The aim of this retrospective, multicenter study was to evaluate clinicopathological characteristics, prognostic factors and treatment outcomes of teenage and adult patients with high-grade osteosarcoma. A total of 240 osteosarcoma patients who were diagnosed and treated from March 1995 to September 2011 were analyzed. Median age was 20 years (range 13-74 years), and 153 patients (63.8%) were male. Primary tumor localization was extremity in 204 patients (85.4 %), trunk in 21 patients (8.8%) and head and neck region in 14 patients (5.9%). According to American Joint Committee on Cancer staging system, 186 patients (77.5%) were stage II, 3 (1.3%) were stage III and 48 (20.0%) were stage IV. Median overall survival (OS) was 55 months (95 % CI 36.8-73.1 months). OS after 2, 5 and 10 years were 67, 49 and 42%, respectively. Univariable analysis for OS showed that male gender (p = 0.032), high baseline lactate dehydrogenase (LDH) level (p < 0.001), high baseline serum alkaline phosphatase level (p = 0.002), telangiectatic subtype (p = 0.023), presence of metastasis at diagnosis (p < 0.001), presence of tumor positive margins after primary surgery (p = 0.015), poor pathological response to preoperative chemotherapy (p = 0.006) and presence of recurrent disease during follow-up period (p < 0.001) were significantly associated with poor survival. Patients who received postoperative methotrexate plus doxorubicin plus cisplatin (M + A + P) combination regimen (p = 0.019), underwent surgery for recurrent disease (p < 0.001) and received chemotherapy for recurrent disease (p < 0.001) had longer OS. In multivariable analysis for OS, only high LDH level (p = 0.002) and the presence of metastasis at diagnosis (p = 0.011) were associated with poor OS, whereas the patients who received chemotherapy for recurrent disease had a longer OS (p = 0.009).

Osteosarcomas with lung metastases are rather heterogenous group. We aimed to evaluate the clinicopathological characteristics and outcomes of osteosarcoma patients with lung metastases and to compare the synchronous and metachronous lung metastatic groups. A total of 93 adolescent and adult patients with lung metastatic osteosarcoma, from March 1995 to July 2011, in a single center, were included. Sixty-five patients (69.9%) were male. The median age was 19 years (range, 14–74). Thirty-nine patients (41.9%) had synchronous lung metastases (Group A) and 54 patients (58.1%) had metachronous lung metastases (Group B). The 5-year and 10-year post-lung metastases overall survival (PLM-OS) was 17% and 15%, respectively. In multivariate analysis for PLM-OS, time to lung metastases (p = 0.010), number of metastatic pulmonary nodules (p = 0.020), presence of pulmonary metastasectomy (p = 0.007) and presence of chemotherapy for lung metastases (p< 0.001) were found to be independent prognostic factors. The median PLM-OS of Group A and Group B was 16 months and 9 months, respectively. In Group B, the median PLM-OS of the patients who developed lung metastases within 12 months was 6 months, whereas that of the patients who developed lung metastases later was 16 months. Time to lung metastases, number and laterality of metastatic pulmonary nodules, chemotherapy for lung metastatic disease and pulmonary metastasectomy were independent prognostic factors for patients with lung metastatic osteosarcoma. The best PLM-OS was in the subgroup of patients treated both surgery and chemotherapy. The prognosis of the patients who developed lung metastases within 12 months after diagnosis was worst.

Granulocytic sarcoma is an uncommon tumor composed of myeloid blasts and/or immature myeloid cells in an extramedullary site which is usually associated with acute or chronic myeloid leukemia. The tumor may also be the initial manifestation of leukemia. The histomorphological diagnosis of granulocytic sarcoma can be challenging to pathologists, especially in the absence of a known hematological disorder. In this case, differentiation of granulocytic sarcoma from malignant lymphomas and other small round cell tumors is very critical. Seven cases of granulocytic sarcoma are reported in this paper. One patient had granulocytic sarcomas at two different sites. Hematoxylin-eosin-stained sections were reexamined. Blastic, poorly differentiated, and well differentiated histopathological variants were found in two, five and one cases, respectively. Immunohistochemical studies were performed on formalin-fixed tissue from all cases using a avidin-biotin-peroxidase complex technique. The panel included antibodies against LCA, CD43, CD34, c-kit, myeloperoxidase, CD68 KP1, CD15, and CD99. All cases stained positively with LCA, CD43, CD34, myeloperoxidase, and CD68. Five cases were positive for c-kit, three cases were positive for CD15, and two cases were positive for CD99. An immunohistochemical panel including at least myeloperoxidase, CD68 and CD34 can be used for detection of myeloid differentiation. It is also important that granulocytic sarcoma be considered in the differential diagnosis of CD99-positive round cell tumors.

ÖZETNodüler tip malign melanom nadir görülen bir malign melanom alt tipidir. Sıklıkla ileri evrede tanı alır ve kötü prognozludur. Bu olgu sunumunda nadir olarak rastlanan, karakteristik cilt bulguları olan, kemik iliği tutulumu ve yaygın damar içi pıhtılaşma tablosunun bir arada bulunduğu bir nodüler tip malign melanom vakası sunuyoruz. Anahtar Kelimeler: Metastatik malign melanom, Nodüler melanom, kemik iliği tutulumu, intravasküler hemoliz, yaygın damar içi pıhtılaşma ABSTRACT Nodular type malignant melanoma a rare subtype of malignant melanoma with poor prognosis. It is often diagnosed at advanced stage. In this case report, we present a metastatic malign melanom case with bone marrow involvement and dissemine intravascular haemolysis.

ÖZETDaha önce Kaposi Sarkomu tanısı alan bir hastanın tanıdan bir yıl sonra supraklaviküler fossada gelişen lenfadenopatisinden görüntüleme eşliğinde ince iğne aspirasyonu ile örnekleme yapılmıştır. Aspirasyon sitolojisinde büyük doku fragmanları yanısıra daha küçük hücre kümeleri izlenmiştir. Gevşek gruplarda iğsi hücreler yuvarlak-oval nükleuslu, açık mavi renk sitoplazmalı izlenmiş ve Kaposi sarkomu tanısı verilmiştir. Lenf düğümünün Kaposi sarkomu tutulumunda ince iğne aspirasyon sitolojisi bulguları literatür eşliğinde gözden geçirilmiştir. Anahtar Kelimeler: Kaposi Sarkomu; Lenf Nodu; Biyopsi; İnce-İğne ABSTRACT Image guided fine needle aspiration from the supraclavicular lymph node of a patient with prior Kaposi sarcoma diagnosis was performed. In the aspiration cytology large tissue fragments and small cell clusters were seen. In looser clusters spindle cells with round to oval nuclei with light blue cytoplasms were seen and Kaposi sarcoma diagnosis was given. Fine needle aspiration cytology findings of Kaposi sarcoma in lymph nodes is reviewed with the literature.