Ki67 Tumor Expression Predicts Treatment Benefit Achieved by Macroscopic Radical Lung-Preserving Surgery in Pleural Mesothelioma-A Retrospective Multicenter Analysis

Pleural mesothelioma (PM), linked to asbestos-induced inflammation, carries a poor prognosis. Therapy ranges from therapy limitation to aggressive multimodality treatment. Given the uncertainty about treatment benefits for patients, this study aimed to assess the role of Ki67 as a prognostic and predictive parameter in PM. Ki67 was measured in the specimens of 70 PM patients (17 female, 53 male) from two centers and correlated to overall survival (OS) and therapy outcome. The median OS was 16.1 months. The level of Ki67 expression was divided into low (≤15%) and high (>15%). A low value of Ki67 expression was associated with a longer OS (Ki67 ≤ 15%: 31.2 (95% CI 6.5-55.8) months vs. Ki67 > 15%: 11.1 (95% CI 7.7-14.6) months, p = 0.012). The 5-year survival represents 22% in the low Ki67 expression group, in contrast to 5% in the high Ki67 expression group. We found a significant interaction term of Ki67 with multimodality treatment (p = 0.031) translating to an OS of 48.1 months in the low expression Ki67 group compared to 24.3 months in the high Ki67 expression group when receiving surgery within multimodality therapy. Therefore, Ki67 stands out as a validated prognostic and, most importantly, novel predictive biomarker for treatment benefits, particularly regarding surgery within multimodality therapy.

PRIMARY SUBRETINAL HYDATID CYST PRESENTING AS LEUKOCORIA IN A CHILD

PURPOSE

To describe a case of subretinal hydatid cyst presenting as leukocoria and treated with limbal vitrectomy.

METHODS

A single case report demonstrated by multimodal imaging.

RESULTS

An otherwise healthy 28-month-old boy was admitted to our hospital with a complaint of leukocoria and underwent combined lensectomy and vitrectomy under albendazole therapy because of vitreous space-occupying subretinal cyst. Systemic workup showed no involvement in other organs. Cyst content was adequately aspirated with a 39-gauge needle, the cyst wall was freed from surrounding attachments to the retina, and the nasal choroid and was extracted through a limbal incision using a cryoprobe. Nasal retinotomy and retinectomy area was lasered and tamponaded with silicone oil. Histopathologic examination confirmed the diagnosis of hydatid cyst disease. Silicone oil was removed at postoperative third month. Retina stayed attached, and the patient had a fix and follow vision under contact lens and amblyopia treatment during the 21-month follow-up period.

CONCLUSION

This is the youngest subretinal hydatid cyst case in the literature. Large subretinal hydatid cyst may rarely cause leukocoria in children without any involvement in other organs. Vitrectomy with limbal approach and 39G needle-assisted cyst fluid aspiration and cryo-extraction seems to be a safe and successful surgical option in such cases.

Vexas Syndrome Presenting As Long Covid-19

Objective VEXAS (vacuoles, E1 enzyme, X-linked, autoinflammatory, somatic) syndrome is a recently described systemic inflammatory syndrome caused by somatic mutations of UBA1. COVID-19 is a viral infection that was described in 2019 and spread widely and quickly all around the world. Constitutional, thrombotic and pulmonary symptoms of these two conditions are similar, which is why cases of VEXAS syndrome may be misdiagnosed as a COVID infection.

Case report We introduced a case report of a 72-year-old male patient with VEXAS syndrome who had fever, fatigue, deep vein thrombosis and a cough and was thought to have a long COVID-19 infection for one year. Then we diagnosed him with VEXAS syndrome with vacuoles in myelomonocytic cells, skin lesions and a mutation of the UBA-1 gene.

Conclusion VEXAS and long COVID are two new conditions with overlapping clinical presentations. Physicians must be aware of these clinical conditions because of their different treatment strategy and prognosis.

Tumour cell PD-L1 expression is prognostic in patients with malignant pleural effusion: the impact of C-reactive protein and immune-checkpoint inhibition

Malignant pleural effusion (MPE) confers dismal prognosis and has limited treatment options. While immune-checkpoint inhibition (ICI) proved clinical efficacy in a variety of malignancies, data on the prognostic role of PD-L1 in MPE is scarce. We retrospectively studied PD-L1 tumour proportion score and Ki-67 index in pleural biopsies or cytologies from 123 patients (69 lung cancer, 25 mesothelioma, and 29 extrathoracic primary malignancies). Additionally, the impact of C-reactive protein (CRP) and platelet count was also analysed. Median overall survival (OS) after MPE diagnosis was 9 months. Patients with PD-L1 positive tumours (≥1%) had significantly shorter OS than patients with negative PD-L1 status (p = 0.031). CRP and Ki-67 index were also prognostic and remained independent prognosticators after multivariate analysis. Interestingly, Ki-67 index and CRP influenced the prognostic power of PD-L1. Finally, patients receiving ICI tended to have a longer median OS and CRP - but not PD-L1 - was a significant prognosticator in this subgroup. In summary, histological and circulating biomarkers should also be taken into account as potential biomarkers in ICI therapy and they may have an impact on the prognostic power of PD-L1. Our findings might help personalizing immune-checkpoint inhibition for patients with MPE and warrant further prospective validation.

A case of bi-focal mediastinal ependymoma

Ependymomas are tumors located in the central nervous system, mostly in the brain and spinal cord. This tumor is rarely seen as a primary mediastinal location. The aim of this study is to discuss this rare pathology in the clinical course of an unusual case. A 47-year-old female patient was referred to our clinic with the complaint of back and shoulder pain, via VATS posterior mediastinum located paravertebral mass excision was performed. The pathology reported as ependymoma. Two years later, CT scans of the routine control showed the well-defined mass in anterior mediastinum. The SUVmax of the lesion was measured as 9.3 at PET-CT. The lesion in the anterior mediastinum was excised by partial sternotomy. The pathology result was the same as the prior operation: Ependymoma. As our case, in these kinds of tumors meticulous follow-up of the patients is important for the detection and treatment of recurrent localization and distant metastases.

The effect of PD-L1 status on survival outcomes in patients with stage II-III non-small cell lung cancer treated with chemotherapy

PURPOSE

There are conflicting results in the literature about the relationship between PD-1/PD-L1 expression and prognosis in non-small cell lung cancer (NSCLC). The purpose of this study was to identify the relationship between NSCLC patients' clinicopathologic characteristics and PD-1/PD-L1 expression.

METHODS

Pathology specimens of eligible stage II-III NSCLC patients were immunohistochemically stained with PD-1 and PD-L1 antibodies. Patient files and digital records were retrospectively reviewed for demographic and clinical features such as age, gender, smoking status, Eastern Cooperative Oncology Group (ECOG) performance status (PS), histological tumor subtype, applied chemotherapeutic types and their dates and survival data. Statistical analyses were performed to evaluate prognostic effects of staining status of PD-L1 and PD-1 in tumor cells and PD-L1 in tumor infiltrating inflammatory cells.

RESULTS

In a total 74 patients, 45.9% of them were positive for PD-L1 in tumor cells, 67.9% positive for PD-L1 in tumor infiltrating inflammatory cells and 83.8% positive for PD-1 in tumor cells (p>0.05). There was a statistically significant relationship between the positive staining of PD-L1 tumor cells and increased overall survival (OS) in univariate analysis (3-year OS; PD-L1(+) 76.6% vs PD-L1(-) 41%, p=0.031). In multivariate analysis only stage and ECOG PS were statistically significant.

CONCLUSIONS

PD-L1 positivity in tumor cells was a positive prognostic factor for OS in patients with stage II and III NSCLC.

Adequacy of EBUS-TBNA specimen for mutation analysis of lung cancer

OBJECTIVE

Convex probe endobronchial ultrasound (EBUS)-guided transbronchial needle aspiration (TBNA) is a minimally invasive technique with high sensitivity in the mediastinal staging of non-small cell carcinoma (NSCLC). In recent years, molecular testing has been developed to study genetic mutations in NSCLC. There are studies revealing improved survival in advanced NSCLC using targeted therapy as the first-line treatment in these patients. The aim of this study was to evaluate the adequacy of EBUS-TBNA in providing adequate size specimens for EGFR, ALK and ROS1 genetic mutation analysis in patients with adenocarcinoma or not otherwise specified (NOS) lung cancer.

MATERIALS AND METHODS

Charts of patients diagnosed with lung adenocarcinoma or NOS via EBUS-TBNA were retrospectively reviewed. Information on patient demographics, number of lymph nodes sampled, their size and location, targeted gene mutations and the adequacy of the material sampled for the molecular testing was recorded.

RESULTS

A total of 114 patients were included in the study, adenocarcinoma 86 (75%) and NOS 28 (25%). EGFR gene mutation was studied in all of the patients included in the study while ALK in 113 and ROS1 in 98. The material adequacy ratios for EGFR gene mutation, ALK and ROS1 rearrangements were found to be 88.6%, 93.8% and 91.8%, respectively. EGFR gene mutation, ALK and ROS1 rearrangements were found positive in 13 (11.4%), 9 (8%) and 1 (1%) patients, respectively.

CONCLUSION

The study demonstrated that EBUS-TBNA provides adequate material for mutation analysis in patients with newly diagnosed adenocarcinoma or NOS lung cancer.

The Evaluation of Exogenous Melatonin Administration in Supraspinatus Overuse Tendinopathy in an Experimental Rat Model

Background

Increased oxidative stress and inflammation play a critical role in the etiopathogenesis of chronic tendinopathy. Melatonin is an endogenous molecule that exhibits antioxidant and anti-inflammatory activity. The aim of this study was to evaluate the biochemical and histopathological effects of exogenous melatonin administrations in supraspinatus overuse tendinopathy.

Methods

Fifty rats were divided into the following four groups: cage activity, melatonin treatment, corticosteriod therapy, and control. Melatonin (10 mg/kg, intraperitoneal; twice a day) and triamcinolone (0.3 mg/kg, subacromial; weekly) were administered to the treatment groups after the overuse period. Biochemical and histopathological evaluations were performed on serum samples and biopsies obtained from rats. Plasma inducible nitric oxide synthase (iNOS), vascular endothelial growth factor (VEGF), total antioxidant status (TAS), total oxidant status (TOS), and oxidative stress index (OSI) levels were evaluated biochemically.

Results

The TAS, TOS, OSI, iNOS, and VEGF values were significantly lower than the pre-treatment levels in rats receiving exogenous melatonin treatment (3 or 6 weeks) (p<0.05). TOS, iNOS, VEGF, and OSI values after 3 weeks of triamcinolone administration, and TOS, VEGF, and OSI levels after 6 weeks of triamcinolone application, were significantly lower than the pre-treatment levels (p<0.05).

Conclusions

Exogenous melatonin application in overuse tendinopathy reduces oxidative stress and inflammation. Melatonin might be an alternative potential molecule to corticosteroids in the treatment of chronic tendinopathy.

A Rare Presentation of Paraovarian Sclerosing Stromal Tumor with High Mitotic Activity

BACKGROUND

Sclerosing stromal tumor is an extremely rare type of benign ovarian sex cord stromal tumor.

CASE

The benign characteristic of this tumor is well known but we present an uncommon case of paraovarian sclerosing stromal tumor with high mitotic activity.

RESULTS AND CONCLUSION

Despite this potential malignancy, our patient was treated successfully with enucleation only.

Evaluation of Neopterin Levels in an Endotoxin-Induced Experimental Uveitis Model

BACKGROUND

In this study, NP levels of intraocular fluids and serum were analyzed in the endotoxin-induced uveitis model.

METHODS

Intravitreal injection of 0.05 ml E. Coli lipopolysaccharide (IVT LPS) has been performed into the right eyes of 14 rabbits. Animals were divided into two groups. Group 1 (n = 7) sacrificed 24 hours after the intravitreal injection, and group 2 (n = 7) 72 hours after the intravitreal injection. Aqueous fluid, vitreous and serum samples were drawn at the time of sacrifice; histopathological changes were also examined.

RESULTS

Significantly elevated aqueous and vitreous NP levels were observed in IVT LPS injected eyes. In IVT LPS injected eyes, aqueous NP levels showed a significant decrease in 72 hours (p < 0.05), whereas vitreous NP concentrations significantly increased in 72 hours (p < 0.05). Both aqueous and vitreous protein concentrations were significantly higher in IVT LPS injected eyes. Histopathologic evaluation revealed that, in the first 24 hours, inflammation was significant in choroid and ciliary body. Retinal histopathological changes were observed mainly at 72 hours.

CONCLUSIONS

This study demonstrates that neopterin levels correlate with early intraocular inflammatory response in an endotoxin-induced uveitis model.

Postmastectomy radiation therapy in locally advanced breast cancer

Despite wide efforts for early detection of breast cancer using screening mammography, locally advanced breast carcinomas account for a remarkable proportion of all breast carcinomas, particularly in developing countries. Locally advanced breast cancer may have widely different clinical and biological features. Radiotherapy plays an important role in the management of locally advanced breast cancer. Postmastectomy radiotherapy has been shown to significantly reduce the risk of loco-regional failure and to improve disease free survival as well as overall survival in high-risk women with breast cancer. This review article summarizes the data from randomized trials revealing a significant benefit from postmastectomy radiation therapy in patients with locally advanced disease.

Hypoxia inducible factor-1 alpha and carbonic anhydrase IX overexpression are associated with poor survival in breast cancer patients

PURPOSE

Hypoxia is common in many solid tumors such as breast, head-neck, and soft tissue malignancies. Hypoxia causes overexpression of hypoxia inducible factor-1 alpha (HIF-1α) and carbonic anhydrase IX (CA IX) which are associated with unfavorable prognosis in breast cancer. In our study, we evaluated HIF-1α and CA IX expression in patients with breast cancer.

METHODS

Between June 1996 and June 2008, 111 women with breast cancer were evaluated. Estrogen receptor (ER) and progesterone receptor (PR) status and Her2/ neu expression were evaluated by immunohistochemical methods. Her-2/neu expression was also assessed by FISH method when needed. Two groups were created: ER and PR positive, Her-2/neu negative (group 1, n=56); and ER and PR negative, Her-2/neu positive (group 2, n=55). HIF-1α and CA IX expressions were investigated in both groups and results were compared. In addition, we investigated the association between HIF-1α and CA IX expressions with stage, grade, lymph node metastasis, tumor size, menopause status and survival.

RESULTS

Median patient age in group 1 was 52 years (range 34-77), and in group 2 47 years (range 27-83). HIF-1α expression was detected in 26 (46.4%) of group 1 and in 46 (83.6%) of group 2 patients (p=0.0001). CA IX expression was detected in 25 (46.4%) of group 1 and in 37 (67.3%) of group 2 patients (p7equals;0.0137rpar;. In group 1, median disease free survival (DFS) was 97 months and in group 2 46 months (p=0.0308). In group 1, median overall survival (OS) was 108 months and in group 2 75 months (p=0.0339).

CONCLUSION

HIF-1α and CA IX overexpressions are observed more often in ER and PR negative, Her-2/neu positive breast cancer and are associated with poor survival.

Posttransplant lymphoproliferative disorder with lung involvement in a renal transplant recipient

Posttransplant lymphoproliferative disorder is one of the most important complications of solid-organ transplant in terms of malignancy. Here, we report a case of Epstein-Barr-virus-negative posttransplant lymphoproliferative disorder of the T-cell type, involving the lung, in a renal transplant recipient. A 23-year-old woman received a living-related renal transplant in 2002. She presented with a 6-month history of weight loss, malaise, night sweats, and lymphadenopathy 6 years after the transplant. Chest radiograph showed miliary opacities. We performed a biopsy of the submandibular mass and computed-tomography-guided transthoracic needle biopsy of the lung. Pathological investigation of lymphadenopathy and lung were inconsistent with posttransplant lymphoproliferative disorder of T-cell type. After the diagnosis of posttransplant lymphoproliferative disorder, her immunosuppressive regimen was modified, and she was treated with cyclophosphamide, doxorubicin, vincristine, prednisolone, ifosfamide, carboplatin, and etoposide chemotherapies, which resulted in partial remission. Posttransplant lymphoproliferative disorders may be seen as an atypical presentation; the differential diagnosis should be thought of pulmonary infiltrates in renal transplant recipients.

Isolated primary lymphomatoid granulomatosis of central nervous system

Lymphomatoid granulomatosis (LG) is an infrequent extranodal Epstein-Barr virus (EBV)-associated B-cell lymphoproliferative disorder characterized by angiocentric and angiodestructive polymorphic lymphoid infiltration. CNS is involved in one of every 4 patients, but isolated CNS involvement at presentation is rare. A 67-year-old man was admitted to our hospital because of visual impairment. Magnetic resonance imaging (MRI) revealed a suprasellar mass lesion isointense to gray matter on T1 and T2-weighted images. The hypotalamic/chiazmatic mass was resected through a transsphenoidal approach. Pathological examination of the biopsy specimen revealed large atypical, CD20-positive B-lymphocytes within a background containing numerous CD3-positive small T-lymphocytes and scattered admixed plasma cells and histiocytes. Necrotic areas and vascular infiltration by a mixed mononuclear cell infiltrate with scattered large atypical lymphoid cells was present. In situ hybridization for EBV showed few large cells both around blood vessels and adjacent to the necrotic zone. This morphologic and immunophenotypic features was diagnostic for lymphomatoid granulomatosis. The patient was successfully treated with steroids, high-dose methotrexate and radiotherapy.

Evaluation of tenoxicam on prevention of arachnoiditis in rat laminectomy model

Post laminectomy arachnoiditis has been shown by experiments with rats and post operative radiological imaging in humans. The purpose of this experimental study was to determine the efficacy of tenoxicam in preventing arachnoiditis in rats. Twenty-four Wistar rats were divided into two groups, and L3 laminectomy was performed. In the tenoxicam group, 0.5 mg/kg tenoxicam was applied intraperitoneally. Normal saline was applied intraperitoneally in the control group. Later, the rats were killed at weeks 3 and 6, and the laminectomy sites were evaluated pathologically for arachnoiditis. The results showed that 6 weeks after surgery, the tenoxicam group showed lowest arachnoiditis grades. However, statistically significant difference was not found in arachnoiditis between the control group and the tenoxicam group. Based on these findings it is concluded that application of the tenoxicam after lumbar laminectomy did not effectively reduce arachnoiditis. Performing the most effective surgical technique without damage around tissue in a small surgical wound and having meticulous hemostasis in surgery seem to be the key for preventing arachnoiditis effectively.

Sister Mary Joseph's nodule as a rare sign of lymphoma

Sister Mary Joseph's periumbilical metastatic nodule is an ominous harbinger of an internal malignancy usually originating from gastrointestinal or genital system primary cancers. At the time of diagnosis, they are inoperable and therefore deemed incurable, suggesting an invariably dismal prognosis. Periumbilical neoplastic deposits from primary non-Hodgkin's lymphoma are extremely rare. A 72-year-old white male with a history of gastric cancer was referred with a painful lesion in the umbilicus. A delayed biopsy of the nodule showed diffuse large B-cell lymphoma. After a work up, he was successfully treated with standard combination chemotherapy and achieved complete remission. However, the patient developed central nervous system relapse and died a few months later. Our patient illustrates the importance of obtaining a tissue diagnosis before diagnosing an internal carcinoma as the underlying cause in patients with Sister Mary Joseph's nodule. We should keep in mind that not all periumbilical tumoral deposits are the same.

Infliximab administration reduces neuronal apoptosis on the optic pathways in a rabbit hydrocephalus model: a preliminary report

OBJECT

This study was designed to explore the effects of infliximab on the optic pathway in kaolin induced hydrocephalus rabbit model.

METHODS

After injection of kaolin to the cisterna magna of 12 New Zealand rabbits for induction of hydrocephalus, animals were divided into 2 groups and received either infliximab or normal saline. The intracranial pressure measurement was performed 2 times; firstly, before kaolin injection and secondly, before decapitation to ensure that the rabbits had hydrocephalus. After 2 weeks, animals were decapitated.

RESULTS

Apoptotic cells in the lateral geniculate body, optic radiation, and optic disc were counted with TUNEL method. Apoptotic cell counts of the lateral geniculate body and the optic radiation were showed statistically significant difference between the infliximab group and the control group.

CONCLUSIONS

This study suggests that infliximab may have a neuroprotective effect through its anti-apoptotic property on hydrocephalus induced optic pathways injury.

The presence of Epstein-Barr virus (EBV) in diffuse large B-cell lymphomas (DLBCLs) in Turkey: special emphasis on 'EBV-positive DLBCL of the elderly'

Accumulated evidence has shown the importance of Epstein-Barr virus in the pathogenesis of various lymphomas. This study aimed to determine the prevalence of Epstein-Barr virus expression and its effect on survival amongst diffuse large B-cell lymphoma (DLBCL) cases from two large tertiary care centres in Turkey with a particular interest in identifying cases of 'Epstein-Barr virus-positive DLBCL of the elderly'. Diffuse large B-cell lymphoma cases diagnosed between 1999 and 2009 were retrieved and 340 cases were used to construct tissue microarrays. The presence of Epstein-Barr virus small ribonucleic acids was examined by in situ hybridization using Epstein-Barr virus (EBV)-encoded small RNA (EBER) oligonucleotides. A total of 18 cases (5.3%) showed Epstein-Barr virus expression. Twelve cases were classified as Epstein-Barr virus-positive DLBCL of the elderly. Epstein-Barr virus-positive DLBCL cases showed a significantly inferior overall survival as compared with Epstein-Barr virus-negative cases (p < 0.001). In our study group Epstein-Barr virus expression is not prevalent in DLBCLs. Epstein-Barr virus-positive DLBCL of the elderly is also rare in the Turkish population. The presence of Epstein-Barr virus, however, is associated with poor prognosis.

Isolated cutaneous aspergillosis in an acute lymphoblastic leukemia patient after allogeneic stem cell transplantation

Cutaneous aspergillosis is very rare and occurs predominantly in immunocompromised patients including transplant recipients. We report a 26-year-old male with acute lymphoblastic leukemia who developed cutaneous aspergillosis after undergoing combined immunosuppressive treatment including corticosteroid, cyclosporine A, mychophenolate mofetil and mesenchymal stem cells for steroid refractory skin acute graft versus host disease after myeloablative haematopoietic stem cell transplantation.  The patient was treated with oral voriconazole therapy and recovered partially. 

Differential expression of CKS-1B in typical and blastoid variants of mantle cell lymphoma

Mantle cell lymphoma is a distinct type of B-cell lymphoma characterized by the t(11;14)(q13;q32). Mantle cell lymphomas exhibit a spectrum of morphologic findings, of which a subset of tumors is clinically aggressive with a high proliferation rate. These neoplasms are known as aggressive variants of which there are blastoid and pleomorphic subsets. CKS-1B (CDC28 protein kinase regulatory subunit 1B) is essential for the ubiquitination and degradation of p27 and cell cycle progression. We analyzed CKS-1B expression in mantle cell lymphoma cell lines and tumors by Western blot and immunohistochemical analysis. In 4 mantle cell lymphoma cell lines, CKS-1B was expressed at variable levels and correlated inversely with p27 expression. In mantle cell lymphoma tumors, CKS-1B was positive in 10 (28.6%) of 35 typical versus 14 (87.5%) of 16 blastoid/pleomorphic cases (Fisher exact test, P = .0002). Analyzed as a continuous variable, the percentage of CKS-1B-positive cells significantly correlated with blastoid/pleomorphic morphology (Mann-Whitney U test, P = .001). Twelve (23.5%) of 51 mantle cell lymphoma tumors expressed p27. Proliferation rate (Ki-67) was higher in blastoid/pleomorphic variants than in typical mantle cell lymphoma tumors and was inversely associated with p27 levels in typical mantle cell lymphoma. However, CKS-1B expression did not correlate with p27 expression, proliferation rate, or prognosis in the entire study group. Fluorescence in situ hybridization analysis of 10 CKS-1B-positive mantle cell lymphoma tumors showed no evidence of CKS-1B gene amplification. We conclude that CKS-1B is commonly expressed in mantle cell lymphoma, particularly in aggressive histologic variants, and may be involved in pathogenesis.

Synchronous testicular liposarcoma and prostate adenocarcinoma: a case report

Prostate adenocarcinoma is the most common malignancy and the second leading cause of cancer related deaths in men. Testicular liposarcomas are uncommon soft tissue neoplasms. We report coexistence of prostate cancer and testicular liposarcoma in a 69 year-old-man because while orchiectomy endications are decreasing day by day, these second malignancies should not be missed.

Ectopic primary B cell lymphoma of the thyroid presenting as an anterior mediastinal mass. A case report

Ectopic thyroid tumours arising in the mediastinum without connection to the cervical thyroid gland are very rare. Follicular adenoma, papillary carcinoma and follicular carcinoma in the mediastinum has been reported, but primary ectopic thyroid B cell lymphoma has not been reported previously. We report mediastinal primary ectopic thyroid large B cell lymphoma in an 80-year-old man. Differential diagnosis from primary mediastinal large B cell lymphoma and clinicopathologic features are discussed.

Primitive neuroectodermal tumor of the kidney in a child

Primary renal primitive neuroectodermal tumor (PNET) is an extraordinarily rare neoplasm in childhood. It generally occurs in young adults and only a few pediatric cases have been reported. PNET in the kidney acts aggressively and the record shows poor therapeutic response. The authors present the case of a 16-year-old girl who was diagnosed with renal PNET and treated with high-dosage chemotherapy and peripheral blood stem cell transplantation (PBSCT).

Association of hypoxia inducible factor-1 alpha and carbonic anhydrase IX overexpression and survival in HER2/neu positive hormone-unresponsive breast cancer patients

e22078

Background: Hypoxia is common in solid tumors with overexpression of hypoxia inducible factor-1 alpha (HIF-1 alpha) and carbonic anhydrase IX (CA IX). In our study, we evaluated HIF-1alpha and CA IX expression in Her-2/neu positive hormone- unresponsive breast cancer patients. Methods: One hundred and eleven patients with operable breast cancer were identified who had paraffin-embedded tissue blocks available. Estrogen and progesterone receptors and Her-2/neu expression were evaluated by immunohistochemistry (IHC). FISH was used for IHC 2+ cases. We assigned two groups with 56 patients who have ER and PR receptor positive, Her-2/neu negative (group 1) and with 55 patients who have ER and PR negative, Her-2/neu positive (group 2). HIF 1 alpha and CA IX expressions were investigated and results were compared for both groups. Additionally, we investigated the association between HIF 1 alpha and CA IX expressions with stage, grade, lymph node metastasis, tumor dimension and menopause status. Results: Median age of the patients was 52 years (range, 34–77) in group 1 and 47 years (range, 27–83) in group 2. Nuclear HIF-1alpha expression was detected in 26 (46.4%) and 46 patients (83.6%) in group 1 and 2, respectively (p<0.0001). Membranous CA IX expression was detected in 25 (46.4%) and 37 (67.3%) patients in group 1 and 2, respectively (p<0.013). In group 1, median disease free survival (DFS) has not been reached. In group 2, median DFS was 46 months (95%CI: 42.98–49.02) (p= 0.0308). In group 1, median overall survival (OS) was 108 months (95%CI: 90.65–125.35) whereas in group 2, median OS was 75 months (95 % CI: 64.94- 85.06) (p= 0.0339). Conclusions: HIF-1 alpha and CA IX overexpressions were more frequently observed in ER and PR negative, Her-2/neu positive breast cancer. This was associated with shorter disease-free and overall survival.

No significant financial relationships to disclose.

Liver schwannoma incidentally discovered in a patient with breast cancer

BACKGROUND

Benign schwannomas, also referred to as neurilemomas, neurinomas, and perineural fibroblastomas, are encapsulated nerve sheath tumors. Primary schwannomas of the liver are extremely rare. We present a case of liver schwannoma, incidentally found in a patient with breast cancer.

CASE

A 66-year-old female consulted her physician for a mass she palpated on her left breast. The abdominal ultrasonography (USG) revealed a 44 x 28 mm mass in the medial segment of the left lobe of her liver suspicious of a metastasis. An USG-guided biopsy was performed and the histo-pathological examination revealed a "peripheral nerve sheath tumor". Positron emission tomography (PET-CT) revealed a pathologic FDG uptake in the lesion that was previously defined in the liver. The tumor resected from the liver was 5 x 4 x 3 cm, yellowish, soft, and capsulated tumor. Microscopic examination revealed that the mass consisted of bundles of spindle cells with hypercellular and hypocellular areas. In immunohistochemistry, there was a strong positive staining for S-100. The tumor was diagnosed as benign liver schwannoma.

CONCLUSION

Schwannomas are benign, encapsulated neoplasms. Symptoms and signs vary depending on the anatomical site and the size of the neoplasm; however, most schwannomas present as an asymptomatic or painless mass. Recurrence is unusual, despite of an incomplete removal, and malignant transformation is exceedingly rare (Fig. 4, Ref. 8). Full Text (Free, PDF) www.bmj.sk.

Ergothioneine Modulates Proinflammatory Cytokines and Heat Shock Protein 70 in Mesenteric Ischemia and Reperfusion Injury

BACKGROUND AND AIM

Ergothioneine (EGT) is a natural compound that is synthesized by soil bacteria in fungal substrates and exhibits antioxidant functions in many cell models. The purpose of this study was to investigate the effect of EGT on mesenteric ischemia and reperfusion injury.

MATERIALS AND METHODS

Rats were supplemented with or without l-ergothioneine (10 mg/kg/d) for 15 days prior to intestinal ischemia. Animals were subjected to ischemia induced by clamping the superior mesenteric artery for 60 min followed by reperfusion. Serum tumor necrosis factor (TNF)-alpha and interleukin-1beta (IL-1beta) levels, tissue malondialdehide (MDA), myleoperoxidase (MPO), and heat shock protein (HSP) 70 levels, as well as histological findings, were evaluated after 1, 2, and 4 h of reperfusion.

RESULTS

Serum TNF-alpha and IL-1beta levels, and tissue MDA and MPO activities at 1, 2 and 4 h after reperfusion in the EGT group, were significantly lower than the control group (P < 0.05). Tissue HSP-70 levels of the study group were significantly greater than the control group at any time point of reperfusion. No significant differences in tissue damage including morphological changes ranging from villous denudation to focal necrosis, ulceration, hemorrhage, and architectural disintegration at 1 and 2 h after reperfusion exist between the two groups; however, after 4 h of reperfusion, the tissue damage based on histopathologic scores by Chiu was considerably lower in the study group (P < 0.05). After 4 h of reperfusion, focal epithelial lifting and occasional areas of denuded villi could be seen in the samples of the treated animals, thus preserving villous height and mucosal architecture.

CONCLUSION

EGT attenuates mesenteric ischemia reperfusion injury in rat intestine by increasing tissue HSP-70 and decreasing TNF-alpha, IL-1beta, MDA, and MPO levels. EGT also improves morphological alterations, which occurred after IR injury after prolonged periods of reperfusion.

Role of gelatinases (MMP-2 and MMP-9), TIMP-1, vascular endothelial growth factor (VEGF), and microvessel density on the clinicopathological behavior of childhood non-Hodgkin lymphoma

The present study was carried out to clarify the role of matrix metalloproteinase-2 and -9 (MMP-2 and MMP-9), tissue inhibitor of metalloproteinase-1 (TIMP-1), vascular endothelial growth factor (VEGF), and microvessel density (MVD) in the clinicopathologic behavior of childhood B-cell non-Hodgkin lymphoma (NHL). Paraffin-embedded biopsy specimens from 25 children with NHL were studied by immunohistochemically and the correlate the expression of these markers to clinicopathologic characteristics. Positive MMP-9 staining was associated with an increased prevalence of B-symptoms (p = .046). High microvessel density (MVD) showed a tendency toward an adverse outcome and it was correlated with clinical stage (p = .023). The event-free survival of high MVD patients was less than for those with low MVD, but the difference was not statistically significant (64.1% vs. 85.71% respectively, p = 0.15). The overall survival of high MVD patients was less than for those low with MVD and the difference was statistically significant (55.53% vs. 100% respectively, p = .039). Neither gelatinases nor VEGF correlated with age, sex, disease stage, the occurrence of bulky disease, or extranodal disease. The results showed that angiogenesis and angiogenic factors might have a role in development and clinical behavior of childhood NHL. Larger series of patients are needed to determine the prognostic value of angiogenesis in childhood non-Hodgkin lymphoma.

Immunohistochemical findings in prosthesis-associated giant papillary conjunctivitis

PURPOSE

To identify functional subsets of inflammatory cells and expression of cytokines in the conjunctiva of patients with ocular prosthesis-associated giant papillary conjunctivitis (P-GPC).

METHODS

Specific immunohistochemical staining using monoclonal antibodies was performed on biopsy specimens obtained from superior tarsal conjunctiva of 18 patients with P-GPC. The prosthetic eyes were taken as the study group, whereas their fellow eyes were used as matched controls.

RESULTS

In normal conjunctiva, mast cells (MCs) were located only in the substantia propria (SP), whereas in P-GPC eyes MCs were also notable in the epithelium in five specimens. Tryptase-chymase-positive MCs (MC(TC)) were predominant both in P-GPC (79%) and in fellow (72%) eyes. MC(TC), CD4(+) lymphocyte, CD8(+) lymphocyte and eosinophil numbers were higher in P-GPC specimens compared with the fellow eyes (P = 0.005, 0.074, 0.012 and 0.025, respectively). Eosinophils were detected in 58.8% of P-GPC specimens and 16.7% of control specimens (P = 0.053). The number of inflammatory cells expressing eotaxin and interleukin (IL)-4 was higher in P-GPC group (P = 0.050 and 0.048, respectively). Nine out of 17 giant papillary conjunctivitis specimens (52.9%) showed eotaxin and IL-4 immunoreactivity, which was considerably higher than the fellow eyes (16.7%) (P = 0.064).

CONCLUSION

These findings suggest that P-GPC is an allergic disease of the eye associated with increased numbers of MC, eosinophils and lymphocytes in the conjunctiva and a remarkable expression of IL-4 and eotaxin both by the conjunctival epithelium and by the inflammatory cells in the SP.

Apoptosis in orbital fibroadipose tissue and its association with clinical features in Graves' ophthalmopathy

PURPOSE

To evaluate the rate of apoptosis in orbital fibroadipose tissue in Graves' ophthalmopathy (GO) patients and investigate its associations with disease characteristics.

METHODS

Orbital tissue samples were obtained during decompression surgery from 25 GO patients. Disease activity was evaluated using the Clinical Activity Score, while the clinical features of GO were evaluated using the Total Eye Score (TES). Tissue samples of 12 patients without any thyroid or autoimmune disease were studied as controls. The rate of apoptosis was evaluated with a terminal deoxyribonucleotidyl transferase-mediated dUTP-digoxigenin nick-end labeling (TUNEL) assay, and ultrastructural features of apoptosis were evaluated with electron microscopy.

RESULTS

The rate of apoptosis in orbital fibroadipose tissue was significantly higher in GO cases than in the control group (p < 0.001) and significantly correlated with TES (r: 0.545; p = 0.005). The rate of apoptosis was 7.9% +/- 6.5%, and 22.0% +/- 7.8% in type 1 and type 2 cases, respectively (p = 0.001). The rate of apoptosis was 21.6% +/- 7.5% in eyes showing dysthyroid optic neuropathy (DON) and 6.7% +/- 5.4% in eyes without DON (p = 0.005).

CONCLUSIONS

The rate of apoptosis was high in the orbital fibroadipose tissue of GO cases and was related to the clinical features of the disease.

Coexistence of Mirizzi syndrome with adenomyomatosis in the gallbladder: report of a case

BACKGROUND

Mirizzi syndrome is a rare complication of cholelithiasis. Adenomyomatosis is a common tumor-like lesion of the gallbladder.

METHODS

A 52-year-old man was admitted to our hospital complaining of right hypochondriac pain and jaundice. Ultrasonography and computed tomography revealed stones in the gallbladder and dilation of the intrahepatic bile ducts. Magnetic resonance cholangiopancreatography revealed narrowing of the common bile duct caused by compression of the gallbladder. Laparotomy revealed type II Mirizzi syndrome.

RESULTS

Partial cholecystectomy with a Roux-en-Y hepaticojejunostomy reconstruction was performed. Histologically, Rokitansky-Aschoff sinus proliferation, hypertrophy of smooth muscles, and fibrosis were seen in the gallbladder. A segmental type of adenomyomatosis of the gallbladder was diagnosed.

CONCLUSIONS

The pathogenic link between the two peculiar entities is unclear. A possible explanation is considered that the pathogenesis of Mirizzi syndrome is resulted from chronic inflammation due to adenomyomatosis.

BETA-GLUCAN ATTENUATES INFLAMMATORY CYTOKINE RELEASE AND PREVENTS ACUTE LUNG INJURY IN AN EXPERIMENTAL MODEL OF SEPSIS

Sepsis is one of the most important risk factors in acute respiratory distress syndrome (ARDS). beta-Glucan is a potent reticuloendothelial modulating agent, the immunobiological activity of which is mediated in part by an increase in the number and function of macrophages. In this study, we investigated the putative protective role of beta-glucan against sepsis-induced lung injury. Sepsis was induced by cecal ligation and puncture (CLP) in Wistar rats. The control group received saline, and the treatment groups received beta-glucan or beta-glucan + beta-1,3-D-glucanase. Five hours thereafter, plasma tumor necrosis factor (TNF) alpha, interleukin (IL) 1beta, and IL-6 levels were determined. Presence of lung injury was determined via lung tissue myeloperoxidase (MPO) activity, intercellular adhesion molecule (ICAM) 1 levels, and histopathological examination at 18 h after CLP. In a separate set of experiments, survival was monitored for 7 days after CLP. beta-Glucan treatment led to a significant increase in survival rate (63% in glucan-treated rats vs 38% in saline-treated rats). Administration of the beta-glucan inhibitor abrogated beta-glucan's survival benefit (50%). After CLP, plasma TNF-alpha, IL-1beta, and IL-6 concentrations were increased in control animals. When beta-glucan was administered, it completely blocked the elevation of TNF-alpha, IL-1beta, and IL-6. Administration of beta-1,3-D-glucanase suppressed glucan-induced decrease in cytokines. Animals treated with beta-glucan showed a significant reduction in lung injury score, a marked decrease in ICAM-1 expression, and a significant decrease in MPO levels. In contrast, beta-1,3-D-glucanase caused a significantly increased MPO and ICAM-1 levels in the lung. These data reveal that beta-glucan treatment improved the course of CLP-induced peritonitis and attenuated the lung injury. Administration of beta-glucanase inhibited the beta-glucan activity and resulted in enhanced lung injury.

Matrix metalloproteinase-9 expression correlated with tumor response in patients with locally advanced rectal cancer undergoing preoperative chemoradiotherapy

PURPOSE

To analyze whether the expression of matrix metalloproteinases (MMPs) and their tissue inhibitors are associated with tumor response to preoperative chemoradiotherapy in rectal cancer patients.

METHODS AND MATERIALS

Forty-four patients who had undergone preoperative chemoradiotherapy were evaluated retrospectively. Treatment consisted of pelvic radiotherapy and two cycles of 5-fluorouracil plus leucovorin. Surgery was performed 6-8 weeks later. MMP-2, MMP-9, and tissue inhibitors of metalloproteinase-1 and -2 expression was analyzed by immunohistochemistry of the preradiation biopsy and surgical specimens. The intensity and extent of staining were evaluated separately, and a final score was calculated by multiplying the two scores. The primary endpoint was the correlation of expression with tumor response, with the secondary endpoint the effect of chemoradiotherapy on the expression.

RESULTS

Preoperative treatment resulted in downstaging in 20 patients (45%) and no clinical response in 24 (55%). The pathologic tumor response was complete in 11 patients (25%), partial in 23 (52%), and none in 10 (23%). Positive MMP-9 staining was observed in 20 tumors (45%) and was associated with the clinical nodal stage (p = 0.035) and the pathologic and clinical response (p < 0.0001). The staining status of the other markers was associated with neither stage nor response. The overall pathologic response rate was 25% in MMP-9-positive patients vs. 52% in MMP-9-negative patients (p = 0.001). None of the 11 patients with pathologic complete remission was MMP-9 positive.

CONCLUSIONS

Matrix metalloproteinase-9 expression correlated with a poor tumor response to preoperative chemoradiotherapy in rectal carcinoma patients.

Malignant Pleural Mesothelioma with Scalp, Cerebellar, and Finger Metastases: A Rare Case

Malignant pleural mesothelioma (MPM) is a rare and asbestosis-associated tumor. MPM commonly invades locally, mostly in the lung, heart, pericardium, chest wall, and vertebrae. Distant metastasis of MPM is very rare. Here we report a patient with MPM who presented with multiple unusual distant metastases. The patient's thorax tomography demonstrated right-sided, irregularly-thickened pleura with nodular masses and invasion of the chest wall into the subcutaneous area. The patient underwent biopsy for a subcutaneous mass in the right anterior chest wall. Pathologic examination revealed a malignant mesenchymal tumor. During follow-up, he suffered from a painful nodule on the scalp and nodules on the fingers, as well as weakness in his right arm. Cranial magnetic resonance imaging illustrated a 1 cm nodule in the left cerebellar hemisphere. Histopathologic examination of the biopsy from the nodule on the scalp revealed a typical mixed type of MPM, with calretinin, vimentin and creatine 5/6 positivity. Distant metastases can be seen in MPM and a biopsy of metastatic regions can yield the diagnosis.

Microanatomy of Milk Ducts in the Nipple

The aim of this study was to determine number and diameter of milk ducts in the nipple and to investigate the possible influences of age, breast weight, and diameter of the nipple on the number of ducts. Two hundred and twenty-six carcinoma mastectomy specimens were weighed and the nipple diameters measured. The number of ducts was counted in histological cross sections. Mean diameter of the nipple and mean breast weight were 13.9 mm and 844.6 g, respectively. There was a small but statistically significant positive correlation between nipple diameter and number of milk ducts (rho = 0.158; p = 0.01), but no correlation with breast weight. The mean number of ducts in the nipple duct bundle was 17.5. This is significantly higher than the number of ducts reported to open on the nipple surface. This discrepancy could reflect duct branching within the nipple or the presence of some ducts which do not reach the nipple surface. Smaller breast ducts (diameter < 0.5 mm) represent nearly 50% of the nipple ducts and could be a challenge to the ductoscopy technology.

Expression of Smac/DIABLO in B-cell non-Hodgkin and Hodgkin lymphomas

Inhibitor of apoptosis proteins (IAPs) are upregulated in cancers and suppress cell death, in part, through their ability to directly inhibit caspases. Inhibitor of apoptosis proteins are differentially expressed in B-cell lymphomas. The functions of some IAPs are counteracted by the cell death inducer, second mitochondrial-derived activator of caspases/direct IAP binding protein with low pI (Smac/DIABLO). In this study, we investigated the expression levels of Smac/DIABLO in 14 lymphoma cell lines by Western blot analysis. We also assessed 247 B-cell non-Hodgkin's lymphoma (NHL) and 40 Hodgkin's lymphoma (HL) tumors using immunohistochemical methods. Smac/DIABLO was expressed in most NHL and all HL cell lines. In NHL, Smac/DIABLO was expressed in 117 (47%) tumors and was differentially expressed in various NHL types. In most NHLs, from 29% to 68% of tumors were positive; however, Smac/DIABLO was not detected in small lymphocytic lymphoma/chronic lymphocytic leukemia and Burkitt lymphoma, and was rare in extranodal marginal zone B-cell lymphoma. In HL, Smac/DIABLO was positive in 25 (63%) tumors. Unlike NHL, all types of HL were positive for Smac/DIABLO, although nodular sclerosis was least often positive. The differential expression of Smac/DIABLO in NHLs suggests that apoptotic mechanisms are differentially involved in their pathogenesis. These results may also have implications for using Smac/DIABLO or its agonists as therapeutic agents.

Candida vertebra osteomyelitis in a girl with factor X deficiency

Candidal vertebra osteomyelitis is a rare condition which occurs primarily in immunocompromised patients. We report a 14-year-old girl with factor X deficiency who developed candida vertebra osteomyelitis during home therapy. The microorganism was probably from a contaminated peripheral cannula used for infusion of factor concentrate. This is the first such case in bleeding disorders to our knowledge.