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    Cauda Equina Paraganglioma with Ependymoma-Like Histology: A Case Report
    (TURKISH NEUROSURGICAL SOC, 2012) Midi, Ahmet; Yener, Arzu Nese; Sav, Aydin; Cubuk, Rahmi
    Paraganglioma affecting the cauda equina region is very rare and can be misinterpreted as an ependymoma which is more common at this site. A 38-year-old woman with a paraganglioma in the cauda equina is presented. MRI revealed a well-circumscribed, intradural, extramedullary tumor nodule with the dimensions of 2.5x1x1 cm. The patient underwent L3 laminectomy and total excision of the tumor. The tumor was diagnosed as ependymoma and the patient was decided to undergo adjuvant radiotherapy. The patient applied to our medical center for a second opinion. Histopathologically, her tumor was found to be a paraganglioma with ependymal features. Therefore no adjuvant therapy was applied. There is no evidence of recurrence or metastases for 15 months after her operation. Paraganglioma in the cauda equina/ filum terminale is very rare and can be misdiagnosed as ependymoma especially when it exhibits ependymoma-like histology. This rare form of paraganglioma behaves like a WHO grade I tumor of CNS like classic paraganglioma. No recurrence or metastasis is expected when it is totally resected. Morphology can be misleading hence immunohistochemistry and/or ultrastructural study is necessary for correct diagnosis.
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    Giant Cell Glioblastoma; Long-Term Survival, and Correlation With Usual Glioblastoma
    (JOURNAL NEUROLOGICAL SCIENCES, 2008) Midi, Ahmet; Belirgen, Muhittin; Sav, Aydin; Bozkurt, Suheyla; Midi, Ipek; Kilic, Tuerker
    Background: Giant cell glioblastoma (GCGB) is a rare tumor of the central nervous system and it accounts for only 1% of all intracranial tumors and 5% of glioblastomas. Objective: The aim of this study is to assess the histopathological and immunohistochemical findings and their correlation with survival time. Material-Method: We retrieved 23 consecutive GCGB specimens from a cohort of 650 glioblastoma cases and 24 usual glioblastoma cases with known survival information between 1995 and 2003. We used silver stain for reticulin framework, Ki-67, GFAP and CD45 as immunohistochemical stains. Results: GCGB accounts for 5% of all glioblastomas. The average survival is 31 and 16 months in GCGB and UGB respectively. There were significant differences between GCGB and UGB including the tumor infiltrating lymphocyte, perivascular lymphocyte, giant cell and oligodendroglia-like cells as histologic parameters. Presence of oligodendroglia-like cells was positively correlated with survival in GCGB. The parameters that were correlated with survival in UGB were younger age, high mitosis rate and a high Ki-67 proliferating index. Other parameters were not statistically significant in correlation with survival. Conclusion: GCGB had an overall longer survival rate than classical glioblastoma but the result was not statically significant.
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    Investigation of The Effect of Radiotherapy on The Proliferative Index (Ki-67) in Recurring Diffuse Glial Tumors
    (JOURNAL NEUROLOGICAL SCIENCES, 2011) Midi, Ahmet; Belirgen, Muhittin; Caglar, Hale; Sav, Aydin
    Introduction: Radiotherapy (RT) has various effects such as apoptosis stimulation, mitosis inhibition, mutagenic effect, chromosomal aberration and neoplastic transformation. Aim: The aim of this study was to investigate the effect of RT administered to diffuse glial tumors on the proliferation activity and mitotic activity of the tumor. Material-Method: An overall of 49 re-operated recurrent cases (16 cases had received postoperative RT while 33 cases did not receive RT) diagnosed as glial tumor were included in this study. The tumor cohort consisted of diffuse astrocytoma, oligodendroglioma and oligoastrocytomas. Ki-67 proliferating index, mitoses and grades of the primary and recurrent tumors were compared. Result: We found that the grades of recurrent tumors were lower than the grade during the first surgery in cases that had RT compared to those that had not. Similarly, Ki-67 was lower in cases that had received RT. We also noted suppressed mitotic activity in cases that had received RT.