OBJECTIVE:Immune thrombocytopenic purpura (ITP) is an immune-mediated bleeding disorder in which platelets are opsonized by autoantibodies and destroyed by an Fc receptor-mediated phagocytosis by the reticuloendothelial system within the spleen. Autoimmune processes are also considered in the pathogenesis of this disorder. CD4+CD25+FoxP3+ regulatory T (Treg) cells and CD8+CD28- Treg cells have roles in autoimmune diseases. We investigated these regulatory cells in ITP patients.MATERIALS AND METHODS:We included 22 ITP patients and 16 age-matched healthy subjects. CD4+CD25+FoxP3+ Treg cells and CD8+CD28- cells were investigated by three-color flow cytometry. The ratios of these cell populations to total lymphocytes were calculated. Statistical analysis was carried out with the Mann-Whitney U test.RESULTS:CD4+CD25+ Treg cells were 9.69±3.70% and 12.99±5.58% in patients with ITP and controls, respectively. CD4+CD25highFoxP3+ cells were 27.72±19.74% and 27.55±23.98% in ITP patients and controls, respectively. The percentages of both of these cell types were not statistically significant when compared to the control group.CONCLUSION:We did not find any differences in ratios of CD4+CD25+FoxP3+ Treg cells or CD8+CD28- T cells in lymphocytes between patients and healthy subjects. We conclude that these circulatory cells are not different in ITP, but further studies are needed to explore the putative roles of these regulatory cells.

Lapatinib is an effective drug in HER2-positive breast cancer. We present a case with successful treatment of lapatinib in brain metastasis of HER2+ breast cancer. Forty-eight years old woman was admitted our clinic with early breast cancer. In third years after adjuvant chemotherapy and trastuzumab, isolated and multiple brain metastasis were detected. After whole brain RT, lapatinib (with capecitabine for 10 months and with letrozole for 3 months) has been used. Volumetric reduction of lesions was achieved and symptoms disappeared. When lapatinib discontinued, brain metastasis relapses. Lapatinib plus capecitabine reinduction has been started. Totally, longer survival than 45 months was achieved after first brain metastasis detection. Because both combinations of lapatinib with capecitabine and letrozole were effective and reinduction treatment was successful, presented case has strongly supported activity of lapatinib treatment in brain metastasis of HER2+ breast cancer.

e15107 Background: Epstein-Barr virus (EBV) causes gastric adenocarcinoma besides other etiologic factors. EBV prevalence among gastric cancers has been reported in several countries. EBV-positive gastric cancer frequency has not been known in Turkey. We aimed to investigate EBV positivity and describe associated clinicopathologic parameters in north-west region of Turkey. Methods: Eighty-five gastric cancer patients and 50 control patients with HP negative chronic gastritis were admitted to the study. Epstein–Barr virus-encoded small RNAs (EBER) in situ hybridization was used for EBV positivity. Results: ISH-EBER was positive in tumor tissues from 2 cancer patients. First EBER positive patient was a 56 years old-woman (in diagnose). Tumor was intermediate-differentiated intestinal type adenocarcinoma in antrum (T3N1M0). After adjuvant chemoradiotherapy, she has been followed up without relapse for over 9 years. Second patient was a 71 years-old man. T3N0M0 tumor was diffuse type, intermediate-differentia...

Objective: Immunosenescence is an important aspect in elderly cancer patients. In aging, T cell dysfunction and increasing CD4+CD25+ Regulatory T (Treg) cells have been reported. However, the status of these cells has not been uncovered so far in elderly cancer patients. In this study, we aimed to investigate Treg cells, CD8+CD28- suppressor cells, and other lymphocyte subpopulations in elderly cancer patients. Materials and Methods: Seventy-five cancer patients were included in the study. Data were obtained from our previous three studies about Treg, suppressive cells and other lymphocyte populations of breast, gastric and lung cancer patients. Total CD4+CD25+ Treg cells, CD8+CD28- suppressor cells, CD8+ memory cells, CD8+ naive cells, Natural Killer (NK) cells, CD8+ and CD4+ T cells had been investigated by flow cytometry. The parameters were compared between in patients over and under the age of seventy. Results: Eighteen patients were older than 70 years of age and fifty-seven patients were not. The percentage of CD4+CD25high cells in CD4+ T cells were higher in elderly cancer patients than control patients (smaller than 70 years old) (13.01%±6.59% vs. 8.43%±5.01%; p:0.02). CD8+CD28- suppressor cells in lymphocytes were similar in both groups (18.12%±7.73% vs 18.03%±8.33%; p:0.97). NK cells were elevated in elderly patients. CD8+ memory cells, CD8+ naive cells, CD8+ T cells, and CD4+ T cells were not different between groups. Conclusion: Our data suggest that CD4+CD25+ Treg cells are increased in elderly cancer patients, but not CD8+CD28- suppressor cells. This may be a cause of age-related immunosuppression in cancer patients.

e22098 Background: HLA-G is expressed in tumor tissue of several cancer types. Micro-RNA (miR)-148a and miR-152 regulate HLA-G expression in placenta. The different expression of these miR molecules has been reported in malignant tissues. However, the relation between HLA-G and these miRs has not been evaluated in cancer patients. We aimed to investigate HLA-G, miR-148a, and miR152 expressions in colorectal cancer. Methods: Sixty-eight patients with colorectal adenocarcinoma were included to the study. HLA-G and miRs were investigated in tumor tissues and nearest normal colon epithelium. HLA-G was shown with immunohistochemistry. Real time reverse transcriptase chain reaction (RT-PCR) was used for expression of miR-148a and miR-152. miR-148a, and miR152 expressions were compared between malignant and normal tissues and between HLA-G (+) and (–) tumor tissues. Results: HLA-G was immunopositive in tumor tissues from 10 colorectal cancer patients (14.7%). miR-152 expression was lower in tumor than in normal tissue (0.814±0.392 fold vs 1.139±0.438 fold; respectively p < 0.0001), but miR-148a was not different (0.733±0.302 fold 0.778±0.254 vs fold p:0,326). miR-152 is higher in HLA-G positive tumor tissue than in HLA-G negative tumor (0.972±0.16 fold vs 0.787±0.41 fold, respectively p:0,032). However, miR-148a was similar in both HLA-G + and – tumors (0,864±0,18 fold vs 0,710±0,31 fold, respectively p:0,121). miR expressions were not related to tumor grad, lymph node or distance metastasis status. Conclusions: miR-152 is lower in tumor tissue with colorectal adenocarcinoma than non-malignant colonic epitelium. Expression of miR-152 is higher in HLA-G (+) tumors than (-) tumors.

Malignant melanoma can be successfully treated when it is identified in its early stages, but the disease is associated with a poor prognosis when it is detected in an advanced stage. Papillary thyroid carcinoma is a thyroid cancer that has a good prognosis. The present study reports a rare case of malignant melanoma and papillary thyroid carcinoma that were diagnosed concurrently and treated simultaneously. The present patient was a 37-year-old male, in whom examination of a skin biopsy that was obtained from a lesion in the right retroauricular region revealed the lesion to be consistent with malignant melanoma. The patient underwent radical neck dissection upon the detection of malignant melanoma metastasis to the sentinel lymph node. Metastases of papillary thyroid carcinoma were detected in four out of 38 lymph nodes. The patient was then diagnosed with papillary thyroid carcinoma and underwent total thyroidectomy. The patient was administered with high-dose followed by moderate-dose interferon-α therapy for the treatment of malignant melanoma. The patient also received concurrent radioactive iodine therapy for the treatment of papillary thyroid carcinoma, at the same time as the interferon therapy. The two primary tumors of the patient were treated successfully. During therapy, no serious side-effects were observed, with the exception of fever caused by high-dose interferon therapy. Malignant melanoma and papillary thyroid carcinoma may occur concurrently, although this is rarely observed. The present study reports a rare case that demonstrates that the two tumors can be successfully treated simultaneously.

The prognosis of metastatic melanoma is poor. Pre-targeted treatment era, the combination of interferon-α (IF-α) plus chemotherapy had been used and have generally short response duration. Herein, we present a metastatic melanoma case that achieved long-term durable complete response (CR) IF-α plus chemotherapy and IF-α maintenance therapy and had lower Regulatory T (Treg) cells. A fifty-year old woman was admitted to the hospital with metastatic melanoma. Lactate dehydrogenase (LDH) level was 660 U/L. The percentage of CD4+CD25+ Treg cells was 2.4% in CD4+ lymphocytes. The IF-α plus chemotherapy and IF-α maintenance were administered. After six courses of chemotherapy, CR was achieved. Vitiligo and hypothyroidism occurred. The patient has remained in CR for approximately 7 years until second pleural metastases were detected and death. The patient has positive prognostic factors such as induction of autoimmunity, small tumor volume, mild elevated LDH level, and lower Treg cell percentage. She survived long term with CR after IF-α treatment with concurrent chemotherapy and maintenance. IF-α plus chemotherapy may be a treatment option for metastatic melanoma in selected cases who cannot reach new targeted drugs.

Cancer is associated with an increased risk of cerebrovascular incidents and treatment with chemotherapy enhances that risk further. Brocha's aphasia is a stroke-related syndrome, the presentation of which has been rarely reported during cisplatin-based chemotherapy. The current study presents the case of a 27-year-old male with advanced-stage small cell lung cancer. The patient developed Broca's aphasia following cisplatin-based chemotherapy.

Background: HLA-G is a non-classical major histocompatibility complex class I molecule. HLA-G expression has been found in various types of solid and hematological malignancies. It is also expressed in normal testicular and epididymal tissue. However, expression of HLA-G in testicular germ cell tumors has not been extensively studied. The aim of this study was to investigate whether HLA-G protein is present in different components of testicular germ cell tumors. Patients and Methods: 34 testicular cancer patients, for whom tumor tissue was available, were included in the study. Immunohistochemical staining was performed on tissue sections from formalin-fixed, paraffin-embedded tissue samples. Results: 7 (20.6%) patients had positive HLA-G staining in at least 1 component of the tumor sample. In 3 of 7 patients with intratubular germ cell neoplasia, staining with HLA-G was seen in this component. All of the choriocarcinoma components were strongly positive, and about 40% of teratoma components had immunopositivity. The components of seminoma and embryonal carcinoma, and most yolk sac tumors were negative. HLA-G immunopositivity was not associated with tumor size, retroperitoneal lymph node involvement, distant metastasis, or relapse/refractory status. Conclusion: This study demonstrated that testicular choriocarcinoma and some teratomas express HLA-G, but not seminoma, embryonal carcinoma, and yolk sac tumors.

BACKGROUND Recent studies have revealed a prognostic impact of the MPV (mean platelet volume)/platelet count ratio in terms of survival in advanced non-small cell lung cancer. However, there has been no direct analysis of the survival impact of MPV in patients with mCRC. The aim of the study is to evaluate the pretreatment MPV of patients with metastatic and non-metastatic colorectal cancer (non-mCRC) and also the prognostic significance of pretreatment MPV to progression in mCRC patients treated with bevacizumab-combined chemotherapy. MATERIALS AND METHODS Fifty-three metastatic and ninety-five non-metastatic colorectal cancer patients were included into the study. Data on sex, age, lymph node status, MPV, platelet and platecrit (PCT) levels were obtained retrospectively from the patient medical records. RESULTS The MPV was significantly higher in the patients with mCRC compared to those with non-mCRC (7.895±1.060 versus 7.322±1.136, p=0.013). The benefit of bevacizumab on PFS was significantly greater among the patients with low MPV than those with high MPV. The hazard ratio (HR) of disease progression was 0.41 (95%CI, 0.174-0.986; p=0.04). In conclusion, despite the retrospective design and small sample size, MPV can be considered a prognostic factor for mCRC patients treated with bevacizumab-combined chemotherapy.

Testicular germ cell tumor (TGCT) is the most common malignant tumor among young males. TGCT containing a teratoma component may show differentiation into various histopathological subtypes and may rarely recur as angiosarcoma. The present case had TGCT containing a teratoma component, and tumor recurrence occurred first as cartilage tissue and then as an angiosarcoma in the retroperitoneal area. After the diagnosis of angiosarcoma was established, the tumor was considered unresectable. The patient received chemotherapy and radiotherapy. The current study presents a rare case of TGCT, and the researchers also conducted a literature review.

AIM OF THE STUDY:To investigate the percentage of CD4+CD25(high) cells (including Treg cells) and CD8+CD28- cells in breast cancer patients with and without high levels of autoimmune thyroid antibodies.MATERIAL AND METHODS:Thirty-five women with breast cancer (9 of them having high thyroid antibodies) and fourteen healthy subjects were enrolled in this study. Flow cytometry was used to count CD4+CD25(high) cells and CD8+CD28- suppressive cells (CD8 cell subtypes).RESULTS:In the patient group, the percentage of CD28- cells in CD8+ lymphocytes were higher [67.50% (55.1180.33) vs. 51.56% (42.5766.38); p = 0.021] and the percentage of CD28+CD45RO- cells (memory cells) in CD8+ lymphocytes were lower than in the control group. CD4+CD25(high) cell percentage in CD4+ lymphocytes was elevated in the patient group [6.44% (4.528.74) vs. 2.97% (1.724.34); p < 0.001]. When the cytometric parameters were compared between patients (with high vs. normal thyroid antibodies), the distribution of CD8+ cell subgroups was also similar. CD4+CD25(high) cells among CD4+ lymphocytes were decreased in patients with high levels of thyroid antibodies [5.19% (3.426.17) vs. 6.99% (4.829.95); p = 0.043].CONCLUSIONS:CD4+CD25(high) cells may play a role in autoimmunity of breast cancer patients, and may be a predictive marker. Advanced studies which evaluate the possible links between regulatory cells and autoimmunity should be established in cancer patients.

Although ionizing radiation is strongest factor linked to multiple myeloma, increased myeloma risk has not been fully explained after pelvic radiation. Pleural involvement of MM is also rare. We present a MM case with pleural involvement as an unusual presentation diagnosed in fifth years of pelvic radiotherapy. A sixty-two-year-old woman with dyspnea and a mass in forehead was admitted to our clinic. Before five year, the patient had received pelvic external beam radiotherapy (RT) with dose of 40 Gy for endometrial adenocarcinoma. PET/CT scan detected FDG uptakes in frontal bone, right pleura, and sacrum. Lambda light chain type multiple myeloma with pleural involvement was diagnosed with histopathological examinations of frontal bone mass, bone marrow, and pleural fluid and with serum/urine electroforesis. The patient died in second course of VAD chemotherapy. Although relation between increased myeloma risk and pelvic radiation is not clear and pleural involvement is rare, multiple myeloma should be included to the differential diagnosis in patients received pelvic radiotherapy or in unexplained pleural effusion.

The aim of this study was to investigate the effect of cisplatin etoposide chemotherapy on platelet indices in advanced stage lung cancer patients. Twenty advanced stage lung cancer patients who received cisplatin and etoposide chemotherapy and 35 healthy subjects were enrolled. The platelet indices (platelet count, mean platelet volume (MPV), plateletcrit (Pct) and platelet distribution width (PDW)) and other blood count parameters were recorded in baseline, before second cycle and after sixth cycle of chemotherapy. In baseline analysis, white blood cell count, but not other blood parameters, were different in patient group compared with control group,. After six cycles of chemotherapy, PDW values were elevated than baseline analysis in lung cancer patients. Other platelet parameters were not changed after chemotherapy. This study showed that MPV, platelet count, or Pct don’t change after cisplatin-etoposide chemotherapy in lung cancer patients.