Guldal Esendagli

Idiopathic granulomatous mastitis (IGM) is a rare, heterogeneous inflammatory breast disease lacking a universally accepted classification or a standardized management pathway. To provide a comprehensive narrative synthesis of the current literature on IGM and to contextualize the Turkish IGM clinical classification and treatment algorithm in relation to existing global evidence. A narrative literature review was conducted using PubMed, Scopus, Web of Science, and Google Scholar (2000-2025). Clinical, radiological, pathological, and therapeutic studies were examined. Previously published Turkish national consensus studies based on a modified Delphi process were incorporated into the synthesis. IGM remains diagnostically challenging due to its diverse presentations and overlap with malignancy. Existing global classification attempts are inconsistent and lack clinical practicality. The Turkish IGM clinical classification addresses these gaps by integrating lesion size, skin involvement, pregnancy/lactation categories, and extramammary findings. Treatment outcomes demonstrate the high efficacy of topical and intralesional steroids, the selective use of systemic immunosuppression, and the limited indications for surgery. The Turkish IGM classification and its associated treatment algorithm provide a practical, standardized framework that aligns with current evidence and may reduce overtreatment and mismanagement in IGM.

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.

Follicular dendritic cell sarcoma (FDCS) is a rare neoplasm of mesenchymal origin arising from B‐cell follicles, typically presenting as a painless, slow‐growing mass. According to the available literature, this is only the second reported case of FDCS during pregnancy and the first associated with fetal growth restriction and preeclampsia. A 30‐year‐old pregnant woman at 28 weeks of gestation was diagnosed with preeclampsia and fetal growth restriction, during which an incidental abdominal mass was identified on ultrasound. Excisional surgery was performed 27 days after an emergency cesarean delivery, and histopathological analysis confirmed FDCS arising in association with hyaline‐vascular type Castleman disease. This case highlights the importance of multidisciplinary evaluation and awareness of rare abdominal neoplasms during pregnancy.

Idiopathic granulomatous mastitis (IGM) is a benign, chronic inflammatory lesion of the breast. Immunoglobulin G4 (IgG4) associated disease is rare in the breast. In our study, we aimed to evaluate the efficacy of steroid treatment on IgG4 levels in tissue in patients diagnosed with IGM. Between 2008 and 2017, 55 patients diagnosed with IGM in our clinic were included in the study. Demographic, clinical, microbiologic and histopathologic characteristics, treatment modality and recovery time were evaluated retrospectively. Patients were divided into 3 groups according to tissue IgG4 levels: negative (Group I), infrequently and slightly positive (Group II), and highly positive (Group III). Group I patients had a complete response rate of 77.8%. In the rest of the patients (22.2%), insufficient response was detected from the beginning of the treatment. In Group II, the response rate was 91.3% and the permanent success rate after treatment was 87.0%. Although group III patients had a complete response at the beginning (95.65%), they relapsed in a short period of time (26.1%) after discontinuation of steroid treatment. At least one steroid-related side effect was observed in 47 (85.8%) patients in all groups. There is no consensus on the dose and duration of immunosuppressive treatment in IGM. In this study, responses to steroid treatment according to IgG4 concentration in pathologic breast tissue and recurrences after the end of treatment were determined. We think that high IgG4 concentration in the tissue is associated with recurrence and other immunosuppressive drugs should be added as maintenance after steroid treatment.

Background and Aim: The histological diagnosis of autoimmune hepatitis (AIH) is challenging. A new consensus recommendation was provided by the International AIH Pathology Group to address the problems in the histological diagnosis. The purpose of this study is to compare the 2008 ‘simplified’ criteria for AIH with the ‘consensus recommendation’ of 2022 in terms of diagnostic sensitivity. Materials and Methods: A retrospective analysis was conducted on pathological specimens of patients diagnosed with Autoimmune Hepatitis (AIH) between 2010 and 2022. Out of 188 patients enlisted, 88 were selected based on exclusion criteria. The specimens were examined by two experienced hepatopathologists and a resident pathologist. All specimens were analyzed using both the “simplified” criteria and the new consensus recommendations. Results: Out of a total of 78 patients, the 2022 consensus recommendations raised the diagnostic category of 16 patients (20.5%) to a higher level. Six patients who were previously diagnosed as “atypical” were now considered “possible AIH”, while 10 patients with a “compatible” diagnosis were elevated to “likely AIH” category. No patients were found to fall into a lower diagnostic category according to the new recommendations. A significant difference in diagnostic sensitivity was observed between the 2008 criteria and the 2022 consensus report (p

Ganglioneuromas (GN) are rare benign tumors that typically occur in the posterior mediastinum or retroperitoneal region, but can also be found in adrenal glands. Up to 50% of patients are asymptomatic, but symptoms can arise from the mass effect or excessive secretion of catecholamines. Careful evaluation is necessary to differentiate GNs from other adrenal tumors. A 19-year-old female patient with no previous comorbidities was diagnosed with a right adrenal incidentaloma. Physical examination and routine laboratory tests were normal. Imaging revealed a solid lesion in the right adrenal gland, and excisional adrenalectomy was performed. Pathological examination confirmed the diagnosis of a right adrenal GN. The patient had an uneventful recovery and showed no recurrence during the follow-up period. Conclusion: After surgical removal of a benign neurogenic tumor, our patient had no tumor recurrence after five months, indicating a positive prognosis. However, long-term follow-up is still recommended because of reported cases of metastases and recurrence in some patients.

Background:: Benign multicystic peritoneal mesothelioma is a multiloculated cystic mass which originates from the peritoneum. This rare tumor is usually seen in women of childbearing age and has a high recurrence rate after surgery. Case Presentation:: We present two benign multicystic peritoneal mesothelioma cases with different imaging modalities, which were also pathologically proven. Conclusion:: The imaging features which may be diagnostic should be well known as there are very few reports regarding this entity