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    Contribution of BAP1 loss and p16 (CDKN2A) deletion analysis to the definitive diagnosis of mesothelioma in effusion cytology
    (Verduci Publisher, 2023) Aydogdu, G.; Ozekinci, S.
    OBJECTIVE: The cytological diagnosis of mesothelioma is a controversial is-sue, and definitive diagnosis often requires ancillary tests. The aim of this study was to investigate the contribution of BRCA1-associated protein (1) (BAP1) loss and p16 (CDKN2A) homozygous deletion (HD) on the early diagnosis of mesothelioma in effusion fluids. MATERIALS AND METHODS: Between 2019-2022, 21 pleural and peritoneal fluid samples di-agnosed with atypical mesothelial proliferation in our institution were included in the study. The slides of the cases that underwent BAP1 immu-nohistochemistry (IHC) were retrieved from the archive and re-examined. Homozygous deletion (HD) of p16 (CDKN2A) was investigated by the fluorescence in situ hybridization (FISH) method in cell blocks of cytology samples. At least 100 atypical mesothelial cells were counted in each case, and the HD threshold value was >10%. RESULTS: The mean age of the cases was 63.47 years (34-90 years), female/male ratio was 3/1. Of the pleural mesothelioma cases, 16 were epithelioid, 2 were biphasic, and 1 were sarco-matoid. Two cases were diagnosed with perito-neal well-differentiated papillary mesothelioma (WDPM). BAP1 loss was observed in 11 (69%) of 16 cases. HD deletion of p16 (CDKN2A) was seen in 11 (58%) patients with FISH. The HD threshold value was 10-20% in 6 of the cases, 30-50% in 3 cases, and above 90% in 2 cases. While HD de-letion was observed in p16 (CDKN2A) in all bi-phasic and sarcomatoid cases (n=3), no deletion was observed in peritoneal WDPM (n=2). Positiv-ity was observed with at least one method in 12 (86%) of 14 pleural mesotheliomas who under-went both BAP1 IHC and p16 (CDKN2A) FISH. Due to technical reasons, the FISH signal could not be obtained in two cell blocks, so no results could be obtained. CONCLUSIONS: Asbestos exposure in ar-eas where mesothelioma is endemic and/or the presence of proliferating mesothelial cells in cy-tological examination are important clues for diagnosis. In controversial cases, BAP1 IHC should be the first step in an ancillary test. Al-though the FISH method applied to cell blocks has cytology-specific limitations and difficul-ties, investigating the p16 (CDKN2A) deletion with FISH in selected cases will contribute to the diagnosis.
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    Management of symptomatic urachal cysts in children
    (Wolters Kluwer Medknow Publications, 2019) Basuguy, E.; Okur, M. H.; Zeytun, H.; Arslan, S.; Aydogdu, B.; Otcu, S.; Aydogdu, G.
    Aim: We report the results of the surgical treatment of symptomatic urachal cysts. Materials and Methods: The medical records of patients who underwent urachal cyst excision between 2012 and 2017 were reviewed retrospectively at our hospital. The age, sex, presenting complaint, method of diagnosis, average cyst diameter, surgical procedure, and postoperative complications of each patient were recorded. Results: Twenty-seven patients who had urachal cyst were included in this study; 5 out of 27 patients were treated conservatively and the rest of patients were treated surgically, made up of 16 males (72%) and 6 females (28%). The average age of the patients was 7 years (range: 1u17). The most common reason for referral was abdominal pain in 12 patients (54%), discharge in 6 patients (28%), fever in 2 patients (9%), and an abdominal mass in 2 patients (9%). An ultrasound scan was performed in all patients as an initial imaging study. The average cyst diameter was 1.5 cm (range: 1u6 cm). Laparotomy was performed in 16 patients, with 6 patients undergoing laparoscopic excision. Postoperative wound infection developed in two patients. Conclusions: Patients with urachal cysts may be managed conservatively initially. However, patients who do not show any clinical and radiological signs of regression, or those who have large cysts, should undergo surgical excision through laparotomy or a laparoscopic approach.