Issin, Gizem; Demir, Fatih; Cagatay, Diren Vuslat; Guvendir, Irem; Simsek, Hasan Aktug; Zemheri, Itir Ebru

Background/Objectives: Appendiceal collision tumors (ACTs), defined by the coexistence of two or more histologically distinct neoplastic components within the appendix, are rare entities. We aimed to characterize their clinicopathologic features, management strategies, and outcomes by integrating an institutional case series with a systematic review of the literature. Methods: We retrospectively identified ACTs diagnosed at our institution and performed a PRISMA 2020-guided search of PubMed, Scopus, and Web of Science databases through May 2025 for case reports and case series. Two reviewers screened studies and extracted data on presentation, histologic composition, treatment, approaches and outcomes. Results: ACTs accounted for 4% of appendiceal tumors in our institution, all combining a neuroendocrine neoplasm (NEN) with a low-grade appendiceal mucinous neoplasm. The literature search identified 69 ACTs from 33 studies; pooled with our cases, 74 patients were evaluated. The most common pairings were NEN–appendiceal mucinous neoplasm (53%) and NEN–adenocarcinoma (26%), while three-component tumors were rare (n = 2). Early-stage tumors (pTis–pT1) were uniformly managed with appendectomy or limited resection, in line with established stage-based management algorithms for appendiceal neoplasms. Advanced-stage tumors (pT3–pT4) were treated according to the biologically dominant component, frequently with colectomy and, in high-risk mucinous disease, cytoreductive approaches. Across stages, outcomes appeared to be driven by the non-neuroendocrine component; a coexisting low-grade NEN did not independently confer worse prognosis. In ACTs with an adenocarcinoma component, goblet cell morphology was common, and outcomes appeared similar to those reported for non-collision appendiceal adenocarcinoma. Conclusions: ACTs represent a heterogeneous group in which prognosis is dictated by the non-neuroendocrine component and tumor stage. Low-grade NEN components appear biologically indolent, whereas adenocarcinoma and high-risk mucinous components have been observed to exhibit behavior similar to their solitary counterparts.

Kama Basci, Ozge; Oral, Alihan; Kirik, Ali; Sen, Hacer; Solmaz, Ihsan; Topaloglu, Ulas Serkan; Demir, Ismail; Dundar, Ahmet; Binnetoglu, Emine; Okuroglu, Nalan

Background/Objectives: Non-invasive fibrosis scores are widely used for risk stratification in metabolic dysfunction-associated steatotic liver disease (MASLD); however, their performance in obese individuals remains controversial. The Fibrosis-4 (FIB-4) index is commonly recommended as a first-line tool, yet it may underestimate fibrosis risk in severe obesity. The BAST score, which incorporates metabolic and anthropometric parameters, has been proposed as an alternative. This study aimed to characterize both the degree and direction of discordance between FIB-4 and BAST in obese patients with MASLD. Methods: This predefined secondary analysis included 2950 adults with obesity (BMI ≥ 30 kg/m2) and MASLD from the multicenter OBREDI-TR cohort. Fibrosis risk categories were assigned using standard cut-offs for FIB-4 and BAST, and agreement was assessed using weighted Cohen’s kappa. Associations among discordance patterns, obesity class, and the visceral adiposity index (VAI) were evaluated using chi-square tests and general linear models. Results: Overall agreement between FIB-4 and BAST was very poor (κ = 0.041, p < 0.001). Discordance was observed in 22.3% of patients and increased markedly with obesity severity. In class III obesity, discordance was predominantly driven by low-risk classification according to FIB-4 despite high-risk classification according to BAST. Patients with this discordant pattern exhibited significantly higher VAI values than concordant cases (p < 0.001), independently of the study center. Conclusions: In obese patients with MASLD, particularly those with morbid obesity, FIB-4 frequently classifies patients as low risk, while BAST identifies elevated fibrosis risk. This systematic discordance suggests that FIB-4 may underestimate fibrosis burden in the context of severe obesity and visceral adiposity, supporting the need for a phenotype-oriented, multimodal approach to fibrosis risk assessment.

Gür, Volkan; Gökgöz, Mehmet Burak; Aydın, Abdurrahman; Issın, Ahmet; Can, Muhammet Ali; Yanmaz, Oğuzhan; Koçkara, Nizamettin; Yapıcı, Furkan

Background: The peroneal tubercle demonstrates substantial morphologic variability and may influence peroneal tendon mechanics. This study evaluated whether peroneal tubercle morphology and size are associated with MRI-detected peroneal tendon abnormality in patients undergoing ankle MRI for ankle pain without documented lateral malleolar/retromalleolar or peroneal tendon-specific symptoms. Methods: In this retrospective cross-sectional study, 487 ankle MRI examinations obtained between 2020 and 2023 were analyzed after excluding cases with lateral ankle/peroneal symptoms, clinically significant acute trauma, prior ankle surgery, or systemic inflammatory disease. Two orthopedic surgeons independently classified peroneal tubercle morphology (single-convex vs. double-convex) and measured tubercle height and anteroposterior length. Peroneal tendon abnormality was defined as MRI features consistent with tendinopathy and/or tenosynovitis. Inter- and intraobserver reliability were assessed using intraclass correlation coefficients and Cohen’s kappa. Unadjusted associations were assessed using Fisher’s exact test and point-biserial correlation. Multivariable logistic regression was performed to evaluate independent associations after adjustment for age, sex, BMI, and hindfoot alignment. Results: Mean age was 43.6 ± 15.6 years; 226 participants were male, and 261 were female. Peroneal tendon abnormality was present in 227/487 examinations (46.6%). Double-convex morphology showed a higher prevalence of abnormality than single-convex morphology (69.6% vs. 43.6%; unadjusted OR 2.97, 95% CI 1.63–5.41; p < 0.001). In the adjusted model, double-convex morphology remained independently associated with peroneal tendon abnormality (OR 2.85, 95% CI 1.52–5.34; p = 0.001). Tubercle height showed a modest independent association (OR 1.12 per mm, 95% CI 1.04–1.20; p = 0.002), whereas tubercle length was not associated (OR 1.008, 95% CI 0.981–1.036; p = 0.541). Reliability was excellent for tubercle height, tubercle length, and hindfoot alignment measurements and substantial to excellent for categorical ratings. Conclusions: In this non-lateral referral cohort, double-convex peroneal tubercle morphology was independently associated with higher odds of MRI-detected peroneal tendon abnormality. These findings reflect cross-sectional imaging associations rather than causation and should be interpreted with caution, given the heterogeneous MRI endpoint and the routine clinical MRI protocol.

Memis, Kemal Bugra; Aydin, Sonay

Background: Recent studies indicate that the organo-axial subtype of a sigmoid volvulus is more prevalent than the conventional mesentero-axial subtype. Our study aimed to assess the clinical and radiological findings that differentiate between these two subtypes, as well as to ascertain treatment outcomes and prognostic characteristics. Methods: A retrospective review included 54 patients, during which abdominal plain radiographs and computed tomography images were analyzed by two radiologists, and data on recurrence, mortality, and treatment outcomes were documented. Results: The mesentero-axial subtype comprised 40 cases (74%). No distinct radiographic findings were observed to differentiate between the two groups. In computed tomography, the sole significant parameter for differentiation was the number of transition zones. The diameter of the segment exhibiting a volvulus was greater in instances of the mesentero-axial subtype. The endoscopic detorsion treatment proved ineffective in five patients within the mesentero-axial sigmoid volvulus cohort. Conclusions: Identifying these two types of SV on CT images is essential because of their distinct prognoses and therapeutic results.

Aydin, Hale; Bozkurt, Cansu; Hayme, Serhat; Bilge, Almila Coskun; Oztekin, Pelin Seher; Avdan Aslan, Aydan; Ozcan, Irem; Gultekin, Serap; Eren, Abdulkadir; Durur Subası, Irmak

Background/Objectives: Segmental non-mass enhancement (NME) is the breast MRI distribution pattern with the highest positive predictive value (PPV) for malignancy. Despite its diagnostic relevance, its imaging characteristics have rarely been examined in isolation, leaving uncertainty in clinical practice. This multicenter retrospective cohort study aimed to evaluate multiparametric MRI features—including internal enhancement pattern, dynamic contrast-enhanced (DCE) kinetics, and diffusion restriction—in segmental NME to identify malignancy predictors. Methods: This retrospective cohort review included 14,834 breast MRI reports from five institutions (September 2017–February 2024), identifying 103 women (mean age, 44.4 ± 9.9 years) with segmental NME (70 malignant, 33 benign). MRI was performed at 1.5 T or 3 T using standardized protocols. Two breast radiologists, blinded to pathology, assessed internal enhancement, DCE kinetics, diffusion restriction, and short tau inversion recovery (STIR) features according to BI-RADS. Statistical analyses included chi-square/Fisher’s tests and logistic regression. Results: Clustered ring enhancement (CRE) was significantly associated with malignancy (p = 0.004). Fast initial-phase enhancement (p < 0.001) and delayed-phase washout (p = 0.011) also correlated with malignancy. On multivariate analysis, fast initial-phase enhancement remained an independent predictor (odds ratio [OR] = 5.133, p = 0.031), whereas slow enhancement predicted benignity (OR = 0.194, p = 0.020). Histologies included ductal carcinoma in situ, invasive ductal carcinoma, granulomatous mastitis, and benign hyperplastic lesions. Conclusions: This study, focusing exclusively on segmental NME, identifies CRE, fast initial-phase enhancement, and washout kinetics as reliable imaging biomarkers. Incorporating these features into breast MRI interpretation may improve diagnostic accuracy, risk stratification, and management decisions.

Cetin, Turkhun; Cinar, Gokce; Ucan, Berna; Memis, Fulya; Irgul, Baris; Aydin, Sonay

Background: Calcifications in the carotid and vertebral arteries may be present on cranial and temporal bone CT imaging of pediatric patients. Few studies have investigated the frequency, location, and patterns of carotid artery calcifications in this age group. However, these studies are outdated and do not include data on the vertebral artery. The aim of this study was to determine the frequency, location, and pattern of incidental carotid and vertebral artery calcifications on cranial CT and temporal bone CT images in children under 15 years of age. We also aimed to investigate possible associations between these calcifications and various diseases. Methods: A total of 300 CT images of the cranial and temporal bone of 300 pediatric patients were retrospectively evaluated for the presence of calcification in the carotid and vertebral arteries. The evaluation included determining the presence of calcification in the artery, the pattern of calcification, the degree of calcification, and its anatomical location. Results: In the current study, 300 CT images were analyzed, and calcifications were found in the vertebral artery in 17 patients (5.6%) and the carotid artery in 82 patients (27.3%). The supraclinoid segment and the carotid siphon regions are the most common locations of carotid artery calcifications, with 62 patients (20.7%). The V4 segment is also the most common location for vertebral artery calcifications, with 15 patients (5%). Focal punctate calcification is the most common pattern (65 patients, 21.7%). Incidental carotid and vertebral artery calcifications did not correlate with other diseases. Conclusions: Carotid and vertebral artery calcifications are common incidental findings in pediatric patients. In our study, no association was found between other diseases and incidental carotid and vertebral artery calcifications.

Durmuş Ece, Berire Şeyma; Yozgat, Zübeyir; İnançlı, Yusuf; Ece, Bunyamin; Aydin, Sonay

Background/Objectives: The aim of this study was to evaluate computed tomography (CT) findings in penetrating globe injuries and their relationship with ocular trauma scores (OTSs). Methods: Patients with penetrating globe injuries who had orbital CT images were included in this study. Demographics, injury zone, and ophthalmologic exam data were collected retrospectively. OTSs and categories were determined. Orbital CT images were evaluated by a radiologist to determine decreased globe volume, globe wall irregularity, chorioretinal layer thickening, lens dislocation, asymmetric anterior chamber depth (ACD), abnormal vitreous density, and intraocular air presence. Results: This study included 30 eyes of 30 patients. The majority of patients (n = 20, 66.7%) had Zone I injuries. The most common CT findings were globe wall irregularity (53.3%) and asymmetric ACD (53.3%). No CT findings were observed in 10 patients (33.3%). Globe wall irregularity was the most frequent CT finding in the OTS II category, while asymmetric ACD was most frequent in the OTS IV category. All patients with decreased globe volume, lens dislocation, abnormal vitreous density, and ≥3 CT findings were in the OTS II category. A significant negative correlation was found between the number of CT findings and OTS (r = −0.644, p < 0.001), and a significant positive correlation was found between the number of CT findings and clinically measured wound size (r = 0.600, p < 0.001). Conclusions: CT findings help assess ocular trauma severity, but clinical examination remains essential for accurate diagnosis.

Memis, Fulya; Kandefer, Meryem Yalvac; Aydin, Sonay; Dalva, Klara; Toprak, Selami Kocak

Background: Interleukin-10 (IL-10) and vascular endothelial growth factor (VEGF) are believed to possess a role in the pathophysiology of multiple myeloma (MM). We aimed to assess the significance of these parameters in the diagnosis, monitoring, and prognosis of the disease by examining them in patients at diagnosis and post-treatment and comparing the findings with those of healthy individuals. Methods: We conducted blood sampling from 35 patients diagnosed with MM at the time of diagnosis and from 15 of these patients post-treatment. We additionally assessed similar serum markers in a control group of 15 healthy individuals. Furthermore, we documented laboratory results, organ involvement, comorbidities, and CD27-CD81 levels assessed using flow cytometry in the bone marrow, along with treatments and patient responses. We also examined the quantity of cells collected during mobilization in patients who had autologous stem cell transplantation. Results: We found a positive correlation (p = 0.028/p = 0.035) between IL-10 and VEGF with the international staging score. In patients with renal involvement, IL-10 levels were higher and VEGF levels were lower than those without renal involvement (p = 0.011/p = 0.012). We showed that VEGF levels decreased significantly with treatment (p = 0.001). We found no statistically significant correlation between treatment responses and IL-10 and VEGF. The number of CD34 cells collected by mobilization showed a negative correlation with CD27 and a positive correlation with VEGF (p = 0.007/p = 0.032). Conclusions: Serum IL-10 level is associated with ISS and renal involvement in MM patients. There is a positive correlation between serum VEGF levels and the number of stem cells collected during mobilization. As CD27 expression increases, the number of stem cells collected in mobilization decreases.

Cetin, Turkhun; Tokur, Oguzhan; Bozkurt, Hayrunnisa Bekis; Aydin, Sonay; Memis, Kemal Bugra; Kantarci, Mecit

Shear wave elastography (SWE) has become popular in clinical practice for many diseases. However, there is not adequate research on spleen-related diseases. This study aimed to investigate the potential of quantitative values obtained through SWE in evaluating spleen pathologies in the pediatric population and to demonstrate its performance to differentiate splenomegaly-related diseases. The research group retrospectively included children with pathological diagnoses related to the spleen from November 2016 to April 2021, and they were categorized into three groups, including portal hypertension (PH), benign lymphoid hyperplasia (BLH), and malignant infiltration (MI). Spleen sizes and parenchymal stiffness were also calculated for each group. Subsequently, mean spleen stiffness in each group was compared with normal values within the same age group. In total, 2781 children (1379 children for the study group; 1402 children for the control group) were enrolled in the study. The highest stiffness was observed in the PH group, which is statistically higher than others (p < 0.05). Although the mean spleen stiffness in the group with BLH was higher than the control and MI group, the difference was not statistically significant (p = 0.08). The mean stiffness in the group with MI was significantly lower than both the control group (p = 0.005) and PH (p = 0.01). In conclusion, using SWE in the differential diagnosis of etiologies causing splenomegaly could make an important contribution.

Barkay, Orçun; Karakeçili, Faruk; Binay, Umut Devrim; Akyüz, Sümeyye

Background: Brucellosis is a zoonotic infectious disease. It is estimated that the number of cases reported today is much less than the actual number. We still have difficulty in diagnosing the disease and its organ involvement. In this sense, new approaches that can be useful in clinical practice are required, and we aimed to evaluate this situation in our study. Methods: 171 of 213 patients followed in our center between January 2021 and April 2024 were included in the study. A total of 150 patients were included in the study as a control group. Rose Bengal test (RBT), Coombs gel test (CGT), enzyme-linked immunosorbent assay (ELISA), and automated blood culture were used for diagnosing brucellosis. Complete blood count, sedimentation, C-reactive protein, and biochemical parameters were obtained. Inflammation markers such as neutrophil–lymphocyte ratio, platelet–lymphocyte ratio, systemic immune-inflammation index, and systemic inflammation response index were calculated. Results: The most successful results in the diagnosis were ELISA (89.4%), RBT (88.3%), CGT (83%), and blood culture (34.8%). For diagnosing sacroiliitis and spondylodiscitis, instead of resorting to expensive methods like magnetic resonance, a combination of ELISA positivity with elevated acute phase reactants and inflammatory markers could be significantly instructive. Conclusions: Optimizing diagnostic algorithms and exploring novel diagnostic approaches, such as inflammatory markers, hold promise for improving diagnosis and management.