Unusual case of bladder duplication: Complete duplication in coronal plane with single urethra and no associated anomalies

Duplication of the bladder is an unusual congenital anomaly. Complete and incomplete forms are well defined in published reports. We present an unusual case of a 3-year-old boy with two separate-walled bladders, one lying in front of the other, communicating through a tiny septum, at the neck of the primary bladder that drained to a normal single urethra. This type of isolated bladder anomaly was not defined in the classification of the duplication of the bladder. In patients with a lower abdominal cystic mass, complete bladder duplication must be included in the differential diagnosis of pelvic cystic masses.

COX-2 and survivin are overexpressed and positively correlated in endometrial carcinoma

OBJECTIVES

To investigate the expressions of survivin and Cyclooxygenase-2 (COX-2), and their possible correlations in the development of endometrial adenocarcinoma (EC). We also looked at their association with classical prognostic factors in EC. To our knowledge, this is the first time survivin expression is investigated in terms of its relation to COX-2 in the developmental pathway of EC.

METHODS

Archived tissue samples of 50 EC, 30 endometrial hyperplasia and 20 proliferative endometrium were selected and immunohistochemically analyzed for survivin and COX-2 expression.

RESULTS

Both survivin and COX-2 were overexpressed in hyperplasia and endometrial adenocarcinoma cases compared to proliferative endometrium, which was statistically significant (p=0.01, p=0.02, respectively). Among EC cases, survivin and COX-2 were strongly positive in 38 (76%) and 30 (60%) patients, respectively. Furthermore, we found survivin and COX-2 to be positively correlated, which was also statistically significant (p=0.0001, r=0.46). Neither survivin nor COX-2 expression was correlated with classical prognostic factors of endometrial carcinoma such as myometrial invasion, grade or lymph node metastasis (p>0.05). Neither COX-2 nor survivin had an impact on overall survival (p>0.05).

CONCLUSIONS

Both survivin and COX-2 are overexpressed, and they seem to be early events in the occurrence of EC. Moreover, protein products of these two genes are positively correlated. COX-2 and survivin might share a common molecular pathway or enhance each other's actions in the developmental pathway of EC. Molecular basis of such a relationship should be further investigated in endometrial carcinogenesis.

Microvessel density, VEGF expression, and tumor-associated macrophages in breast tumors: correlations with prognostic parameters

Angiogenesis plays an important role in tumor growth, metastasis, and prognosis. Vascular endothelial growth factor (VEGF) is a potent endothelial mitogen and acts on the angiogenic stimulation of human neoplasias. In infiltrative ductal carcinoma (IDC), VEGF expression is correlated with high vascularity. Tumor-associated macrophages (TAMs) contribute to tumor proliferation, progression and angiogenesis and have a complex role in tumor biology. In this study, the correlations between microvessel density (MVD), VEGF expression, and TAMs and their relations to clinicopathological parameters such as tumor size, metastatic lymph node, mitotic activity index (MAI) and tumor grade were investigated in 48 cases of IDC and 30 infiltrative lobular carcinoma (ILC) cases. MVD showed a significant positive correlation with TAMs, VEGF, metastatic lymph nodes, tumor size and grade in IDC (P < 0.001). In ILC, MVD and tumor size were positively correlated (P = 0.003), while MVD was not correlated with VEGF, TAMs, MAI, metastatic lymph nodes, and grade. These findings are suggestive of angiogenesis stimulation in IDCs by VEGF, driving the macrophages into the tumor area. MVD and TAMs were found to be important prognostic factors in IDCs. On the other hand, however, VEGF did not contribute to angiogenesis in ILCs, and MVD and TAMs did not have any prognostic significance. These results suggest the involvement of factors not related to VEGF in the angiogenesis of lobular carcinoma.

Lobular carcinoma of the breast metastatic to the uterus in a patient under adjuvant anastrozole therapy

This is the first report of breast carcinoma metastatic to the endometrium in a patient on adjuvant anastrozole therapy. We report a case of metastatic lobular carcinoma of the breast in a 63-year-old patient on adjuvant anastrozole therapy for 8 months. She was asymptomatic and metastatic endometrium was diagnosed after transvaginal ultrasound revealed suspicious findings along with elevated Ca 15-3 levels. As further work up showed no other metastatic sites her uterus was taken out along with her ovaries and pelvic lymph nodes. Uterine metastases should be kept in mind in asymptomatic patients on anastrozole therapy.

Expression of cyclin H in normal and cancerous endometrium, its correlation with other cyclins, and association with clinicopathologic parameters

Cyclins are known as regulatory proteins in cell cycle. Cyclin H is a part of cyclin H/Cdk7/Mat1 complex, which is necessary for cellular proliferation. This study was designed to investigate the correlation of cyclin H expression with tumorigenesis of the endometrium and clinicopathologic variables. Immunohistochemical staining using labeled streptavidin-biotin complex was performed on formalin-fixed, paraffin-embedded endometrial tissues of the proliferative, hyperplastic, and carcinomatous types. Immunostaining for cyclins A, B1, D1, D3, E, H, and cyclin dependent kinase 2 were evaluated. The expression of cyclins A, D1, D3, and H in hyperplasia was significantly more frequent than those of proliferative phase and less than those of endometrioid adenocarcinoma. The expression of cyclin H was correlated with lymphvascular space invasion and clinical stage in carcinoma but not with myometrial invasion, lymph node metastasis, and menopause status. The expression of cyclin H could be involved in the transformation of the endometrium into malignancy and might be a marker for more proliferative and malignant features. It might be one of the biomarkers for determining proliferative activity in endometrial hyperplasia and endometrioid adenocarcinoma.

Expression of survivin, PTEN and p27 in normal, hyperplastic, and carcinomatous endometrium

We aimed to investigate if expressions of survivin and p27 proteins are involved in the development of endometrioid carcinoma, along with whether there are any correlations between these proteins and loss of wild-type PTEN that is found in up to 80% of endometrial carcinomas. We also studied their correlations with classical prognostic factors and survival in endometrial carcinoma. To our knowledge, this is the first time survivin expression is investigated in endometrial hyperplasia along with endometrioid adenocarcinoma. For immunohistochemical analysis, 29 endometrioid adenocarcinoma, 38 endometrial hyperplasia, and 10 proliferative endometrium tissue samples were selected in the pathology archives. Staining of cells was scored as +2 if >50%, +1 if <50%, and negative if none were stained positive. Survivin expression increased from proliferative to hyperplasia to carcinoma cases. PTEN and p27 expressions decreased in hyperplasia and carcinoma cases with respect to proliferative endometrium. All these differences were statistically significant (P < 0.05). PTEN positively correlated to p27 (P < 0.05); however, neither was correlated with survivin. None of these genes were correlated with classical prognostic factors such as grade and myometrial invasion in endometrioid adenocarcinoma. However, mean survival was statistically significantly higher in PTEN-positive cases (46.6 vs 16.4 months) (P < 0.05). Survivin overexpression might be one of the important mechanisms in the development of endometrioid adenocarcinoma along with lost or decreased activity of PTEN and p27. However, survivin seems to exert its role in ways different from those of PTEN or p27 in the development of endometrioid adenocarcinoma. These findings on the role of survivin in endometrioid adenocarcinoma should be confirmed and the pathways through which survivin acts in endometrioid adenocarcinoma studied further with a larger sample size.

Effects of aspirin on placenta and perinatal outcomes in patients with poor obstetric history

OBJECTIVE

The aim of this study was to compare a low-dose aspirin treatment on placental and perinatal effects in the patients with poor obstetric history such as preeclampsia, intrauterine growth retardation (IUGR) in previous pregnancy.

STUDY DESIGN

This retrospective study of 86 pregnant women was conducted between April 2002 and June 2005. In this study period 364 placentas were examined and the patients with poor obstetric history such as IUGR and preeclampsia were selected. Then the patients were assigned to three groups; group 1 (n = 30) was composed of women with no risk in previous pregnancy; group 2 (n = 27) was composed of patients with poor obstetric history (e.g., preeclampsia, IUGR) who were treated with aspirin and patients in group 3 (n = 29) had poor obstetric history without any treatment (patients who were started to follow-up after 14 weeks of gestation). Patients in group 2 were treated with a low-dose aspirin (80 mg/day) as soon as a urinary pregnancy test was positive. Treatment was usually stopped at 34 completed weeks of gestation. On histopathologic examination of the placenta, uteroplacental vascular pathologic features and secondary villous damage (such as fibrinoid necrosis of desidual vessels, villous infarct, severely increased villous fibrosis, severely increased syncytiotrophoblast knotting, obliteration of the vessel lumen, severely increased villous hypervascularity) and also lesions involving coagulation (such as excessive perivillous fibrin deposition, multiple occlusive thrombi in uteroplacental vessels, avascular villi ) were examined.

RESULTS

There were no significant differences between the groups with respect to maternal age, body mass index at the first trimester and delivery. Also there were no significant differences among groups with respect to placental weight, fetal height, weight, gestational week, umbilical artery pH, pO2, pCO2 and base excess status. The incidences of preeclampsia were 3.3, 7.4, 6.8% and the incidences of IUGR were 6.7, 11.1, 6.8% in the groups, respectively (P > 0.05 for both). Although the percentages of all pathologic findings were higher in groups 2 and 3, these differences were not statistically important.

CONCLUSION

When low-dose aspirin is taken, starting at the beginning of pregnancy in patients with poor obstetric history, there are still high frequencies of uteroplacental vascular and related villous lesions persisted on placental bed. Also it has no beneficial effects on perinatal outcomes in these patients.

Expression of survivin, PTEN and p27 in normal, hyperplastic, and carcinomatous endometrium

We aimed to investigate if expressions of survivin and p27 proteins are involved in the development of endometrioid carcinoma, along with whether there are any correlations between these proteins and loss of wild-type PTEN that is found in up to 80% of endometrial carcinomas. We also studied their correlations with classical prognostic factors and survival in endometrial carcinoma. To our knowledge, this is the first time survivin expression is investigated in endometrial hyperplasia along with endometrioid adenocarcinoma. For immunohistochemical analysis, 29 endometrioid adenocarcinoma, 38 endometrial hyperplasia, and 10 proliferative endometrium tissue samples were selected in the pathology archives. Staining of cells was scored as +2 if >50%, +1 if <50%, and negative if none were stained positive. Survivin expression increased from proliferative to hyperplasia to carcinoma cases. PTEN and p27 expressions decreased in hyperplasia and carcinoma cases with respect to proliferative endometrium. All these differences were statistically significant (P < 0.05). PTEN positively correlated to p27 (P < 0.05); however, neither was correlated with survivin. None of these genes were correlated with classical prognostic factors such as grade and myometrial invasion in endometrioid adenocarcinoma. However, mean survival was statistically significantly higher in PTEN-positive cases (46.6 vs 16.4 months) (P < 0.05). Survivin overexpression might be one of the important mechanisms in the development of endometrioid adenocarcinoma along with lost or decreased activity of PTEN and p27. However, survivin seems to exert its role in ways different from those of PTEN or p27 in the development of endometrioid adenocarcinoma. These findings on the role of survivin in endometrioid adenocarcinoma should be confirmed and the pathways through which survivin acts in endometrioid adenocarcinoma studied further with a larger sample size.

Gastrointestinal stromal tumors presenting as pelvic masses: report of two cases

We present two cases of gastrointestinal stromal tumors (GISTs) that presented as pelvic masses. These tumors can present diagnostic problems and they may be difficult to discover preoperatively. GISTs are neoplasms that can be diagnosed utilizing immunohistochemistry, especially detecting CD117 (c-kit) reactivity along with associated histological features. GISTs, should be considered in the differential diagnosis of ovarian tumors especially when imaging studies and rectovaginal examination findings are inconclusive and vague. Histologic diagnosis of these tumors are important considering the efficacy of tyrosine kinase inhibitor therapy after surgery in such cases.

Giant chondroblastoma of the scapula with pulmonary metastases

A 53-year-old man presented with a 12-year history of a progressively growing solid mass at his left shoulder. A 39x30x18-cm and 14.440-kg mass including the scapula was resected. Pathologic features were specific for chondroblastoma. During the 36-month follow-up, he had multiple inoperable metastatic lesions in his lungs. Histology of the transthoracic needle biopsy showed the metastatic nodules had features specific for chondroblastoma; however, the microscopic features additionally had hyperchromasia and increased mitotic activity in some areas. In the English literature, there are a few cases of chondroblastoma located in the scapula. It is exceptional to see this lesion in the sixth decade of life and with pulmonary metastases.

Sterile vesicoureteral reflux decreases tubular cell apoptosis in rat kidney

OBJECTIVES

To assess the possible role of apoptosis in reflux-related renal scarring by investigating how sterile vesicoureteral reflux affects apoptosis of glomerular and tubular cells in the rat kidney.

METHODS

Twenty-nine rats were assigned to one of three groups: group 1, reflux (n = 10); group 2, sham surgery (n = 9); and group 3, controls (n = 10). All rats underwent bilateral nephrectomy 42 days later. Terminal deoxynucleotidyl transferase-mediated dUTP-biotin nick-end labeling was used to detect the apoptotic cells, and separate apoptotic index values for glomerular cells (GCAI) and tubular cells (TCAI) were calculated in each kidney (left and right from each animal).

RESULTS

The mean TCAI value in the left kidney from groups 1, 2, and 3 was 0.86% +/- 0.26%, 1.20% +/- 0.18%, and 1.19% +/- 0.14%, respectively. The corresponding TCAI values for the right kidneys were 0.77% +/- 0.21%, 1.10% +/- 0.34%, and 1.06% +/- 0.15%. The mean GCAI value in the left kidney from groups 1, 2, and 3 was 0.26% +/- 0.14%, 0.28% +/- 0.08%, and 0.20% +/- 0.10%, respectively. The corresponding GCAI values for the right kidneys were 0.23% +/- 0.06%, 0.26% +/- 0.06%, and 0.22% +/- 0.12%. Analysis revealed no significant differences among the groups with respect to GCAI in the left kidneys (P = 0.258) or right kidneys (P = 0.618). The mean TCAI values in group 1 were significantly lower than the corresponding values in groups 2 and 3 for the left (P = 0.001) and right (P = 0.012) kidneys.

CONCLUSIONS

This is the first study to have shown that sterile vesicoureteral reflux decreases apoptosis in tubular cells in rat kidneys with vesicoureteral reflux.

A rare cause of acute appendicitis: parasitic infection

The role of parasitic infection in the aetiology of acute appendicitis has been discussed for more than 100 years. The aim of this retrospective study was to determine the prevalence of parasitic infection in surgically removed appendices, and to identify whether this type of infection is associated with appendicitis. 104 appendices were removed from patients clinically diagnosed with acute appendicitis, and 30 were removed in the course of other surgical procedures. All the operations were performed at Baskent University Adana Hospital between January 1999 and December 2004. Enterobius vermicularis was identified in 4 (3.8%) appendices from patients with clinical appendicitis, and Entamoeba histolytica was detected in 1 (1.0%) appendix from this group. No parasites were found in the 30 appendices that were removed during other surgical procedures. Specimens from 3 of the 4 appendices with E. vermicularis showed no histological evidence of acute inflammation. It is concluded that parasites in the appendix may produce symptoms which resemble acute appendicitis, but parasitic infection rarely causes acute appendicitis.

Malignant struma ovarii: A case report

Malignant struma ovarii is a rare form of the ovarian germ cell tumors. Hence, diagnosis and management of malignant struma ovarii have not been clearly defined. We present the case of a 34-year-old woman with papillary carcinoma arising in struma ovarii. The malignant component of this tumor was detected after laparoscopic removal, and a re-staging operation was performed afterwards. There was no evidence of clinical malignancy or metastases. In this paper, clinical features, treatment guidelines, diagnostic features, and immunohistochemical characteristics of this tumor are reviewed.

MALTOMA Presenting With Thrombocytopenia

Immune thrombocytopenia of malignancy is most frequently associated with lymphoproliferative disorders. Thrombocytopenia generally does not develop in MALT subtype of lymphoma (MALTOMA) unless the tumor has infiltrated the bone marrow. Cytopenias resulting from immunologic causes in patients with MALT lymphoma were rarely reported in the literature. In this report, a woman was diagnosed with stage IIE gastrointestinal MALTOMA. Bone marrow infiltration was not present. Patient also had thrombocytopenia, which did not improve after intravenous steroid treatment. Thrombocyte count increased after a single gamma-globulin infusion, and 6 cycles of chemotherapy were given every 21 days. The patient has remained in complete remission.

Helicobacter pylori eradication lowers serum homocysteine level in patients without gastric atrophy

AIM

To determine whether Helicobacter pylori (H pylori)infection caused hyperhomocysteinemia by altering serum vitamin B(12), serum folate and erythrocyte folate levels and whether eradication of this organism decreased serum homocysteine level.

METHODS

The study involved 73 dyspeptic H pylori-positive patients, none of them had gastric mucosal atrophy based on rapid urease test and histology. Out of 73 patients, 41 (56.2%) showed a successful eradication of H pylori 4 wk after the end of treatment. In these 41 patients, fasting serum vitamin B(12), folate and homocysteine levels, and erythrocyte folate levels before and 4 wk after H pylori eradication therapy were compared.

RESULTS

The group with a successful eradication of H pylori had significantly higher serum vitamin B(12) and erythrocyte folate levels in the post-treatment period compared to those in pre-treatment period (210+/-97 pg/mL vs 237+/-94 pg/mL, P<0.001 and 442+/-212 ng/mL vs 539+/-304 ng/mL, P = 0.024, respectively), but showed no significant change in serum folate levels (5.6+/-2.6 ng/mL vs 6.0+/-2.4 ng/mL, P = 0.341). Also, the serum homocysteine levels in this group were significantly lower after therapy (13.1+/-5.2 micromol/L vs 11.9+/-6.2 micromol /L, P = 0.002). Regression analysis showed that serum homocysteine level was positively correlated with age (P = 0.01) and negatively with serum folate level before therapy (P = 0.003).

CONCLUSION

Eradication of H pylori decreases serum homocysteine even in patients who do not exhibit gastric mucosal atrophy. It appears that the level of homocysteine in serum is related to a complex interaction among serum vitamin B(12), serum folate and erythrocyte folate levels.

Unusual case of skull metastasis secondary to pancreatic adenocarcinoma

Skull metastasis must be kept in mind when considering the differential diagnosis of a skull tumor. Skull metastases cause local swelling that is usually painless, and rarely they lead to neurologic dysfunction. Despite the fact that hematogenous skull metastases can be caused by nearly all types of tumors (lung, prostate, thyroid carcinoma, malignant melanoma), breast cancer is associated with the highest rate of metastatic skull lesions. We report an extremely rare case of skull metastasis from a pancreatic adenocarcinoma, in a 65-year-old woman, presented with painless frontoparietal scalp swelling which developed within three months. To the best of our knowledge, this is the second case involving the skull secondary to a pancreatic adenocarcinoma, and the first case when skull metastasis was the first evidence of a pancreatic adenocarcinoma.

Epidermoid carcinoma arising in Warthin’s tumor

Warthin's tumor is a well-defined salivary gland neoplasm consisting of benign epithelial and lymphoid components. However, malignant transformation is extremely rare and the differential diagnosis of metastasis from an epidermoid carcinoma in Warthin's tumor is important. We present a case with epidermoid carcinoma arising in Warthin's tumor of parotid gland in a 48-year-old woman, and differential diagnosis is discussed.

p53 EXPRESSION AND APOPTOSIS IN VARICOCELE IN THE RAT TESTIS

PURPOSE

We investigated the presence of p53 expression and apoptosis in an experimental model of varicocele in the rat.

MATERIALS AND METHODS

A total of 30 adult male Sprague-Dawley rats were studied in 3 groups, namely group 1-13 with varicocele, group 2-9 with sham operation and group 3-8 controls. All animals underwent orchiectomy after 30 days and sections of the left testis from each animal were studied. TUNEL was used to detect apoptotic germ cells and an apoptotic index (AI) was calculated for each testis specimen. p53 expression was determined immunohistochemically and graded according to the proportion of cells stained in each specimen.

RESULTS

AI values in group 1 testes were 0% to 0.51% (mean 0.06% +/- 0.13%) and the corresponding range in group 2 was 0.04% to 0.69% (mean 0.25 +/- 0.21%). No group 3 control specimens showed TUNEL staining (AI 0% in all). Although the mean AI in group 1 was higher than that in controls, this difference was not statistically significant (p = 0.318). The mean AI value in group 2 was significantly higher than in the control group (p = 0.021) but it was comparable to that in group 1 (p = 0.099). Seven (53.8%) and 2 (22.2%) specimens in groups 1 and 2, respectively, showed p53 staining in germ cell nuclei. None of the specimens in group 3 showed nuclear p53 expression. The grade of p53 expression in group 1 was significantly higher than that in groups 2 (p = 0.042) and 3 (p = 0.011). Expression grades in groups 2 and 3 were not significantly different (p = 0.426).

CONCLUSIONS

To our knowledge p53 expression that may reflect abnormal spermatogenesis has been documented for the first time in an experimental model of varicocele in the rat testis. In contrast to other investigations, no link between apoptosis and varicocele was detected.

Primary thyroid lymphoma: report of two cases

Primary thyroid lymphoma is a rare disease. Most of the patients have a history of Hashimoto's thyroiditis. Main histopathologic subtypes are either mucosa-associated lymphoid tissue (MALT) or diffuse large cell lymphomas. Treatment options are surgical resection in localised, low-grade MALT lymphomas or systemic chemotherapy in aggressive, diffuse large cell lymphomas. But, sometimes other histopathologic subtypes can be seen and therapeutic approaches must be done. We report two patients who have primary thyroid lymphoma. There was no history of Hashimoto's thyroiditis in either case, and neither of them had MALT histologic subtype. First patient a sixty four year old woman, admitted to hospital because of bilateral thyroid nodules. Histological subtype was B cell follicular lymphoma. Subtotal thyroidectomy was performed and radiotherapy was administered to the entire neck region. Second patient, a 50 year old man, presented with complaints of a left thyroid mass and dyspnoea. Total thyroidectomy was carried out and chemotherapy was given. Histological diagnosis was diffuse large B cell lymphoma. Thyroid lymphomas had heterogenous histological and clinical characteristics. In localised, non-aggressive subtypes, surgical treatment must be considered. Postoperative chemotherapy or radiotherapy may be necessary in some patients.

Lumbar meningeal hamartoma and epidermoid cyst associated with spinal dysraphism in an elderly patient

Meningeal hamartoma associated with spinal dysraphism in an elderly patient is an extremely rare clinical presentation. A 62-year-old woman who progressively developed gait disturbance and urinary retention was admitted to our hospital. Magnetic resonance imaging (MRI) revealed a large cystic mass associated with a dermal sinus at the L4-L5 level. MRI was useful in the diagnosis and determination of this lesion. However, preoperative differential diagnosis of the tumor was not possible based on neuroimaging evidence. The diagnosis of meningeal hamartoma was based on the histological and immunohistological findings of the specimen obtained from the tumor. Meningeal hamartoma associated with spinal dysraphism should be kept in mind, even in adult cases. In this article, we also discuss the radiological and pathological appearance of this rare clinical entity.

An unusual cause of acute abdomen: torsion of colonic duplication over a duplicated appendix

A 2-year old boy with torsion of colonic duplication, which had a proximal communication with the cecum via an incomplete duplicated appendix, is presented. The clinical picture and complications of this rare association are discussed.

EXPERIMENTAL VARICOCELE INDUCES HYPOXIA INDUCIBLE FACTOR-1α, VASCULAR ENDOTHELIAL GROWTH FACTOR EXPRESSION AND ANGIOGENESIS IN THE RAT TESTIS

PURPOSE

In this study we investigated hypoxia inducible factor-1alpha (HIF-1alpha) and vascular endothelial growth factor (VEGF) expression, and angiogenesis in an experimental model of varicocele in the rat testis.

MATERIALS AND METHODS

A total of 30 adult male Sprague-Dawley rats were investigated in 3 groups, namely varicocele group 1 (13), sham operated group 2 (9) and control group 3 (8). At 30 days after surgery was completed in groups 1 and 2 orchiectomy was performed in all rats. Histological findings in the left testicles of rats from each group were compared. HIF-1alpha and VEGF expression was immunohistochemically studied and CD31 panendothelial antigen was used to identify the number of microvessels, that is microvessel density (MVD), in paraffin embedded sections of testis tissue. Data were analyzed using the chi-square test, Fisher's exact test, 1-way ANOVA and the Tukey HSD test for post hoc comparison.

RESULTS

HIF-1alpha expression was detected in 12 specimens (92.3%) in group 1, 4 (44.4%) in group 2 and 2 (25%) in group 3. The frequency of HIF-1alpha positivity in group 1 was significantly higher than the rates in groups 2 (p = 0.023) and 3 (p = 0.003). VEGF expression was detected in 8 specimens (61.5%) in group 1 but none of the group 2 or 3 specimens were VEGF positive. The frequency of VEGF positivity in group 1 was significantly higher than that in groups 2 (p = 0.006) and 3 (p = 0.007). Mean MVD +/- SD in group 1 was 7.53 +/- 1.50 (range 6 to 12), and findings in groups 2 and 3 were 5.88+/-1.45 (range 4 to 8) and 5.12 +/-1.12 (range 4 to 7), respectively. Mean MVD in group 2 was higher than in group 3 but this difference was not significant (p = 0.509). Mean MVD in group 1 was significantly higher than the mean values in groups 2 (p = 0.030) and 3 (p = 0.002).

CONCLUSIONS

Previous study of experimental varicocele models in rats documented HIF-1alpha and VEGF expression combined with angiogenesis in the testis. The results of this study show that varicocele can lead to tissue hypoxia and related pathophysiological events, such as angiogenesis.

Acinic cell carcinoma with follicular pattern of the soft palate

Acinic cell carcinoma (ACC) is an uncommon low-grade malignancy of the salivary glands. Most cases occur in the major salivary gland, but a few cases affecting the minor salivary gland have also been described. Although various growth patterns have been reported in the literature, a few cases have been diagnosed as ACC with follicular pattern. We present a rare case of ACC with follicular pattern of the soft palate in a 60-year-old man. The occurrence of ACC in this area is extremely rare, and its striking thyroid-like appearance may cause confusion in the differential diagnosis.

Acute interstitial nephritis due to cefoperazone

OBJECTIVE

To describe a case of cefoperazone-induced acute interstitial nephritis (AIN) in which the diagnosis was supported by renal biopsy.

CASE SUMMARY

A 35-year-old woman presented to our hospital with decreased urine output and no past history of renal problems. Fifteen days prior to presentation, she had started treatment with intramuscular cefoperazone 1 g/day for a scalp infection. On day 12 of therapy, the patient noted decreased urine output, anorexia, and weakness, but she continued taking cefoperazone for 3 more days. Hemodialysis and oral prednisolone 1 mg/kg (30 mg twice daily) were started. Renal function returned to normal after 2 months of prednisolone treatment.

DISCUSSION

Although AIN has been linked with other cephalosporins, as of June 18, 2004, to our knowledge, this is the first report of a cefoperazone-induced case. We based our diagnosis on the features of acute-onset renal failure, abnormal urinalysis findings, eosinophilia, inflammatory infiltrate in the interstitium, and recovery from renal failure after initiation of corticosteroid treatment. Application of the Naranjo probability scale indicated a probable relationship between the acute renal failure secondary to the possible AIN and cefoperazone therapy in this patient.

CONCLUSIONS

This case indicates that cefoperazone, like other cephalosporins, can cause AIN. We recommend close monitoring of renal function in patients who are prescribed this drug.