[Orbital varix presenting with enophthalmos. A case report]

We report a 23-year-old patient, presenting with enophthalmos in the left eye. The ophthalmologic examination was normal, except a 3-mm enophthalmos measured using the Hertel's exophthalmometer and an intermittent proptosis observed through the Valsalva maneuver. Orbital imaging tests disclosed a retroocular vascular lesion. A carotis arteriography was performed, and it revealed a tumor with vascular elements presumed to be orbital varix. Ultrasound Doppler examination showed a nonechogenic lesion with an increasing volume during Valsalva. Based on these findings, the tumor was diagnosed as orbital varix. We decided to manage the patient conservatively, in the absence of complications such as proptosis with corneal exposure, optic nerve compression, or esthetically unacceptable appearance. Orbital varix is a vascular anomaly, accounting for 2 % of orbital tumors. It generally presents with an intermittent exophthalmos or orbital hemorrhages. The development of enophthalmos associated with varices, such as reported in our case, is rare.

Good prognosis for primary ovarian pure nongestational choriocarcinoma using the EMA/CO regime

Nongestational choriocarcinoma of the ovary is a rare germ cell tumor with a worse prognosis than gestational choriocarcinoma. In this report we present a case of nongestational chroriocarcinoma where the EMA/CO regime was applied. The clinical features, management, and outcome are discussed.

Co-existence of gastrointestinal stromal tumors with malign epithelial tumors: a report of two cases

AIM

To emphasize the importance of a detailed observation for incidental simultaneous tumoral masses during surgery for gastrointestinal stromal tumors (GISTs) at any location in the gastrointestinal system.

CASE PRESENTATIONS

Case 1: a 39-year-old female patient with an esophageal squamous cell carcinoma and a synchronous small intestinal GIST discovered incidentally during esophagectomy. Case 2: a 73-year-old female patient with a gastric GIST and a synchronous colorectal cancer detected incidentally during gastrectomy. In both cases, immunohistochemical examinations of the resected specimens confirmed the coexistences of GISTs and epithelial malignancies.

CONCLUSION

The coexistences of GISTs with epithelial tumors have been increasing in recent years. In any case of a GIST or gastrointestinal adenocarcinoma, the surgeon should be alert to recognize a possible coexistent tumor with different histological origin.

Relationship between serum soluble E‐selectin levels and development of diabetic retinopathy in patients with type 2 diabetes

OBJECTIVE

To investigate whether diabetic retinopathy is associated with serum soluble E-selectin (ssE-selectin) level in type 2 diabetic patients.

MATERIAL AND METHODS

Fifty-six patients with type 2 diabetes classified as Groups A, B, C and D according to grade of retinopathy were enrolled in the study. Sixteen age- and gender-matched healthy control subjects were also enrolled. Levels of ssE-selectin were measured using enzyme-linked immunosorbent assays (ELISAs) in all patients and control subjects. Clinical characteristics and ssE-selectin levels were compared between the groups.

RESULTS

There was no statistically significant difference in ssE-selectin levels between diabetic patients and non-diabetic control subjects (p>0.05). There was also no statistically significant difference in levels of ss E-selectin between diabetic subgroups (Groups A, B, C, D) (p>0.05). No correlation was found between ssE-selectin level and HbA1c, or duration of diabetes in the whole group of diabetic patients (r = 0.10, p>0.05 and r = -0.12, p>0.05, respectively).

CONCLUSIONS

The study shows that no significant elevation of ssE-selectin occurs in patients with type 2 diabetes in comparison with control subjects. Our results also indicate that there is no statistically significant correlation between ssE-selectin level and the development or grade of diabetic retinopathy.

Carcinoma of breast in males in Turkey: a Turkish oncology group study

Abstract #4132

Purpose: Compared to breast carcinoma in women breast carcinoma in males is frequent and information in males is limited. The aim of this multicentric study is to evaluate the treatment results of male patients with breast cancer treated in cancer centers in Turkey.
 Methods: Between 1973-2006, 167 male breast cancer patients who were treated, analyzed retrospectively respect to clinical presentation, treatment, survival and prognostic factors. Median age was 61 (range: 32-90), 51.5% were found in right breast. Majority of the tumors were occured in the central(36.5%) and upper outer quadrant (32.9%). Except one patient, all of them underwent mastectomy. Stage distrubution was as follows; Stage I 9%, Stage II 34.7 %, stage III 44.9%, stage IV 4.8% and 11 patients (6.6%) can not be staged due to Tx or Nx status. The most common histologic type was invasive ductal carcinoma (89.8%). Contralateral breast cancer developed in 3 patients. Of the patients 81.4% (136) received adjuvan radiotherapy for the whole breast and also to the periferial lymphatics for patients carrying high risk factors. Median total dose was 50 Gy with a daily fraction dose of 2 Gy. Five patients were treated with radiotherapy due to recurrences, 3 patients were treated for metastases and one patient was treated for curative intent. Radiation therapy was not given to 22 patients. Adjuvant chemotherapy and hormonal therapy were used in 83 and 70 patients, respectively.
 Results: During a median follow-up duration of 66 months (range: 1-237 months) . Isolated local-regional recurrence and distant metastases were observed in 13.2% and 34.1% of cases, respectively. Five-years overall survival, disease free survival and local control were, 66.1%, 63.4%, 89%, respectively. The prognostic factors influencing overall survival were presence of positive axillary lymp node (p=0.000), T stage (p=0.000), lymph node ratio (>50%) (p=0.001), AJCC stage (p=0.000), skin invasion (p=0.00), nipple invasion (p=0.027) and blood vessel invasion (0.006) in the univariate analysis. In the multivarian analysis, the only prognostic factor which has impact on overall survival was AJCC stage (p=0.023). No prognostic factor was found to be significant for disease free survival and local control.
 Conclusion: In the present study positive axillary lymp node, T stage, Lymph node ratio (>50%), AJCC stage (p=0.000), skin invasion, nipple invasion and blood vessel invasion were the significant prognostic factors for overall survival. In absence of prospective randomised trials, retrospective review data from multi-centre approaches are necessary and this can provide useful guidelines for understanding the biology of breast cancer in males.

Citation Information: Cancer Res 2009;69(2 Suppl):Abstract nr 4132.

Efficacy of deferoxamine, N-acetylcysteine and selenium treatments in rats with Adriamycin-induced nephrotic syndrome

BACKGROUND

Various experimental models related to Adriamycin (ADR)-induced nephropathy have been reported. The purpose of the present study was to evaluate the efficacy of N-acetylcysteine (NAC), deferoxamine (DFO) and selenium in protection against renal injury in ADR nephropathy.

METHODS

The study included 53 Sprague Dawley male rats. Nephrotic syndrome was induced by injection of ADR 5 mg/kg intravenously (n=46). Control rats (n=7) were injected with an equal volume of isotonic saline. After ADR administration, they were divided into a group given only ADR (n=17) and 3 antioxidant treatment groups: (i) NAC (n=10), (ii) DFO (n=10) and (iii) selenium (n=9). In both renal tissue and erythrocytes, oxidative system parameters and trace elements were determined.

RESULTS

Nephrotic syndrome was proven in ADR-injected rats 4 weeks after injections, with proteinuria, higher blood lipids and hypoalbuminemia. All of the antioxidant agents used in the present study to prevent the development of nephrotic syndrome provided benefits for the nephrotic state. Of them, selenium seemed to offer relatively lower and statistically insignificant efficacy for preventing proteinuria compared with the others.

CONCLUSIONS

Our results showed that concomitant administration of some antioxidants with ADR injections seems to have beneficial effects on clinical parameters even if antioxidants were given in a single dose. NAC and DFO are more effective than selenium to prevent renal injury.

Ischemia-reperfusion injury in the liver during renal transplantation: does perfusion solution play any role?

The effect of ischemia-reperfusion (I/R) injury within a transplanted kidney has not been reported on the liver as a remote organ. One hypothesis is that there is no difference between kidney perfusion solutions regarding antioxidants in liver after an I/R injury. We used four pigs with Ringer's lactate (RL); four with university of Wisconsin (UW); and two in a control (C) group. A liver parenchymal biopsy was obtained before renal artery/vein solution clamping for 20 minutes. Either RL or UW solutions were infused through arterial cannulas for 20 minutes as previously described elsewhere. For the sham group, we used 0.9% NaCl. After reperfusion for 20 minutes, we obtained a second liver parenchymal biopsy. Measurements of superoxide dismutase (SOD), glutathione peroxidase (GP-x), and malondialdehyde (MDA) levels were compared using paired student t tests within groups and analysis of variance between groups. The results were expressed as mean values +/- SEM with P < .05 accepted as significant. Although GP-x, SOD, and MDA decreased after ischemia-perfusion-reperfusion injuries in all groups, except MDA in UW and SOD, and MDA in C groups; only the MDA for C was significant (P = .04) Comparing the groups, GP-x (P = .01) and MDA (P = .003) levels after ischemia-perfusion-reperfusion were significant while changes in SOD levels did not show any difference (P > .05). In a kidney transplantation model, the liver was affected during the ischemia-perfusion-reperfusion process as evidenced by antioxidant enzymes. The pathophysiology and clinical importance of this phenomenon requires further study. Comparing the perfusion solutions, no difference was found between RL and UW regarding their effects to decrease renal I/R injury on the liver in pigs.

Radiotherapy in congenital vulvar lymphangioma circumscriptum

Congenital lymphangioma circumscriptum (LC) of the vulva is a rare disorder with unknown etiology. Treatment options include ablative approaches such as laser therapy, sclerotherapy, and surgery. Radiotherapy has been shown to be effective in the management of congenital lymphangioma especially in the thoracic and abdominal lesions. In this report, we describe a patient with persistent vulvar LC despite sclerosing therapy and several surgical excisions. She was treated with a course of external radiotherapy and showed a dramatic objective response with relief of all symptoms

The relation between pure papillary and follicular variant in papillary thyroid carcinoma

OBJECTIVE

Pure papillary thyroid carcinoma and the follicular variant papillary thyroid carcinoma are the most common subtypes of papillary thyroid carcinoma. The aim of this study was to investigate the effects of prognostic factors of these two subgroups in our series.

PATIENTS AND METHODS

Histopathological type of carcinoma was retrospectively revised in 199 patients who were then divided according to such type. Patients' age and gender as well as the size and multicentricity of tumor, association with Hashimoto's thyroiditis, serum thyroglobulin and anti-thyroglobulin antibodies levels, metastatic lymph node and distant metastases status for both groups were evaluated.

RESULTS

Gender, size, multicentricity of tumor, serum thyroglobulin and anti-thyroglobulin levels were similar in both groups. It was found that, although the tumor size of pure papillary thyroid carcinoma was smaller than that of follicular variant papillary thyroid carcinoma, lymph node metastases occurred more frequently when both subgroups were examined.

CONCLUSION

The pathological and clinical signs of pure papillary thyroid carcinoma and follicular variant papillary thyroid carcinoma were found similar. According to these results, this study does not support the literature which claims that follicular variant papillary thyroid carcinoma is more aggressive than pure papillary thyroid carcinoma. Moreover, it could be assumed that the number of patients who are diagnosed as pure papillary thyroid carcinoma may be higher when associated with Hashimoto's thyroiditis.

Morphological investigations on the circulus arteriosus cerebri in mole-rats (Spalax leucodon)

The aim of the present study is to investigate the circulus arteriosus cerebri in mole-rats (Spalax leucodon). Six adult mole-rats were used for this purpose. Coloured latex was injected into the left ventriculus of the hearts of all the animals. After careful dissection, the circulus arteriosus cerebri (the circle of Willis) was investigated. The cerebrum and the cerebellum were supplied by the internal carotid- and the basilar arteries respectively forming the circulus arteriosus cerebri in mole-rats. In the investigated objects, the internal carotid- and the basilar arteries were not united directly and for this reason the circulus arteriosus cerebri was not formed completely in mole-rat. The branches supplying the medulla oblongata and the cerebellum originate from the basilar artery formed by union of the left and right vertebral arteries and the internal ophthalmic, the caudal cerebral, the choroid, the median cerebral, the rostral cerebral arteries originated from the internal carotid artery. After giving off the medial cerebral artery, the right and left rostral cerebral arteries on every two sides divided into the lateral and medial twin branches and by union of the lateral branches the internal ethmoidal artery, and by union of the medial branches, the ramus extending to facies medialis cerebri were formed. The ramus extending to the facies medialis cerebri was anastomosed with the branch of the caudal cerebral artery on the back of the corpus callosum. The last part of the basilar artery gave the two branches running toward the right and left side on the pontocrural groove (sulcus pontocruralis) and every one of these branches ramified into two rami. One of these rami formed into the rostral cerebellar artery and the other one extended to the tectum mesencephali. In conclusion, the arterial circle of the cerebrum and cerebellum was supplied by the internal carotid artery and the basilar artery respectively in mole-rats.

Virchow's node as a first manifestation of ovarian serous carcinoma: case report

Ovarian carcinoma is a malignancy with a poor prognosis especially in patients with advanced disease. The majority of patients with ovarian serous carcinoma are diagnosed in advanced stages. Palpable extraabdominal lymphadenopathy at the time of presentation is distinctly uncommon. This case report addresses a patient with serous ovarian carcinoma presenting as left supraclavicular lymphadenopathy (Virchow's node) and no other symptoms. Not only thyroid or thoracic malignancies but also ovarian malignancies like serous ovarian carcinoma could present with a supraclavicular lymph node without any other symptoms.