. Patients received BEP/EP or CP according to institutional practice and physician discretion. The primary endpoint was disease-free survival (DFS), while secondary endpoints included treatment delivery and treatment-related toxicity. Results: A total of 58 patients were included, with 26 receiving BEP/EP and 32 receiving CP. Patients treated with CP were older, whereas fertility-sparing surgery was more common in the BEP/EP group. After a median follow-up of 75.5 months, 14 recurrences were observed; when deaths without prior recurrence were included according to the prespecified DFS definition, a total of 19 DFS events occurred. Median DFS was 77.2 months in the BEP/EP group and 126.2 months in the CP group. The estimated 5-year DFS rates were 75.5% and 83.5%, respectively, with no statistically significant difference between treatment groups (log-rank p = 0.296). In an exploratory multivariable Cox model restricted to age and treatment regimen, increasing age was associated with a higher risk of a DFS event (adjusted HR 1.046 per year, 95% CI 1.011–1.082; p = 0.010), whereas CP versus BEP/EP was not significantly associated with DFS (adjusted HR 0.426, 95% CI 0.167–1.083; p = 0.073). Treatment completion rates were numerically higher with CP (84.4% vs. 69.2%; p = 0.17). Peripheral neuropathy occurred more frequently with CP (p = 0.007), whereas nephrotoxicity occurred only in the BEP/EP group (p = 0.014). Pulmonary toxicity was observed only with bleomycin-containing treatment, and one patient developed secondary acute myeloid leukemia following BEP. Conclusions: No statistically significant difference in DFS was detected between BEP/EP and CP, while distinct toxicity patterns were observed. Given the retrospective design, limited sample size, and potential for treatment-selection bias and residual confounding, these findings should be considered exploratory and should not be interpreted as evidence of equivalent efficacy between the regimens.

Aim Routine ultrasound scanning for fetal anomaly detection has enabled increased recognition of adnexal masses during pregnancy in recent years. In addition to incidental detection during routine antenatal follow-up, adnexal masses may also be identified in pregnant women presenting with an acute abdomen. In this study, we aimed to evaluate the clinicopathological features of lesions detected in pregnant women presenting with acute abdomen and in those with incidentally detected adnexal masses during routine antenatal clinical and radiological examinations. Methods Pregnant women evaluated between 2013 and 2020 who presented with acute abdomen or had incidentally detected adnexal masses during routine clinical and radiological examinations were retrospectively identified from the clinical databases of the Departments of General Surgery and Obstetrics and Gynecology. Patients with ectopic pregnancy were excluded. Results We included 44 pregnant women with a median age of 28.5 years (range, 18–42 years). Ten patients presented during the first trimester, 24 during the second trimester, and 10 during the third trimester. Most patients did not require surgery. Among surgically treated patients, benign lesions predominated, with mature cystic teratoma being the most common benign neoplasm. Conclusion The types of adnexal lesions detected during pregnancy (non-neoplastic and neoplastic; benign, borderline, or malignant), their frequencies, and the gestational trimester at diagnosis were consistent with the published literature. Functional ovarian cysts were the leading cause of adnexal masses during the first trimester, whereas neoplastic lesions were more frequently encountered during the second and third trimesters. Mature cystic teratoma was the most common benign neoplasm. Borderline and malignant lesions were uncommon. Treatment-related conditions and uterine anatomical anomalies should also be considered in the differential diagnosis because they may mimic adnexal masses during pregnancy.

Aim: To investigate the predictive value of pretreatment breast magnetic resonance imaging (MRI) findings, clinicopathological characteristics, and molecular tumor features for pathological response to neoadjuvant chemotherapy (NACT).Method: This retrospective study included 194 patients with invasive breast cancer who underwent pretreatment breast MRI, received NACT, and subsequently underwent surgery between 2015 and 2020. Pathological response was assessed using the Miller–Payne grading system and categorized as complete/near-complete response (grades 4–5), partial response (grade 3), or limited response (grades 1–2). Quantitative and morphological MRI parameters, together with clinicopathological and molecular characteristics, were analyzed. Independent predictors of pathological response were identified using multinomial logistic regression analysis.Results: According to the Miller–Payne classification, 80 patients (41.2%) achieved complete/near-complete response, 98 (50.5%) partial response, and 16 (8.2%) limited response. Histologic subtype, tumor grade, HER2 status, Ki-67 index, molecular subtype, ADC, BPE, tumor margins, enhancement pattern, and MSI were significantly associated with pathological response. In multivariable analysis, non-ductal histology and minimal BPE independently predicted limited versus complete/near-complete response, whereas non-luminal molecular subtype, minimal BPE, and MSI ≥429 independently predicted limited versus partial response. Lower ADC independently distinguished partial from complete/near-complete response. However, substantial overlap in biological and imaging features remained across response groups.Conclusion: Pretreatment MRI biomarkers may provide complementary information for predicting NACT response when interpreted with clinicopathologic and molecular features. Lower ADC was not an independent predictor of limited response. The occurrence of similar biological and imaging features in both highly responsive and limited-response tumors highlights substantial treatment-response heterogeneity and supports an integrated multiparametric assessment rather than reliance on any single biomarker.

Background and Objective: The clinical success of novel antibody-drug conjugates has led to the identification of a new subgroup within traditionally HER2-negative breast cancers, termed ‘HER2-low.’ The aim of this study was to investigate the clinicopathological differences between HER2-low and HER2-negative groups in neoadjuvant-naive primary breast cancer patients, with a specific focus on stromal tumor-infiltrating lymphocyte (sTIL) density. Materials and Methods: The study included 731 neoadjuvant-naive invasive breast cancer patients. Tumors were classified as HER2-negative (IHC 0) and HER2-low (IHC 1+ or 2+/ISH-negative). sTIL levels were evaluated following the International TILs Working Group guidelines. Results: The HER2-low group (38.7%) demonstrated significantly higher histological grade (p = 0.033) and higher sTIL density (p = 0.006) compared to the HER2-negative group. A stepwise increase in sTIL rates was observed parallel to the HER2 immunohistochemical score (0 → 1+ → 2+) (p = 0.015). The HER2-low/hormone receptor (HR)-negative subgroup exhibited the highest sTIL density (median 35%). No statistically significant difference in overall or disease-free survival was found between the groups. Conclusions: HER2-low breast cancers were associated with a more immunogenic tumor microenvironment compared to HER2-negative tumors. This robust immune infiltration may offset the higher histological grade observed in the HER2-low cohort, potentially explaining the comparable survival outcomes. These findings provide a biological rationale for exploring the synergy between novel antibody–drug conjugates and immune checkpoint inhibitors, particularly in the highly immunogenic HER2-low/HR-negative subgroup.

Background and Objectives: Differentiating between subtypes of renal cell carcinoma (RCC) can be challenging due to overlapping immunohistochemical and histomorphological features. Furthermore, despite the evaluation of numerous histopathologic parameters, predicting metastasis and prognosis remains unclear. In this study, we aimed to evaluate the potential of microRNA (miRNA) expression levels in establishing definitive diagnoses, assessing metastatic potential, and determining patient prognosis. Materials and Methods: A total of 35 clear cell RCC (cc-RCC), 11 chromophobe RCC (ch-RCC), 9 papillary RCC (p-RCC) cases, and 9 cc-RCC metastases were retrospectively analyzed. MiRNA-21 and miRNA-210 expression profiles were assessed using non-parametric tests, receiver operating characteristic (ROC) analysis, and Cox regression models. Results: The expression levels of both miRNA-21 and miRNA-210 were significantly elevated in cc-RCC and p-RCC cases. In contrast, miRNA-210 expression levels were significantly reduced in all ch-RCC cases, whereas miRNA-21 expression showed no significant change. Although miRNA-21 expression levels were higher in metastases compared to primary cc-RCC tumors, the difference was not statistically significant (p=0.053). No significant difference was observed in miRNA-210 expression between metastatic and primary cc-RCC tumors (p=0.237). Regardless of histological subtype, an increase in miRNA-210 expression was associated with a significant reduction in overall survival (p=0.03, HR=1.729, 95% CI: 1.043-2.864). Conclusion: The findings suggest that miRNA-21 and miRNA-210 expression levels can help distinguish ch-RCC from cc-RCC and p-RCC. Additionally, miRNA-210, but not miRNA-21, may differentiate cc-RCC from p-RCC. Higher miRNA-210 expression levels were associated with worse overall survival in RCC patients. While miRNA-21 levels were increased in cc-RCC metastases, further studies with larger sample sizes are needed to establish its role in predicting metastasis.

Cervical embryonal rhabdomyosarcoma is a rare mesenchymal solid tumor that accounts for less than 1% of all cervical neoplasms in the female genital system. There is no standardized protocol for the treatment of cervical embryonal rhabdomyosarcoma, and the literature primarily consists of case reports and series. Treatment options described in the literature range from conservative, fertility-preserving approaches to radical surgery in combination with chemotherapy and radiotherapy. A combined approach involving surgery, chemotherapy, and radiotherapy is believed to yield better outcomes for the disease. In this article, we present a case of cervical embryonal rhabdomyosarcoma in a 45-year-old female patient presenting with a polypoid cervical mass. Histopathological and immunohistochemical examination confirmed that the localized mass in the cervix was of cervical origin and consistent with embryonal rhabdomyosarcoma. Following total abdominal hysterectomy, the patient was administered a combination treatment of adjuvant chemoradiotherapy, and she has remained disease-free for a period of 23 months.

(1) Background and Objectives: Endometriosis is defined as the presence of endometrial glands and stroma outside the uterine cavity. It affects 5–15% of women of reproductive age. Ovarian cancer develops in approximately 1% of patients with endometriosis. Prediction of those with endometriosis who will develop ovarian cancer is among the current research topics. (2) Materials and Methods: With this study, we aimed to reveal the role of miRNA 200b and miRNA 21 in endometriosis-associated ovarian carcinoma (EAOC). Thirteen patients diagnosed as having EAOC between 2015 and 2023 were included, with their endometriosis and eutopic endometrium tissues (Group 3: 13 patients, 39 tissue samples). Two separate groups were then detected to compare with these cases: Group 2 composed of tuba-ovarian endometriosis with its eutopic endometrium (10 patients, 20 tissue samples) and Group 1 composed of eutopic endometrium only (10 patients, 10 tissue samples). The foci marked on H&E sections were determined from the area on the relevant paraffin blocks and small tissue samples were taken in tubes to be studied with real-time PCR. (3) Results: No significant difference was detected for miRNA 21 and miRNA 200b expression levels among eutopic endometrium, endometriosis, and cancer foci in Group 3. However, miRNA 21 and miRNA 200b expression levels in the eutopic endometrial tissue of cases with ovarian cancer were significantly higher than in the eutopic endometrial tissues of cases with (Group 2) and without endometriosis (Group 1). (4) Conclusions: This study suggests that increased miRNA 200b and miRNA 21 expression levels detected in eutopic endometrial tissue of patients with endometriosis may contribute to identifying cases that may develop EAOC.

Background and Objectives: A recent clinical trial has demonstrated that breast cancer with low-HER2 expression levels responds to trastuzumab deruxtecan treatment. This has prompted a re-evaluation of HER2-targeted therapies in the HER2-negative group. Further research is required in the form of more detailed information about HER2-negative breast cancers with HER2-null, HER2-ultralow, and HER2-low subgroups. This study represents a novel approach to this field. Materials and Methods: HER2-negative breast cancer patients were classified into three groups as HER2-null, HER2-ultralow, and HER2-low. A comparison of clinicopathological features was analyzed retrospectively. Results: Of 722 patients, 22.3% were HER2-null, 23.7% were HER2-ultralow, 54.0% were HER2-low. While two-thirds of all the patients were evaluated as having T2 tumors, T4 tumors constituted 2.4%. Among HER2-negative cases, 11.8% were triple-negative and 88.2% were hormone-positive. The mean tumor diameter was 0.57 cm larger in the HER2-ultralow group than in the HER2-null group and 0.34 cm larger in the HER2-low group than in the HER2-null group. HER2-null tumors tend to be smaller. The HER2-low group was more likely to relapse than the HER2-null group. There were no significant differences in the distribution of hormone positivity or negativity (TNBC) among the groups; they accounted for 89.2% and 10.8% of all cases, respectively. Conclusions: HER2-negative breast cancer is a heterogeneous disease and deserves a detailed review in terms of diagnosis and treatment. HER2-ultralow tumors are larger in size and have a prognosis comparable to HER2-null tumors. HER2-low tumors tend to recur much more frequently and with poorer outcomes. In this field, new therapeutic approaches may result in better outcomes.

Background and Objectives: Axillary lymph node metastasis and the number of metastatic lymph nodes are important prognostic factors which are directly related to overall survival in women with breast cancer. Several factors have been identified to predict the likelihood of axillary lymph node metastasis in early-stage breast cancer. High PR expression is often more prevalent in the luminal A subgroup, which is associated with a better prognosis. The aim of this study was to determine the relationship between the percentage of PR expression and the likelihood of axillary metastasis in Her-2-negative, clinical T1-T2N0 luminal type breast cancer. Materials and Methods: A hundred and ninety-nine cases with luminal type, Her-2-negative, clinically and radiologically axilla-negative T1-T2 breast cancer who received radiotherapy were evaluated retrospectively. The pathological specimens were assessed by an experienced pathologist. Results: The statistical evaluation showed that tumor diameter greater than 2 cm, (p = 0.003), presence of lymphovascular invasion (p = 0.001), and PR expression level below 80% (p = 0.037) were identified as significant predictors of lymph node positivity in breast cancer patients. Conclusions: Percentage of progesterone receptor expression along with other molecular biological markers and clinicopathological parameters should be evaluated altogether when predicting axillary metastasis risk before surgery.