Person: GÜLER, BERIL
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Publication Metadata only SPLENİK LEZYONLARIN TANISINDA KOR BİYOPSİNİN ROLÜ; EKSTRAMEDÜLLER HEMATOPOEZ OLGU SUNUMU(2022-10-28) Nazar M. H.; Güler B.; NAZAR, MUHAMMET HİKMET; GÜLER, BERILÖZETGiriş: Çoğunluğu rezeksiyon olan splenik biyopsilerpatoloji rutininde seyrek karşılaşılan spesmenlerdir. Splenektomisebepleri çoğunlukla travma, daha sonra lenfoid/myeloid neoplaziler, vasküler ve kistik lezyonlar olarak sayılabilir.Ekstramedüller hematopoez ve hemolitik anemi gibinon-neoplastik hematolojik antiteler de splenik biyopsilerdekitanı çeşitliliğini arttırmaktadır. Kor biyopsi örnekleme yöntemi,splenik lezyonlara yaklaşımda majör komplikasyonlar veteknik zorluklar sebebiyle girişimsel radyologlar tarafındangenellikle tercih edilmemektedir.Olgu: Bilinen serebrovasküler atak ve asetilsalisilik asit kullanımöyküsü bulunan, halsizlik şikayetiyle hastanemizebaşvuran 71 yaşındaki erkek hastanın tetkiklerinde anemi(Hb:10,52 g/dL) ve LDH (592 U/L) yüksekliği saptanmıştır.Üst batın tomografisinde, dalak anterior posterior çapı 153mm ölçülmüş olup artmış, parankim dansitesi doğal görülmüştür.Pozitron emisyon tomografisinde (PET-CT), splenikFDG tutulumu karaciğer parankimine denk düzeydedir (SUVmax:3.8). Tariflenen bu nonspesifik bulgu düşük metabolikaktiviteli lenfoproliferatif neoplaziler yönünden şüpheli bulunmuştur.Radyolojik olarak görüntüleme eşliğinde 18Gtru-cut iğne ile kor biyopsi örneği alınmıştır. Hematoksilen-Eozinkesitlerde, splenik doğal çatının net seçilemediği ödemlidokuda difüz, polimorfik hücresel infiltrasyon izlenmiştir. Popülasyonunbüyük kısmını küçük boyutlu lenfoid hücreleroluşturmaktadır. Arada kümeleşme gösteren nötrofil ve eozinofilinfiltrasyonu mevcuttur. İmmünohistokimyasal CD61ile pozitif, bir kısmı hiperkromatik, hiperlobe nükleuslu, getoplazmalıizlennişsitoplazmalı, dismorfik özellikler gösteren megakaryositformları dikkati çekmiştir. E-cadherin ile eritroid öncü hücregrupları da tespit edilen olguya ekstramedüller hematopoeztanısı verilmiştir. İşlem sonrası komplikasyon gelişmeyen hastahalen takipte olup, klinik açıdan stabildir.Sonuç: Özgün vasküler yapılanmaya sahip dalak dokusundayüksek kanama riski sebebiyle kor biyopsi örnekleme yöntemirutin olarak tercih edilmemektedir. Ancak seyrek de olsasplenektomi için yüksek komorbidite taşıyan hastalarda dahaaz invaziv olan bu yönteme şans verilmektedir. Histopatolojikdeğerlendirmesi patologlar için zorlayıcı olabilen bu örneklerde,ayırıcı tanıda ekstramedüller hematopoezin de akıldabulundurulmasının gerektiğini düşünmekteyiz.Anahtar Kelimeler: Dalak, Ekstramedüller hematopoez, KorbiyopsiPublication Metadata only EVALUATION OF HISTOPATHOLOGIC CHARACTERISTICS AND CLINICAL SIGNIFICANCE OF INCIDENTAL / ISOLATED IN SITU FOLLICULAR NEOPLASIA(2020-11-15T00:00:00Z) Güler, Beril; GÜLER, BERILABSTRACT Introduction: Diagnosis of in situ follicular neoplasia (ISFN) limited in the physiological compartment of germinal centers is difficult, histopathologically. However, it is accepted as the early phase of lymphogenesis and/or premalignant according to recent clinical and molecular studies. INTERNATIONAL GEVHER NESİBE HEALTH SCIENCES CONFERENCE-VI/ November 13-15, 2020 Ankara/ Proceedings Book -289- Objective: It was aimed to discuss the histopathological features of ISFN. We targeted to investigate which criteria should be considered in case selection for immunohistochemical studies. In addition, the importance of diagnosis in the clinical process was tried to be interpreted. Material-Method: Between 2014-2019, hematoxylin-eosin sections and CD10, Bcl2, ki67 stained immunohistochemistry slides of seven lymph node excisions diagnosed with ISFN were re-evaluated, retrospectively. Clinical informations were obtained from the hospital information system. Results: Four of the cases were female and three were male. The average age is 49.17. The average of the largest diameters of lymph nodes was 2.07 cm. Four of the cases presented with the complaint of cervical/axillary swelling. Lymph nodes were detected incidentally in three cases. The architecture was preserved in all lymph node sections. Atypical follicles were randomly scattered and had strong expression by CD10 and Bcl2. No polarization was seen in ki67 staining. Germinal centers were of normal size, cytology was monotonous. Tingible body macrophages were absent or decreased. The number of neoplastic cells in atypical follicles was variable. Similar histopathological features were observed in the re-biopsy (in 2019) of the case in which ISFN and hyaline vascular Castleman-like changes were detected in 2014. Lymphoma development was not detected in any of the cases. Conclusion: In situ follicular neoplasia cases, in which it is difficult to determine the true incidence due to its subclinical nature, can be diagnosed infrequently. Histopathological diagnosis, in which the use of immunohistochemistry is essential, is a concern for pathologists. The fact that there was no progression to lymphoma in our case group is partially soothing. Keywords: Lymphoma, Follicular; Neoplasia; CD10; Bcl2; Ki67Publication Metadata only Core Needle Biopsy in the Diagnosis of Thyroid Nodules(2022-11-01) Aysan E.; GÜLER B.; KIRAN T.; Idiz U. O.; GÜLER, BERIL; KIRAN, TUĞÇEBackground Core needle biopsy (CNB) is a relatively new technique for the diagnosis of thyroid nodules, and there are currently no large clinical series available. CNB results from 3000 cases are presented in this article. Methods A spring-loaded 20-gauge needle was used for CNB under local anesthesia and ultrasonography guidance for 3000 patients with nodular goiter (584 males, 2416 females, mean age: 48.5). One physician performed all biopsy procedures without conducting on-site pathological examinations. Results There were non-diagnostic 22 (.7%), benign 2620 (87.4%), atypia of undetermined significance and/or, follicular lesion of undetermined significance 90 (3%), follicular neoplasms and/or suspicious for follicular neoplasm 53 (1.7%), suspicious for malignancy 160 (5.4%), and malignant 55 (1.8%) cases. The CNB procedure was repeated in 19 non-diagnostic cases, and 17 of these patients were benign and two had malignancy. Thyroidectomy was performed on patients who had malign CNB results. All final pathology reports, except for one, were malignant for the patients who had malignant CNB results. The specificity and the sensitivity of CNB were found to be 99.9% and 100%, respectively. There were no serious complications. Conclusion In thyroid nodules, core needle biopsy is a highly sensitive, specific, and reliable method that could be performed by a single physician. It does not require on-site pathological analysis and has a low incidence of complications and non-diagnostic rates.Publication Metadata only Can PET-CT replace bone marrow biopsy for lymphoma staging? Retrospective analysis of 198 Hodgkin and non-Hodgkin lymphoma cases(2021-06-01T00:00:00Z) Güler, Beril; Adilli, Adila; Uysal, Ömer; GÜLER, BERIL; ERDOĞAN, EZGİ BAŞAK; UYSAL, ÖMERAim: Lymphoma staging is important from the prognostic and therapeutic point of view and bone marrow biopsy performed for this purpose makes up a large part of current hematopathology practice. PET-CT is the currently preferred method to evaluate bone marrow involvement by lymphoproliferative disorders as it is non-invasive and practical. The aim of this study was to compare trephine biopsy and PET-CT results as regards determining bone marrow involvement in various lymphoma subtypes. Materials and Methods: A total number of 198 bone marrow biopsies and 185 PET-CT images of cases consisting of various lymphoma subtypes were included in the study. The results of both methods evaluated for bone marrow infiltration were grouped as positive, negative, and suspicious to compare consistency. Statistical agreement was calculated with the kappa coefficient. The sensitivity, specificity, and the positive and negative predictive values were calculated as the diagnostic test measures. Results: Twenty-six cases (15.8%) had lymphoma involvement in trephine biopsies and 36 cases (21.2%) had positive findings for lymphoma involvement of the bone marrow on PET-CT. The two methods had weak statistical agreement (κ= 0.21). Biopsy and PETCT results were similar in 132 cases (71.20%). PET-CT showed false negative results in 11 cases in which infiltration was observed with biopsy. Twenty-six cases that were negative for lymphoma involvement on biopsy were accepted as positive on PET-CT and 16 of these cases were classical Hodgkin-s lymphoma. One case with suspicious bone marrow biopsy was positive on PET-CT, while four cases with suspicious PET-CT results were positive on biopsy. Conclusion: The results showed that both of the methods have advantages and disadvantages as regards lymphoma staging. However, histopathology is globally accepted as the gold standard for a definite diagnosis. We believe that the complementary use of the two methods is more beneficial for correct guidance during clinical practice.Publication Metadata only Gastrointestinal Sistemin Primer ve Sekonder Hematolenfoid Neoplazileri: Tek Merkez Deneyimi(2022-07-01) Güler B.; GÜLER, BERILGiriş: Gastrointestinal sistem, hematolenfoid neoplazilerin en sık görüldüğü ekstranodal bölgedir. Bununla birlikte inflamatuar lezyonlar ve epiteliyal neoplazilere kıyasla oldukça nadir gözlenen bu grup neoplazilerde tanı zorlukları yaşanabilmektedir. Bu çalışmada gastrointestinal sistemin sık görülen hematolenfoid neoplazilerinin klinikopatolojik özelliklerini sunmayı, nadir görülen antitelere ise dikkat çekmeyi amaçladık. Gereç ve yöntemler: Patoloji arşivimizden, 2014-2021 yılları arasında, gastrointestinal sistem infiltrasyonu ile hematolenfoid neoplazi tanısı alan 46 hasta retrospektif olarak tespit edilmiştir. Patoloji raporları yanı sıra demografik ve klinik verilere, endoskopi ve görüntüleme bulgularına hastane bilgi sisteminden ulaşılmıştır. Bulgular: Otuzaltı hastada primer odak gastrointestinal sistemdi. Dokuz hastada, gastrointestinal infiltrasyon sistemik hastalığın sekonder yayılımı olarak kabul edildi. Hastalardan birinde, mevcut verilerle primer veya sekonder hastalık ayrımı yapılamadı. Ortalama yaş 56 idi. Olguların yaklaşık dörtteüçü (%73,9) endoskopik biyopsi ile tanı aldı. Hastaların sıklıkla başvuru sebebi nonspesifik gastrointestinal semptomlardı (%73,9). Barsak yerleşimli orgularda ise ileus tablosu ile karşılaşıldı. En sık tanı diffüz büyük B hücreli lenfoma (n:26), ardından MALT lenfomaydı (n:6). Duodenal tip foliküler lenfoma tanısı alan dört hastamız mevcuttu. Nadir vakalarımız; IRF4 ile ilişkili büyük B hücreli lenfoma (n:1), EBV pozitif büyük B hücreli lenfoma (n:1), ekstrakaviter/solid varyant primer efüzyon lenfoma (n:1), myeloid sarkomdu (n:1)., Tartışma: Difüz büyük B hücreli lenfoma hasta sayısının MALT lenfomanın dört katından fazla olması beklenmeyen bir farktır. Özellikle nadir görülen yüksek dereceli lenfomalar ve myeloid neoplazilerin, az diferansiye karsinomlarla karıştırılabilme olasılığı önemli bir handikaptır. Duodenal lenfoid foliküller dikkatlice değerlendirilmeli ve immünhistokimyasal değerlendirme yapılmalıdır. Anahtar kelimeler: Gastrointestinal Neoplaziler, Lenfoma, Hematolojik NeoplazilerPublication Metadata only HHV8(+) EBV(+) Extracavitary/solid variant of primary effusion lymphoma in a HIV-negative and nonimmunosuppressed patient.(2021-04-29T00:00:00Z) Güler, Beril; Çetin, Güven; GÜLER, BERIL; ÇETİN, GÜVENAdditional test needed: PET/CT: Several hypermetabolic lymph nodes, approximately 1.5 cm in diameter, were observed at the subcarinal level (SUVmax: 12,7). A hypermetabolic mass/multiple lymphadenopathies with a conglomerate appearance of approximately 10 cm in diameter was detected in the periportal, peripancreatic and paracaval areas (SUVmax:18.3). No effusion was detected on imagings. ALT: 760 U/L, AST: 410 U/L, ALP: 838 U/L, GGT: 1055 U/L, Total Bilirubin: 5,6 mg/dL, Direct Bilirubin: 3,7 mg/dL, WBC: 12400 cells/uL, Neutrophil: %80,43-9680, Lymphocyte: %11,49-1380.Points to discuss at the panel meeting: Virally associated lymphoproliferative disorders have a broad spectrum and can present different clinical features. Actual rates of these lymphoma group may be higher than currently reported. They should also be considered in the differential diagnosis in cases without a history of immunosuppression or HIV enfection. HHV8 and EBV related lymphomas should be kept in mind especially in null cell phenotype lymphomas.Case description: Previously healthy, 50-year-old HIV(-) male patient who was hospitalized due to right upper quadrant pain, vomiting and icterus. No systemic B-symptoms were present. There was no history of malignancy, drug use, hepatitis B or hepatitis C infection or other causes of immunosuppression.Biopsy fixation details: Pancreatic head and celiac lymph node EUS/FNA; 4 alcohol fixed, 3 air-dried smears, 2 cell block materials. Duodenal endoscopic biopsy and portal hilar mass CNB: 10% neutral buffered formalinFrozen tissue available: -Details of microscopic findings: EUS guided FNA: The smears were moderately to highly cellular in the necrotic background. Discohesive, scattered atypical cells had medium- to large-sized round nuclei, coarce chromatin, single or several small nucleoli. Some of the cells are in the form of naked nuclei, some of them have a moderate amount of basophilic cytoplasm and plasmacytoid morphology. Mitotic figures are frequent, especially in cell block sections.Duodenal endoscopic biopsy: A diffuse proliferation of atypical cells that effaced the normal architecture and ulcerated surface was observed at the hematoxylin eosin sections. Atypical cells are large with round-to oval or lobulated nuclei, coarce chromatin, single or several prominent nucleoli and moderate amount eosinophilic or clear cytoplasma. In some areas plasmacytoid morphology was predominant. Mitosis was common.Portal hilar mass CNB: Core biopsy specimen was completely infiltrated with atypical cells. Atypical cells had similar morphological features to those observed in other biopsies.Immunophenotype: Positive: LCA, EMA, HHV-8, MUM1, IgM, CD38 (duodenum-, portal hilus weak+). Ki67 (%80-85).Negative: CD138, CD30, CD79a, CD20, Pax-5, CD3, CD4, CD8, CD2, CD5, CD7, CD43, CD56, CD10, Bcl6, CD34, CD117, MPO, CD99, ALK, CD68, CD33, CD1a, CD11c, CD123, CD163, CD21, CD15, S100, CD61, Glicophorin A, Kappa, Lambda, Pancytokeratin, Oscar-keratin, Chromogranin a, Synaptophysin, CEA, Desmin, Myogenin, MyoD1, HMB45, CD31. Oct2 (suboptimal reaction).Cytogenetics: -Molecular studies: EBER(+)Proposed diagnosis: HHV8(+), EBV(+) Extracavitary/solid variant of primary effusion lymphoma.Interesting feature(s) of submitted case: Disease has been presented with icterus and cholestasis. There was no history of malignancy, drug use, HIV, hepatitis B or hepatitis C infection or other causes of immunosuppression. The serous effusion was not detected in the patient. The case was diagnosed by duodenal endoscopic biopsy. Atypical lymphocytes had a null cell phenotype and were positive for both EBV and HHV8.Publication Metadata only GAMMA HEAVY CHAIN DISEASE; HISTOPATHOLOGICAL FEATURES IN BONE MARROW AND LYMPH NODE, CASE REPORT(2022-09-18) Güler B.; Çetin G.; GÜLER, BERIL; ÇETİN, GÜVENCase Description: A 31-year-old female patient from Djibouti/North Africa had a complaint of neck swelling for one year. No other symptoms were described. It was reported that she was diagnosed with lymphoma (Hodgkin? Non-Hodgkin?, pathology report not available) in her country but was not treated. In PET-CT images, lymph nodes with 17-27 mm diameters (SUVmax: 2.4-4.0) were detected in the left cervical lymphatic stations, bilateral axilla, mediastinum, paraaortocaval regions, bilateral iliac chain and inguinal fossa. Spleen size increased and intraparenchymal FDG uptake was slightly increased homogeneously. A few millimetric nodular areas of density increase were observed in both lung parenchyma. In biochemistry and hemogram tests; Albumin:3.8, Total Protein:5.6, Urea:23, Urate:6.8, Creatinine:0.56, LDH:194, WBC:2430, Neutrophil:1800, Lymphocyte:410, Hb:7.48, Hct:22.87, Plt:121000. Beta-2 microglobulin: 3.26, Kappa(total, serum):0.9, Lambda(total, serum):0.5, IgA:48(65-421), IgG:1586(552-1631), IgM:21(33-293). No kappa or lambda light chain detected in urine immunofixation electrophoresis. IgG monoclonal band observed in serum immunofixation electrophoresis. Hepatic viral markers and HIV were negative. Left supraclavicular lymph node excision and bone marrow biopsy were evaluated in our department.Biopsy Fixation Details: 10% neutral buffered formalin. Bone marrow biopsy was decalcified in 10% formic acid for 8 hours.Frozen Tissue Available: -Details of Microscopic Findings:Lymph node: The architecture was totally effaced. There was atypical infiltration in diffuse and coarse nodular pattern consisting of polymorphic cells. Most of the atypical cells had a plasmacytoid morphology. Small-medium sized lymphoid cells with coarse chromatin were accompanying the plasmacytoid cells. Scattered atypical lymphocytes were observed, some resembling Reed-Sternberg cells, with large round/lobulated nuclei, vesicular chromatin, and prominent single or few small nucleoli.Bone marrow: The biopsy with six intertrabecular field was hypercellular. Alternating areas with light/dark staining and vague nodulation foci were seen. Hematopoietic cells were pushed to the paratrabecular zone by atypical infiltration. The atypical infiltration was composed of a polymorphic cellular population in this biopsy as well. Numerous plasma cells were observed in the periphery of the nodular areas. In the center of the nodules, small-medium sized lymphoid cells with coarse chromatin and scant cytoplasm were present. In a focal area atypical lymphoid cells were mixed with epithelioid histiocytes. Clusters of medium-sized lymphoid cells with vesicular chromatin were seen in some areas. Occasionally, eosinophils were also accompanying.Immunophenotype:Lymph node: CD20:(Positive in atypical B lymphocytes), CD138:(Positive in atypical plasma cells), IgG-MUM1:(Positive in atypical cellular population), Kappa-Lambda-IgG4-IgD-IgA-IgM:(Positive in rare reactive plasma cell), CD30:(Positive in Reed-Sternberg-like cells), CD15:(-), Fascin:(-), HHV8:(-).Bone marrow: CD138-CD38:(Positive in atypical plasma cells), CD19-CD20:(Positive in atypical B lymphocytes), CD3:(Positive in abundant reactive T lymphocytes), IgG:(Positive in atypical cellular population), Kappa-Lambda-IgG4-IgD-IgA-IgM:(Positive in rare reactive plasma cell).Cytogenetics: -Molecular Studies: EBER:(-)Proposed Diagnosis: Gamma heavy chain diseaseInteresting Feature(s) of Submitted Case: This neoplasm is a very rare immunosecretory disorder. Atypical infiltration was morphologically similar to lymphomas with plasmacytoid differentiation. Some of the atypical cells in lymph node sections had Reed Sternberg-like morphology.Publication Metadata only The Relationship of Prognostic Factors with Regulatory T Cells in Langerhans Cell Histiocytosis(2023-12-01) Çoban G.; Coşanay Tekden B.; Güler B.; Çakır F. B.; Toluk Ö.; Gücin Z.; Elagöz Ş.; ÇOBAN, GANİME; COŞANAY TEKDEN, BÜŞRA; GÜLER, BERIL; ÇAKIR, FATMA BETÜL; GÜCİN, ZÜHAL; ELAGÖZ, ŞAHANDE