Person: BOZKURTLAR, EMİNE
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BOZKURTLAR
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EMİNE
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Publication Open Access Outcome of solid and cavitary pulmonary nodules in rheumatoid arthritis patients— case series(2022-01-01) AKSOY, AYSUN; BOZKURTLAR, EMİNE; KARAKURT, SAİT; ERYÜKSEL, SEMİHA EMEL; İNANÇ, GÜZİDE NEVSUN; KOCAKAYA, DERYA; AKSOY A., KOCAKAYA D., Yalçinkaya Y., BOZKURTLAR E., KARAKURT S., Eryüksel E., İnanç N.© TÜBİTAK.Background/aim: Rheumatoid pulmonary nodule can be detected in up to 32% of rheumatoid arthritis (RA) patients and approximately one-third of nodules may cavitate. We aimed to evaluate characteristics of patients with RA developing cavitary pulmonary nodular (CPN) lesions under disease-modifying antirheumatic drugs (DMARDs), follow-up of both cavitary and solid nodules, and their outcome with the treatment. Materials and methods: RA patients who presented with CPN lesions during follow-up were recruited retrospectively in this case series analysis. Total numbers and mean diameters of cavitary and solid nodules in each thorax computed tomography (CT) have been determined and followed up by two experienced pulmonary physicians. Moreover, changes in treatment after the development of the CPN lesions and characteristics of cavitary nodules were collected. Results: Eleven patients with CPN lesions were reported. At the time of CPN diagnosis, more patients were taking leflunomide than methotrexate (81% vs 19%). Half of the patients were receiving biologic therapy and only 18% were taking anti-TNF drugs. After a median of 24 (3–65) months of follow-up, the regression of CPN lesions was determined in 45% (5/11) of patients. Four of these 5 (80%) patients were switched to a treatment regimen without leflunomide and three of them to nonanti-TNF biologic treatment or targeted synthetic DMARDs (tocilizumab, tofacitinib, and rituximab). Conclusion: CPN lesions seen in RA patients are often pulmonary manifestations of the underlying disease; however, one must rule out malignancies or infections. If lesions progress under DMARDs, it is advised to discontinue synthetic DMARDs (LEF/MTX) and switch to another biological DMARD with different modes of action.Publication Open Access Optimal waiting period to surgical treatment after neoadjuvant chemoradiotherapy for locally advanced rectum cancer: A retrospective observational study(2023-12-01) ATICI, ALİ EMRE; BOZKURTLAR, EMİNE; YEGEN, ŞEVKET CUMHUR; Aslanov K., ATICI A. E., Karaman D., BOZKURTLAR E., YEGEN Ş. C.Background: The optimal waiting period after neoadjuvant treatment in patients with locally advanced rectal cancers is still controversial. The literature has different results regarding the effect of waiting periods on clinical and oncological outcomes. We aimed to investigate the effects of these different waiting periods on clinical, pathological, and oncological outcomes. Methods: Between January 2014 and December 2018, a total of 139 consecutive patients with locally advanced rectal adenocarcinoma, who were treated in the Department of General Surgery at the Marmara University Pendik Training and Research Hospital, were enrolled in the study. The patients were split into three groups according to waiting time for surgery after neoadjuvant treatment: group 1 (n = 51) included patients that have 7 weeks and less (≤ 7 weeks) time interval, group 2 (n = 45) 8 to 10 weeks (8–10 weeks), group 3 (n = 43) 11 weeks and above (11 weeks ≤). Their database records, which were entered prospectively, were analyzed retrospectively. Results: There were 83 (59.7%) males and 56 (40.3%) females. The median age was 60 years, and there was no statistical difference between the groups regarding age, gender, BMI, ASA score, ECOG performance score, tumor location, and preoperative CEA values. Also, we found no significant differences regarding operation times, intraoperative bleeding, length of hospital stay, and postoperative complications. According to the Clavien–Dindo (CD) classification, severe early postoperative complications (CD 3 and above) were observed in 9 patients. The complete pathological response (pCR, ypT0N0) was observed in 21 (15.1%) patients. The groups had no significant difference regarding 3-year disease-free and 3-year overall survival (p = 0.3, p = 0.8, respectively). Local recurrence was observed in 12 of 139 (8.6%) patients and distant metastases occurred in 30 of 139 (21.5%) patients during the follow-up period. There was no significant difference between the groups in terms of both local recurrence and distant metastasis (p = 0.98, p = 0.43, respectively). Conclusion: The optimal time for postoperative complications and sphincter-preserving surgery in patients with locally advanced rectal cancer is 8–10 weeks. The different waiting periods do not affect disease-free and overall survival. While long-term waiting time does not make a difference in pathological complete response rates, it negatively affects the TME quality rate.Publication Metadata only The Importance of Lymph Node Drainage Areas of Ampullary Carcinomas(2022-03-01) BOZKURTLAR, EMİNE; BAĞCI ÇULÇİ, PELİN; Akar K., BOZKURTLAR E., BAĞCI ÇULÇİ P., Balci S.Publication Open Access Unilocular and multilocular thymic cysts: A study on the possible histomorphological and/or clinical differences(2022-01-01) BOZKURTLAR, EMİNE; BOZKURTLAR E.Objective: Thymic cysts are rare mediastinal cystic pathologies and have two subtypes namely unilocular and multilocular. This study aims to investigate the clinicopathological characteristics of thymic cysts and to compare the clinical and histopathologic features of multilocular thymic cysts (MTCs) and unilocular thymic cysts (UTCs).Publication Metadata only Centrally-necrotic/hyalinizing demarcated (CND) carcinomas of the pancreas: A clinico-pathologically distinct group with divergent metaplastic patterns and high-grade characteristics(2022-03-01) BAĞCI ÇULÇİ, PELİN; BOZKURTLAR, EMİNE; Cengiz D., Saka B., BAĞCI ÇULÇİ P., Altinmakas E., Bozkurt E., Armutlu A., PEHLİVANOĞLU B., BOZKURTLAR E., Reid M., Mericoz M. A., et al.Publication Open Access Problems in the reproducibility of classification of small lung adenocarcinoma: an international interobserver study(2019-11-01) BOZKURTLAR, EMİNE; Shih A. R., Uruga H., BOZKURTLAR E., Chung J., Hariri L. P., Minami Y., Wang H., Yoshizawa A., Muzikansky A., Moreira A. L., et al.Aims The 2015 WHO classification for lung adenocarcinoma (ACA) provides criteria for adenocarcinoma in situ (AIS), minimally invasive adenocarcinoma (MIA) and invasive adenocarcinoma (INV), but differentiating these entities can be difficult. As our understanding of prognostic significance increases, inconsistent classification is problematic. This study assesses agreement within an international panel of lung pathologists and identifies factors contributing to inconsistent classification. Methods and results Sixty slides of small lung ACAs were reviewed digitally by six lung pathologists in three rounds, with consensus conferences and examination of elastic stains in round 3. The panel independently reviewed each case to assess final diagnosis, invasive component size and predominant pattern. The kappa value for AIS and MIA versus INV decreased from 0.44 (round 1) to 0.30 and 0.34 (rounds 2 and 3). Interobserver agreement for invasion (AIS versus other) decreased from 0.34 (round 1) to 0.29 and 0.29 (rounds 2 and 3). The range of the measured invasive component in a single case was up to 19.2 mm among observers. Agreement was excellent in tumours with high-grade cytology and fair with low-grade cytology. Conclusions Interobserver agreement in small lung ACAs was fair to moderate, and improved minimally with elastic stains. Poor agreement is primarily attributable to subjectivity in pattern recognition, but high-grade cytology increases agreement. More reliable methods to differentiate histological patterns may be necessary, including refinement of the definitions as well as recognition of other features (such as high-grade cytology) as a formal part of routine assessment.Publication Metadata only Pulmoner arter sarkomanın cerrahi sonuçları: Histoloji sağkalımı etkiler mi(2023-08-01) BOZKURTLAR, EMİNE; OLGUN YILDIZELİ, ŞEHNAZ; MUTLU, BÜLENT; KOCAKAYA, DERYA; BEKİROĞLU, GÜLNAZ NURAL; YILDIZELİ, BEDRETTİN; Başar V., Olgun Yıldızeli Ş., Bozkurtlar E., Ercelep ., Mutlu B., Kocakaya D., Bekiroğlu G. N., Taş S., Sunar H., Küçükoğlu M. S., et al.Publication Open Access Severe allergic dysregulation due to a gain of function mutation in the transcription factor STAT6(2023-01-01) BARIŞ, SAFA; YÜCELTEN, AYŞE DENİZ; BOZKURTLAR, EMİNE; CİNEL, ZELİHA LEYLA; AYDINER, ELİF; ÖZEN, AHMET OĞUZHAN; BARIŞ S., Benamar M., Chen Q., Catak M. C., Martínez-Blanco M., Wang M., Fong J., Massaad M. J., Sefer A. P., Kara A., et al.Background: Inborn errors of immunity have been implicated in causing immune dysregulation, including allergic diseases. STAT6 is a key regulator of allergic responses. Objectives: This study sought to characterize a novel gain-of-function STAT6 mutation identified in a child with severe allergic manifestations. Methods: Whole-exome and targeted gene sequencing, lymphocyte characterization, and molecular and functional analyses of mutated STAT6 were performed. Results: This study reports a child with a missense mutation in the DNA binding domain of STAT6 (c.1114G>A, p.E372K) who presented with severe atopic dermatitis, eosinophilia, and elevated IgE. Naive lymphocytes from the affected patient displayed increased TH2- and suppressed TH1- and TH17-cell responses. The mutation augmented both basal and cytokine-induced STAT6 phosphorylation without affecting dephosphorylation kinetics. Treatment with the Janus kinase 1/2 inhibitor ruxolitinib reversed STAT6 hyperresponsiveness to IL-4, normalized TH1 and TH17 cells, suppressed the eosinophilia, and improved the patient\"s atopic dermatitis. Conclusions: This study identified a novel inborn error of immunity due to a STAT6 gain-of-function mutation that gave rise to severe allergic dysregulation. Janus kinase inhibitor therapy could represent an effective targeted treatment for this disorder.Publication Open Access FDG PET/CT features of polysaccharide-based hemostatic agent chronic inflammatory changes can mimic metastatic lesions(2022-07-01) KOCAKAYA, DERYA; ASLAN, SEZER; BOZKURTLAR, EMİNE; Bozkurtlar E., Oksuzoglu K., Bostanci K., Aslan S., Kissa T. N., Kocakaya D., Ones T.Purpose To prevent hemorrhagic complications, hemostatic agents (HAs) have been widely used in recent years. The use of HAs can lead to false-positive results on postoperative imaging. There exists only 1 study in the literature evaluating these applications during surgical procedures. Therefore, we aimed to evaluate the postoperative imaging features of polysaccharide-based HAs in thoracic surgery patients who have had F-18-FDG PET/CT scans. Patients and Methods Two hundred nine consecutive patients who underwent thoracic surgery were enrolled in this study. A topical polysaccharide-based HA was applied to the surgical bed for all of the patients. The patients diagnosed with cancer were followed up with subsequent thoracic CT scans, and 42 of these patients were also imaged with F-18-FDG PET/CT, which then comprised the main study group. Due to suspicion of metastasis, 19/42 patients were reoperated or rebiopsied. The latest histopathological findings were accepted as criterion standard, and previous FDG PET/CT images were retrospectively reevaluated. Results Polysaccharide-based HAs that appear as amorphous basophilic material were identified in histopathological samples of 11/19 patients. Lymphocytes, plasma cells, and histiocytes, which formed foreign body reaction and/or foreign body granuloma, indicating the presence of chronic inflammation, were seen in all of the samples. F-18-FDG PET/CT showed increased FDG uptake in all of these lesions. Conclusions Despite the inconsistency of the literature, polysaccharide-based HAs can be demonstrated in human surgical specimens as amorphous basophilic materials even after a long time from the initial surgical procedure. These agents almost always cause chronic inflammatory changes. In addition, these agents may mimic \"false-positive\" findings on postoperative FDG PET/CT scans.Publication Open Access Pulmonary artery sarcoma treated with pulmonary endarterectomy and leaflet reconstruction using Ozaki technique(2022-11-01) AK, KORAY; ÖZTÜRK, FATİH; BOZKURTLAR, EMİNE; ARSAN, SİNAN; YILDIZELİ, BEDRETTİN; Arslanhan G., AK K., Ozturk F., Turker A., BOZKURTLAR E., ARSAN S., YILDIZELİ B.Pulmonary arterial intimal sarcomas (PAIS) are rare malignancies with a poor prognosis. Sarcomas present with signs and symptoms mimicking pulmonary thromboembolic disease, delaying the diagnosis. We present a 29-year-old male patient diagnosed with PAIS in the right and main pulmonary arteries extending to the left pulmonary leaflet. The patient was treated with pulmonary endarterectomy and pulmonary leaflet reconstruction using the Ozaki technique.