Association between Pityriasis Rosea (PR) and HHV-6/HHV-7 Infection: Importance of Sample Selection and Diagnostic Techniques

Recent studies have focused on the role of human herpesvirus 6 (HHV-6) and human herpesvirus 7 (HHV-7) in PR etiology with varying results. In our study, with the approach that the discrepancy between the results may be related to the different samples and techniques used, we aimed to clarify the etiology by examining tissue and plasma samples using molecular methods and evaluating the results together with serological parameters. Skin biopsies and plasma samples of twenty-five PR patients were tested to detect HHV-6 and HHV-7 DNA using calibrated quantitative real-time polymerase chain reaction (CQ RT-PCR). IgG and IgM antibodies against HHV-6 and HHV-7 were tested by enzyme-linked immunosorbent assay and indirect immunofluorescence. Of the patient group, 64% were positive for HHV-6 IgG without IgM positivity. HHV-6 DNA was present in seven tissue and ten plasma samples. HHV-7 positivity was 100% and 12% for IgG and IgM antibodies, respectively. HHV-7 DNA was detected in four tissue samples and one plasma sample. Patients with HHV-7 DNA-positive plasma and tissue samples had also HHV-7 IgM antibodies. In conclusion, our results seem to support the role of HHV-6/HHV-7 in the etiology of PR. To clarify the etiology of PR and avoid confusion, the collection of different biological materials simultaneously and the usage of CQ RT-PCR as a diagnostic technique are recommended.

Efficacy of Neoadjuvant Chemotherapy in Lobular and Rare Subtypes of Breast Cancer

OBJECTIVE

To determine the predictive factors for the pathological complete response (pCR) in patients with non-ductal invasive breast cancer (ND-BC) receiving neoadjuvant chemotherapy.

STUDY DESIGN

Observational study. Place and Duration of the Study: Departments of Medical Oncology, Tekirdag Namik Kemal University, Sirnak State Hospital, Aydin Adnan Menderes University, Marmara University, Bakirkoy Sadi Konuk Hospital, Basaksehir Cam and Sakura Hospital, Sakarya University, Balıkesir Ataturk Hospital, Turkiye, from April 2016 to December 2022.

METHODOLOGY

A total of 222 non-metastatic breast cancer patients who received neoadjuvant chemotherapy were included in this retrospective multicentric study. The clinicopathologic data were obtained from the hospitals' electronic-record-system. The logistic regression models were used to identify predictive factors for pCR.

RESULTS

One hundred and twenty-six patients (56.8%) had invasive lobular carcinoma and 28 patients (12.6%) had signet ring cell/mucinous carcinoma. A total of 45 patients (20.3%) achieved pCR. The pCR rate was 14.3% for lobular carcinoma and 17.9% for signet ring cell/mucinous carcinoma. The univariate analysis showed that estrogen receptor-negative tumours (p = 0.017), high Ki-67 (p = 0.008), high histologic grade (p<0.001), HER2+ expression (p<0.001), and non-lobular histologic type (p = 0.012) were predictive factors for pCR. The multivariate model revealed that HER2 expression (p<0.001) and Ki-67 (p = 0.005) were independent predictors.

CONCLUSION

Neoadjuvant chemotherapy demonstrated effectiveness in ND-BC patients, leading to favourable pCR rates and enabling breast-conserving surgery. Predictive markers for pCR varied depending on histologic types, with HER2 expression, ER status, Ki-67, and histologic grade showing significance in non-ductal subtypes, while HER2 status alone was predictive in lobular carcinoma.

KEY WORDS

Neoadjuvant chemotherapy, Non-ductal breast cancer, Lobular carcinoma.

How Many Bundles Does the Anterior Cruciate Ligament Consist of? A Case Report

In some cases with anterior cruciate ligament (ACL) injury, physical examination and magnetic resolution imaging cannot clearly identify whether the ACL is intact or partially or completely ruptured. A 40-year-old female patient was admitted to our clinic with complaints of knee pain. After the requested examinations, we could not clearly identify whether the ACL was intact or partially or completely ruptured. Arthroscopic knee surgery was planned for the patient. In diagnostic arthroscopy, it was also determined that there was a multibundle ACL that was not surrounded by the synovium and was tight in the figure 4 position. The surgery was completed by repairing the meniscal tear. It was seen in the current case report that the ACL was a multibundle structure without overlying synovium around. In such cases, it is difficult to evaluate the ACL, and it should be kept in mind that there may also be variations of the ACL.

Impact of the 3rd Edition of the Bethesda System for Reporting Thyroid Cytopathology on Grey Zone Categories

INTRODUCTION

Thyroid Bethesda Reporting System is a six-tiered system that aims to bring uniformity in reporting thyroid cytology and improve the communication with clinicians. The system has achieved its goal as a presurgical diagnostic method; however, it remains a screening method in the grey zone categories, namely atypia of undetermined significance (AUS) and follicular neoplasm (FN). The book recently released the 3rd edition, following the recent changes in thyroid pathology. One of the most important novelties is subgrouping AUS category and FN to be able to make a better risk stratification in these categories. Our group aims to retrospectively analyze a large dataset based on the new TBSRTC, with a focus on the grey zone categories.

METHODS

Only patients who underwent lobectomy or total thyroidectomy were included, allowing for direct comparison between cytological and histopathological results. Cytological evaluations, based on the TBSRTC 3rd edition, were methodically compared with their respective histopathological results, enabling a comprehensive analysis.

RESULTS

Of the 244 patients (female:male ratio = 8.8:1, mean age = 56), a total of 252 nodules were evaluated. A distinction was noted with 79 nodules (31%) diagnosed as AUS and 173 nodules (69%) as FN. Intriguingly, the risk of malignancy (ROM) for AUS-overall stood at 44.3%, with AUS-nuclear atypia at 50% and AUS-other at 43.2%. Although the AUS subdivisions did not demonstrate statistical significance, a significant disparity was observed in their distribution, with 15% as AUS-nuclear atypia compared to 85% as AUS-other. This disparity raises the question: Could AUS-other be considered the new waste-basket category in the TBSRTC 3rd edition? Using the TBSRTC 3rd edition as a base, we added a subclassification for FN nodules based on the presence or absence of papillary thyroid carcinoma (PTC) nuclear features. Our findings showed that differentiating FN with oncocytic characteristics correlated well with histological outcomes and ROMs. Though retrospective in design with inherent bias potential, our data suggest a possible improvement in PTC case segregation in the FN category when differentiating between FN nodules with and without PTC nuclear features.

CONCLUSION

Our retrospective study sheds light on the potential advantages of the TBSRTC 3rd edition, particularly in refining the AUS and FN categories for thyroid nodules. The clear disparity in AUS subcategories raises important questions about their classification and potential future refinements. Moreover, the differentiation of FN nodules based on PTC nuclear features holds a promising approach for better risk stratification.

Investigation of serum E-Cadherin, VEGF121, Survivin, Tenascin C and Tetraspanin 8 levels in patients with glioblastoma

OBJECTIVE

The aim of this study is to determine biomarkers, which may be used in order to understand the pathophysiology, the diagnosis, progression surveillance/monitoring, and treatment efficacy of high graded glial tumors.

BACKGROUND

Radiological imaging in the diagnosis and relapse surveillance of glial tumors is sometimes insufficient. There is need for additional methods of diagnosis and surveillance in order to rule out contradictory circumstances.

METHOD

Using enzyme like immune sorbent assay method, E-Cadherin, Tenascin C, Tetraspanin 8, Survivin and VEGF121 levels were investigated in serum and tumor tissues of 28 patients diagnosed with pathological glioblastoma, and in the serum of 26 healthy individuals. Correlation between tumor tissue values and Ki67 percentage, and P53 mutation, and difference between unhealthy and healthy serum levels were sought.

RESULTS

It was found out that E-Cadherin and VEGF 121 levels in the unhealthy serum were high in comparison to the control group (p 0.05).

CONCLUSION

EC and VEGF121 are biomarkers, which have the potential to be used in the diagnosis, recurrence and treatment follow-up in high graded glial tumors (Tab. 2, Fig. 1, Ref. 37). Text in PDF www.elis.sk Keywords: E-Cadherin, VEGF, Survivin, Tenascin-C, Tetraspanin, glioblastoma.

A Rare Case in Urology: Inflammatory Myofibroblastic Tumour

Inflammatory myofibroblastic tumour (IMT) is a soft tissue malignancy with a mixture of myofibroblastic spindle cells with hyalinised stroma and inflammatory infiltrates. We report a case of a 35-year male patient with a 100×90 mm mass located at the posterior wall of the urinary bladder just adjacent to the prostate and rectum. The mass caused grade 3 hydronephrosis in the left kidney and grade 1 hydronephrosis in the right kidney. The patient was operated and the mass lesion was excised completely. Because the left ureter was adherent to the mass, it was excised at the most distal part and uretero-neo-cystostomy was performed as the bladder and the prostate were preserved. Morphology and immunohistochemistry were consistent with IMT. With surgical excision of the tumour, no recurrence or metastases were seen up to 3 years postoperatively. Key Words: Inflammatory myofibroblastic tumour, Bladder, Urinary system, Hydronephrosis.

COVID-19 pandemic impact on cytopathology practice in the post-lockdown period: An international, multicenter study

BACKGROUND

In a previous worldwide survey, the authors showed a drastic reduction in the number of cytological specimens processed during the coronavirus disease 2019 "lockdown" period along with an increase in malignancy rates. To assess the continued impact of the pandemic on cytological practices around the world, they undertook a second follow-up worldwide survey collecting data from the post-lockdown period (2020).

METHODS

Participants were asked to provide data regarding their cytopathology activity during the first 12 weeks of their respective national post-lockdown period (2020), which ranged from April 4 to October 31. Differences between the post-lockdown period and the corresponding 2019 period were evaluated, and the authors specifically focused on rates of malignant diagnoses.

RESULTS

A total of 29 respondents from 17 countries worldwide joined the survey. Overall, a lower number of cytological specimens (n = 236,352) were processed in comparison with the same period in 2019 (n = 321,466) for a relative reduction of 26.5%. The overall malignancy rate showed a statistically significant increase (12,442 [5.26%] vs 12,882 [4.01%]; P < .001) during the same time period. Similar results were obtained if both malignancy and suspicious for malignancy rates were considered together (15,759 [6.58%] vs 16,011 [4.98%]; P < .001).

CONCLUSIONS

The data showed a persistent reduction in the cytological specimen volume during the post-lockdown period (2020). However, the relative increase in the cytological workload in the late part of the post-lockdown is a promising finding of a slow return to normality.

The shrinkage effect of formalin on renal cell carcinoma: Does it change the stages?

Objective: To determine the shrinkage effect of formalin on renal cell carcinoma. Method: The retrospective study was conducted from October to November 2020 at Tekirdag Namil kemal University, Turkey and comprised all radical and partial nephrectomy cases performed by a single surgeon in a single clinic between January 2014 and August 2020. Preoperative images and postoperative pathology were reviewed by the same clinician. Preoperative longest tumour diameter of radiological images and pathological specimens measured after formalin fixation shrinkage were compared, and the effect of the difference between the two measurements on the circumference of the tumour was examined. The formalin related shrinkage rates of renal tumours according to the tumour size and the tumour types were also analysed. Data was analysed using SPSS 20. Results: Of the 101 cases, 58(57.4%) were of radical and 43(42.6%) of partial nephrectomy. Also, there were 77(76.2%) renal cell carcinoma cases, 22(21.8%) benign renal tumours and 2(1.9%) had other malignant tumours. There were 59(58.4%) males and 42(41.6%) females with an overall mean age of 58.1±12,2 years (range: 30-82 years). The mean radiological size of the renal tumours was 55.3±30.4mm and it was 52.9±31.6mm at pathological examination (p>0.05). Conclusion: Formalin fixation of tissues post-surgery caused a difference between the radiological and pathological dimensions. Though the difference was no significant, under-staging due to the shrinkage post-surgery should be considered. Key Words: Renal tumours, Tissue shrinkage, Formalin, radiological dimension, Pathological dimension. ---Continue

Global impact of the COVID-19 pandemic on cytopathology practice: Results from an international survey of laboratories in 23 countries

BACKGROUND

To the authors' knowledge, the impact of the coronavirus disease 2019 (COVID-19) pandemic on cytopathology practices worldwide has not been investigated formally. In the current study, data from 41 respondents from 23 countries were reported.

METHODS

Data regarding the activity of each cytopathology laboratory during 4 weeks of COVID-19 lockdown were collected and compared with those obtained during the corresponding period in 2019. The overall number and percentage of exfoliative and fine-needle aspiration cytology samples from each anatomic site were recorded. Differences in the malignancy and suspicious rates between the 2 periods were analyzed using a meta-analytical approach.

RESULTS

Overall, the sample volume was lower compared with 2019 (104,319 samples vs 190,225 samples), with an average volume reduction of 45.3% (range, 0.1%-98.0%). The percentage of samples from the cervicovaginal tract, thyroid, and anorectal region was significantly reduced (P < .05). Conversely, the percentage of samples from the urinary tract, serous cavities, breast, lymph nodes, respiratory tract, salivary glands, central nervous system, gastrointestinal tract, pancreas, liver, and biliary tract increased (P < .05). An overall increase of 5.56% (95% CI, 3.77%-7.35%) in the malignancy rate in nongynecological samples during the COVID-19 pandemic was observed. When the suspicious category was included, the overall increase was 6.95% (95% CI, 4.63%-9.27%).

CONCLUSIONS

The COVID-19 pandemic resulted in a drastic reduction in the total number of cytology specimens regardless of anatomic site or specimen type. The rate of malignancy increased, reflecting the prioritization of patients with cancer who were considered to be at high risk. Prospective monitoring of the effect of delays in access to health services during the lockdown period is warranted.

Cytological features of pure micropapillary carcinoma of various organs: A report of eight cases

Micropapillary carcinoma (MPC) is a rare aggressive tumor, which generally accompanies the primary carcinoma of the organ of its origin, while the pure form is extremely uncommon. Angiolymphatic involvement is widespread and a considerable proportion of the cases present with metastases. The current study presents eight pure MPC cases arising from the breast (n=3), urinary bladder (n=3), parotid gland (n=1) and lung (n=1, presenting with pericardial effusion), with the cytological findings. The eight patients included three female and five male cases aged between 48 and 74 years. The most common cytological findings were three-dimensional aggregates, cell clusters with angulated or scalloped borders, single cells with a columnar configuration and eccentric nuclei, and high-grade nuclear features. Histopathological sections showed accompanying in situ ductal carcinoma in the cases of MPC arising in the parotid gland and breast (n=3), and one case in the bladder exhibited only in situ MPC. The average follow-up period was 20 months (range, 6–54 months) and, during this period, three patients succumbed to the disease. At present, four patients are alive with disease and one patient is alive and disease-free. In conclusion, cytology is an important tool for the diagnosis and management of MPC.

The first case of Henoch-Schonlein purpura associated with rosuvastatin: colonic involvement coexisting with small intestine

Henoch-Schönlein purpura (HSP) is a systemic vasculitis affecting small vessels. It is the most common systemic vasculitis in children, and is rare in adults. Serious gastrointestinal complications are more common in childhood. Infections and drugs are the most prominent factors in the aetiology. Wall thickening in segments of the small intestine is commonly seen in imaging studies in gastrointestinal system (GIS) involvement. Simultaneous involvement of small intestine and colon is rare. An HSP case involving small intestine and colon in an adult patient due to the use of rosuvastatin, an antihyperlipidaemic agent, is presented, and is first of its kind reported in the literature.

Gastric gastrointestinal stromal tumor with bone metastases - case report and review of the literature

Gastrointestinal stromal tumors (GISTs) represent rather rare neoplasms. Most GISTs are benign; malignant tumors account for 20- 30% of cases (overall, approximately 10- 30% of GISTs exhibit malignant behavior). GISTs most commonly metastasize to the liver and abdominal cavity. Distant metastases to other sites, especially to the bones, are relatively rare. We report a case of a 62 year  old man with metastatic spread of GIST to skull, ribs and both sacroiliac joints manifesting six months after surgical resection of a gastric tumor. Although bone metastases from GISTs are rare and there are only a few reported cases in the literature, this case emphasizes that metastatic disease should always be considered in a patient with gastric GIST and suspicious bone lesions.

Protective effects of onion (Allium cepa) extract against doxorubicin-induced hepatotoxicity in rats

Background/aim:

Doxorubicin (DOX) is a widely used and potent chemotherapeutic agent. However, serious dose-limiting toxicity through generation of free oxygen radicals is a commonly encountered clinical problem. The aim of the current study was to assess the protective role of onion ( Allium cepa) extract (ACE) against DOX-induced hepatotoxicity in rats.

Method:

A total of 24 rats were randomly divided into 3 equal experimental groups: (1) DOX; (2) ACE + DOX; and (3) control groups. ACE was given orally as 1 mL of fresh ACE juice for 14 consecutive days followed by DOX injection. DOX was injected intraperitoneally in a single dose of 30 mg/kg body weight to induce hepatotoxicity, and the rats were killed after 48 h from injection. Control group was given saline only.

Results:

In the ACE pretreated group (ACE + DOX), serum aspartate transaminase, alanine transaminase, and tissue malondialdehyde and glutathione levels were significantly lower, while superoxide dismutase and glutathione peroxidase were higher compared with the DOX group. The histopathological examination of liver specimens revealed parenchymal necrosis, proliferation of biliary duct in DOX group; while ACE pretreatment provided marked reduction in these changes.

Conclusion:

Our study indicates that pretreatment with ACE protects against DOX-induced hepatotoxicity due to the antioxidant properties of ACE. Further studies on efficacy of antioxidant treatment by ACE in DOX-mediated toxicity and underlying mechanisms would provide a better explanation.

Lymphangioma: surrounding the ovarian vein and ovary

Lymphangiomas are usually benign lesions seen in the head and neck region in children. Intra-abdominal localisation is rare and the majority of these cases are in early childhood. Retroperitoneal lymphangiomas constitute approximately 1% of all lymphangiomas. They are generally diagnosed incidentally, may be asymptomatic or may present with a palpable abdominal mass. A limited number of cases of ovarian lymphangiomas have been reported in women, whereas there are no reported cases of paraovarian localisation. We present a rare case of lymphangioma located in bilateral paraovarian region and along the left ovarian vein with radiological findings.

Tear osmolarity and ocular surface changes in patient with polycystic ovary syndrome

PURPOSE

To evaluate the tear osmolarity and ocular surface changes in patients with polycystic ovary syndrome (PCOS).

MATERIALS AND METHODS

Forty-eight patients with recently diagnosed PCOS and thirty-three control volunteers were enrolled in this prospective, observational study. Ocular surface disease index (OSDI) score was calculated. Tear osmolarity was measured using the TearLab Osmolarity System (Tearlab, San Diego, CA, USA). All subjects also underwent the following ophthalmologic evaluation: Schirmer I test, tear-film breakup time (TBUT), ocular surface flourescein staining, and conjunctival impression cytology.

RESULTS

Mean OSDI score was significantly higher in patients with PCOS than control subjects (P = 0.001). Tear osmolarity was similar in both groups (P = 0.404). There were no significant differences between groups in Schirmer I test results, TBUT, and ocular surface flourescein staining scores (P > 0.05). Compared to control group, a statistically significant squamous metaplasia was observed in temporal bulbar conjunctival impression cytology specimens in PCOS group (P = 0.032).

CONCLUSIONS

In patients with recently diagnosed PCOS, tear volume and osmolarity are not affected but, conjunctival morphology may be affected, though on a limited scale.

A synchronous occurrence of urothelial carcinoma with abundant myxoid stroma and inverted papilloma of the urinary bladder

Abundant myxoid stroma rarely occurs in urothelial carcinomas, and may cause diagnostic challenges when cells with eosinophilic cytoplasm forming nests and cords in a myxoid background are seen, particularly in the absence of typical carcinomatous appearance. Microscopic examination of transurethral resection specimen of a 71-year-old male patient revealed non-cohesive oval or elongated tumor cells with eosinophilic cytoplasm arranged in cord-like filigree pattern in an abundant myxoid stroma. Immunohistochemically the tumor was positive for cytokeratin 7, cytokeratin 20, and 34BE12. About 90 to 100% nuclear staining was observed with p63, p53, and Ki-67. A second neoplasm with a flat overlying urothelial epithelium and a complete inverted cellular growth pattern was also noted. The neoplasm exhibited less than 2% and 10% nuclear staining with Ki-67 and p53, respectively. Considering histological, histochemical, and immunohistochemical findings, a diagnosis of synchronous urothelial carcinoma with abundant myxoid stroma and inverted papilloma was made.

A rare cause of virilization; Ovarian steroid cell tumor, not otherwise specified (NOS)

Sex cord-stromal tumors account for 5% of ovarian tumors and 2% of malignant ovarian tumors. Steroid cell tumors (SCT), not otherwise specified (NOS), are rare sex cord-stromal tumors of the ovary and account for less than 0.1% of all ovarian tumors. We report a rare case of a post-menopausal woman presented with hirsutism, virilism and with findings of hyperestrogenism.

Giant cell tumor-like lesion of the urinary bladder: a report of two cases and literature review; giant cell tumor or undifferentiated carcinoma?

Summary

Giant cell tumor, excluding its prototype in bone, is usually a benign but local aggressive neoplasm originating from tendon sheath or soft tissue. Malignant behavior is uncommon. Visceral organ involvement including urinary bladder is rare. Giant cell tumors in visceral organs usually accompany epithelial tumors and the clinical behavior of giant cell tumor in urinary bladder is similar to its bone counterpart. Here, we report two cases of giant cell tumor located in urinary bladder in comparison with nine reported cases in the English literature. Concurrent noninvasive urothelial carcinoma was also described in all these previous reports and only one patient with follow-up died of disease. One of the two cases we present had no concurrent urothelial tumor at the time of diagnosis but had a history of a low grade noninvasive urothelial carcinoma with three recurrences. The histology of these two cases was similar to the giant cell tumor of bone and composed of oval to spindle mononuclear cells with evenly spaced osteoclast-like giant cells. Immunohistochemically, the giant cells showed staining with osteoclastic markers including CD68, TRAP, and LCA. Immunohistochemical expression of vimentin, CD68, LCA, and smooth muscle actin in mononuclear cells supported a mesenchymal origin with histiocytic lineage. The histologic and immunohistochemical properties in our cases as well as their clinical courses were consistent with a giant cell tumor. Consequently, tumors in urinary bladder showing features of giant cell tumor of bone may also be considered and termed "giant cell tumor".