Enhancing resolution and contrast in fibre bundle-based fluorescence microscopy using generative adversarial network

Fibre bundle (FB)-based endoscopes are indispensable in biology and medical science due to their minimally invasive nature. However, resolution and contrast for fluorescence imaging are limited due to characteristic features of the FBs, such as low numerical aperture (NA) and individual fibre core sizes. In this study, we improved the resolution and contrast of sample fluorescence images acquired using in-house fabricated high-NA FBs by utilising generative adversarial networks (GANs). In order to train our deep learning model, we built an FB-based multifocal structured illumination microscope (MSIM) based on a digital micromirror device (DMD) which improves the resolution and the contrast substantially compared to basic FB-based fluorescence microscopes. After network training, the GAN model, employing image-to-image translation techniques, effectively transformed wide-field images into high-resolution MSIM images without the need for any additional optical hardware. The results demonstrated that GAN-generated outputs significantly enhanced both contrast and resolution compared to the original wide-field images. These findings highlight the potential of GAN-based models trained using MSIM data to enhance resolution and contrast in wide-field imaging for fibre bundle-based fluorescence microscopy. Lay Description: Fibre bundle (FB) endoscopes are essential in biology and medicine but suffer from limited resolution and contrast for fluorescence imaging. Here we improved these limitations using high-NA FBs and generative adversarial networks (GANs). We trained a GAN model with data from an FB-based multifocal structured illumination microscope (MSIM) to enhance resolution and contrast without additional optical hardware. Results showed significant enhancement in contrast and resolution, showcasing the potential of GAN-based models for fibre bundle-based fluorescence microscopy.

Dynamic thiol-disulphide homeostasis as a biomarker for predicting the development of contrast medium-associated acute kidney injury in the endovascular treatment of peripheral arterial disease: should intravenous N-acetylcysteine be given before the procedure?

AIM

To determine the predictive ability of serum thiol-disulphide levels for contrast medium-associated acute kidney injury (CA-AKI) after endovascular treatment (EVT) of peripheral arterial disease (PAD) and evaluate the efficacy of intravenous N-acetylcysteine (NAC) in preventing CA-AKI.

MATERIAL AND METHODS

This double-blind, randomised controlled study included 85 consecutive adult patients who underwent EVT for PAD. Patients were divided into NAC negative (NAC-) and positive (NAC+) groups. While the NAC- group received only 500 ml saline, the NAC + group received 500 ml saline plus intravenous 600 mg NAC before the procedure. Intra- and intergroup patient characteristics, procedural details, preoperative thiol-disulphide levels, and ischaemia-modified albumin (IMA) levels were recorded.

RESULTS

There was a significant difference between NAC- and NAC + groups regarding native thiol, total thiol, disulphide/native thiol ratio (D/NT), and disulphide/total thiol ratio (D/TT). There was also a significant difference between the NAC- (33.3%) and NAC+ (13%) groups in CA-AKI development. Logistic regression analysis showed that the D/TT (OR 2.463) and D/NT (OR 2.121) were the most influential parameters for CA-AKI development. In the receiver operating characteristic (ROC) curve analysis, the sensitivity of native thiol to detect the development of CA-AKI was 89.1%. The negative predictive values of native thiol and total thiol were 95.6% and 94.1%, respectively.

CONCLUSION

The serum thiol-disulphide level can be used as a biomarker to detect CA-AKI development and reveal patients with a low risk for CA-AKI development before EVT of PAD. Furthermore, thiol-disulphide levels allow for the indirect quantitative monitoring of NAC. Preprocedural intravenous NAC administration significantly inhibits CA-AKI development.

DeepCAN: A Modular Deep Learning System for Automated Cell Counting and Viability Analysis

Precise and quick monitoring of key cytometric features such as cell count, cell size, cell morphology, and DNA content is crucial for applications in biotechnology, medical sciences, and cell culture research. Traditionally, image cytometry relies on the use of a hemocytometer accompanied with visual inspection of an operator under a microscope. This approach is prone to error due to subjective decisions of the operator. Recently, deep learning approaches have emerged as powerful tools enabling quick and highly accurate image cytometric analysis that are easily generalizable to different cell types. Leading to simpler, more compact, and less expensive solutions, these approaches revealed image cytometry as a viable alternative to flow cytometry or Coulter counting. In this study, we demonstrate a modular deep learning system, DeepCAN, that provides a complete solution for automated cell counting and viability analysis. DeepCAN employs three different neural network blocks called Parallel Segmenter, Cluster CNN, and Viability CNN that are trained for initial segmentation, cluster separation, and cell viability analysis, respectively. Parallel Segmenter and Cluster CNN blocks achieve highly accurate segmentation of individual cells while Viability CNN block performs viability classification. A modified U-Net network, a well-known deep neural network model for bioimage analysis, is used in Parallel Segmenter while LeNet-5 architecture and its modified version called Opto-Net are used for Cluster CNN and Viability CNN, respectively. We train the Parallel Segmenter using 15 images of A2780 cells and 5 images of yeasts cells, containing, in total, 14742 individual cell images. Similarly, 6101 and 5900 A2780 cell images are employed for training Cluster CNN and Viability CNN models, respectively. 2514 individual A2780 cell images are used to test the overall segmentation performance of Parallel Segmenter combined with Cluster CNN, revealing high Precision/Recall/F1-Score values of 96.52%/96.45%/98.06%, respectively. Overall cell counting/viability analysis performance of DeepCAN is tested with A2780 (2514 cells), A549 (601 cells), Colo (356 cells), and MDA-MB-231 (887 cells) cell images revealing high counting/viability analysis accuracies of 96.76%/99.02%, 93.82%/95.93%, and 92.18%/97.90%, 85.32%/97.40%, respectively.

An adaptive feature extraction method for classification of Covid-19 X-ray images

This study aims to detect Covid-19 disease in the fastest and most accurate way from X-ray images by developing a new feature extraction method and deep learning model . Partitioned Tridiagonal Enhanced Multivariance Products Representation (PTMEMPR) method is proposed as a new feature extraction method by using matrix partition in TMEMPR method which is known as matrix decomposition method in the literature. The proposed method which provides 99.9% data reduction is used as a preprocessing method in the scheme of the Covid-19 diagnosis. To evaluate the performance of the proposed method, it is compared with the state-of-the-art feature extraction methods which are Singular Value Decomposition(SVD), Discrete Wavelet Transform(DWT) and Discrete Cosine Transform(DCT). Also new deep learning models which are called FSMCov, FSMCov-N and FSMCov-L are developed in this study. The experimental results indicate that the combination of newly proposed feature extraction method and deep learning models yield an overall accuracy 99.8%.

Assessment of plasma microRNA potentials as a non-invasive biomarker in patients with axial spondyloarthropathy

OBJECTIVE

It is assumed that abnormally expressed MicroRNAs (miRNAs) may be present in the plasma of patients with radiographic axial spondyloarthropathy (rad-AxSpA). Thus, the present study was conducted with the aim of investigating the expression profile of miRNAs in patients with rad-AxSpA.

PATIENTS AND METHODS

A total of 15 patients diagnosed with rad-AxSpA according to the Assessment of the SpondyloArthritis International Society (ASAS) classification criteria and nine healthy controls matched for age and gender were included in the study. Demographic data were collected, and disease activity was evaluated using the Bath Ankylosing Spondylitis Disease Activity Index (BASDAI). Peripheral blood samples were collected, and miRNAs were extracted. The expression of microRNAs was analyzed using quantitative Real Time-Polymerase Chain Reaction (qRT-PCR) by the miScript miRNA PCR Array Human Inflammatory Response and Autoimmunity.

RESULTS

A total of 84 miRNA profiles were evaluated, and expressions in the study and control groups were compared. When compared to the control group, 6 miRNAs (miR-125b-5p, miR-144-3p, miR-19a-3p, miR-20a-5p, miR-29c-3p, miR-30b-5p) were detected to be upregulated, and 42 miRNAs were detected to be downregulated in the rad-AxSpA group. A p-value < 0.05 was accepted as statistically significant. A significant association was found between miR-145-5p and BASDAI (p = 0.04941). MiR-144-3p, miR-302b-3p, miR-381-3p, miR-497-5p, miR-511-5p, and miR-9-5p were found to be significantly upregulated in the HLA-B27+ patients (p = 0.03063).

CONCLUSIONS

Abnormal miRNA expressions were detected in the plasma of the patients with rad-AxSpA. It was concluded that comprehensive studies should be continued to define these miRNAs as diagnostic biomarkers for rad-AxSpA in order to detect its association with Ankylosing Spondylitis disease activity.

DEATH DUE TO CARDIAC ANGIOSARCOMA: AUTOPSY CASE REPORT

Background. Primary tumors of the heart are rarely detected at autopsy, especially angiosarcomas which are primary malignant one. Objective. We presented autopsy case of cardic angiosarcoma with morphologic findings. Methods. We described adult man died in emergency service of the hospital. Results. Reported case was 33 year-old-man who was died in emergency service of hospital where he was taken when he was ill after leaving home. According the prosecution documents, and the expressions of family, it was reported that he had a heart disease; his symptoms repeated 3 day ago before he died, he thought to attend the Cardiology Clinic due to his symptoms. At autopsy on macroscopic internal examination, mass with rough surface in the right atrium, hematoma at the posterior of the right atrium, blood in the pericardia, nodular lesions in hemorrhagic appearance in the sections of lung, liver and spleen were detected. In histopathologic examination; in the heart angiosarcioma as primary malign heart tumor and metastatic masses in the liver, spleen and lung were detected. Conclusions. We aimed to discuss cardiac angiosarcoma case with autopsy and histopathologic findings in the aspect of medico legal literature.

Reliability of reporting the presence of transformation zone material in Papanicolaou smears using an automated screening system

OBJECTIVE

This study was conducted to evaluate the reliability of using an interactive automated screening system (IAS) to determine the presence of endocervical and/or metaplastic cells (transformation zone material; TZM) in liquid-based cytology (LBC) Papanicolaou (Pap) smear slides.

MATERIALS AND METHODS

A series of LBC Pap smears was manually screened to determine the presence or absence of TZM. The results were compared to those obtained through IAS.

RESULTS

ThinPrep^® Imaging System (Imager)-assisted screening indicated that 22.4% of the slides did not contain TZM in cases in which previous manual screening revealed that 100% of the slides did contain TZM.

CONCLUSION

The reliability of determining TZM through IAS is limited. Manual screening of the slides appears to be necessary to report the presence of TZM accurately.

Multi-digit contracture release using medial sural artery perforator flap with syndactylization-desyndactylization method

BACKGROUND

The medial sural artery perforator flap, with a long pedicle, has tremendous potential for applications in a variety of soft tissue defects. It can be used for reconstruction of multi-digit contractures of the palmar region.

MATERIALS AND METHODS

We present herein the key features of the management of postburn multi-digit volar contractures, using medial sural artery perforator flaps with the syndactylization and desyndactylization method. We describe the use of the free medial sural artery perforator flap in two patients, to reconstruct complex composite hand defects including the second, third, fourth and fifth digits following thermal burns.

RESULTS

Both flaps healed uneventfully. In both patients, the hand contractures released completely and adequate joint motion was achieved after a 3-month period of physiotherapy.

CONCLUSIONS

The thin medial sural artery perforator flap permits high accuracy of soft tissue reconstruction of the hand and reduces the morbidity at the donor site. The MSAPF is a useful flap in areas such as the hands, in the case of soft tissue deficiency and tendon exposition. Hippokratia 2015; 19 (4): 366-368.

The importance of hemosiderin deposition in the infant brain: an autopsy study

BACKGROUND/AIM

Iron is an essential element involved in many metabolic processes. Presence and accumulation of iron in various body systems can result in different outcomes. Its accumulation in the central nervous system (CNS) cannot be detected routinely by application of hematoxylin-eosin staining. Detection of the presence of hemosiderin in the brain and cerebellum by application of Perls' dye is of importance in cases of infant deaths.

MATERIAL AND METHODS

In this study, brain and cerebellar specimens obtained from 52 eligible infants  (aged 0-1 years) autopsied in our institute between the years 2010 and 2013, independent of the cause of death, were analyzed in order to detect possible presence of hemosiderin. Perls' dye was used to detect histopathological staining intensity and distribution of hemosiderin in the brain and cerebellum.

RESULTS

Cases did not differ significantly as for the patients' age and gender (p =0.473), type of the culprit trauma (p =0.414), death/crime scene (p =0.587), and diagnosis groups (p =0.550). In this autopsy study blue colored hemosiderin granulations, stained with Perls' dye were detected in the brain (n: 39, 75%), and cerebellum (n: 35, 67.3%). A weakly negative, but significant correlation was detected between the postmortem interval and intensity values of cerebellar hemosiderin (Spearman's correlation coefficient: -0.381, p =0.024). A statistically significant difference was found between the distribution scores of cerebral hemosiderin in cases with and without trauma history (p =0.03). Median cerebral hemosiderin distribution scores were 2.5 and 2, respectively.

CONCLUSIONS

The detection of a correlation between the presence of cerebral and cerebellar hemosiderin, and postmortem interval in the age group of 0-1 years, should be interpreted as an important finding in the analysis of cerebral iron. The presence of hemosiderin in the CNS may be a significant finding in the elucidation of infant deaths and this procedure should be carried out on a routine basis.Hippokratia 2015; 19 (2):164-171.

Familial Mediterranean fever gene (MEFV) mutations and disease severity in systemic lupus erythematosus (SLE): implications for the role of the E148Q MEFV allele in inflammation

OBJECTIVE

Observed low prevalence of SLE among familial Mediterranean fever (FMF) patients in several large cohorts suggests a possible protective effect of the MEFV mutations from SLE. In contrast, SLE patient carriers for the common MEFV mutations had rather complex disease expression with an increased frequency of febrile episodes and pleurisy and a decreased renal complication rate. Our aim was to investigate the prevalence of MEFV gene mutations in patients with SLE and their effect on organ involvement in a well-defined group of biopsy-proven SLE nephritis patients.

MATERIAL AND METHOD

The prevalence of four MEFV gene mutations (M694V, M680I, V726A and E148Q) was investigated in 114 SLE patients and effect on disease severity was analyzed in patients with biopsy-proven SLE nephritis.

RESULTS

None of the SLE patients fulfilled the revised Tel-Hashomer criteria. Fourteen of 114 SLE patients (12.2%) were found to carry at least one MEFV mutation. A single patient in the SLE-Nephritis group was compound heterozygous for M694V/M680I mutations and only one patient in the SLE-Mild group was homozygous for E148Q mutation. Carrier frequency was similar to controls in SLE patients (12.2 vs 18.8%, p = 0.34). After the exclusion of the less penetrant E148Q mutation, re-analysis revealed an association between exon 10 mutations and SLE nephritis (p = 0.050, odds ratio (OR) = 4.16, 95% confidence interval (CI) = 1.04-16.6). Carrier rate for the E148Q mutation decreased in the SLE group (controls vs. SLE = 20/186 vs. 3/114, p = 0.08) and E148Q mutation was absent in SLE nephritis (controls vs. SLE nephritis = 20/186 vs. 0/47, p = 0.016, OR = 11.69, 95% CI = 0.69-197.13).

CONCLUSIONS

Carrier rate for the studied MEFV mutations was slightly lower in the SLE group, which is in agreement with previous observations that FMF may confer some protection from SLE. Exon 10 mutations were associated with SLE nephritis after the exclusion of the E148Q mutation. The significance of the E148Q as a disease-causing mutation is controversial, and whether E148Q substitution is a polymorphism generally affecting inflammatory pathways is not addressed in the current literature. In this regard, absence of the E148Q mutation in SLE nephritis may serve as a clue for further investigation into its role as a general modulatory polymorphism for inflammation. This clarification is necessary to conclude whether other more penetrant MEFV gene mutations confer susceptibility to nephritis in SLE.

Frostbite injury of the breast: a case report

This paper presents an unusual case of frostbite injury to the breast area caused by faulty cryotherapy application. Cryotherapy, commonly used by patients and health professionals, relieves pain and edema after trauma and sports injuries. However, applying cold therapy is not common for surgical procedures involving soft tissue. The frostbite injury to the breast presented here occurred due to persistent use of a self-prepared ice pack following a needle aspiration biopsy. Cold exposure to soft tissue may cause frostbite. It is crucial to inform patients about proper application of cryotherapy and possible complications, particularly for the procedures in which cold therapy is not widely used.

Sudden death due to a rare brain tumor: an autopsy case

Sudden death in persons with intracranial neoplasms is a rare mechanism of death detected in the forensic autopsies. 10 years-old girl was brought to a local clinic death shortly after analgesic therapy for headache. Autopsy findings showed a large, solid cerebellar mass. Histological diagnosis was pilomyxoid astrocytoma, low-grade tumor with features alike to pilocytic astrocytomas. In this case report we present and discuss rare autopsy case of pilomyxoid astrocytoma from medicolegal point of view.

KEYWORDS

sudden death - brain - pilomyxoid astrocytoma - autopsy.

Age-related histopathological changes in the cardiac conducting system in the Turkish population: an evaluation of 202 autopsy cases

BACKGROUND

Histopathological features of the cardiac conducting system (CCS) in the Turkish population have not been investigated previously.

MATERIAL AND METHODS

We examined CCS of 202 autopsy heart specimens dissected between the years 2004 and 2005 in Bursa Forensic Medicine Institution. Of the 202 cases from all age groups, 154 were males and 48 were females.

RESULTS

In our cases, an increase in fibrous and adipose tissue concordant with age, indicating an age-related nature, were detected. Fibrous and fatty tissue infiltration appeared at the age of 35. Fatty infiltration started between the ages 20 and 34 years at the sinoatrial node (SAN). There was no relationship between obesity and fatty tissue infiltration in SAN and atrioventricular node (AVN). In 4 cases calcification and in 19 cases inflammation was observed. Amyloid accumulation was not present. In 7 cases myocardial infarction not involving CCS was seen. In 1 case fibroelastoma was detected.

CONCLUSIONS

In the Turkish population age-related fibrosis and fatty infiltration in CCS appeared at the age of 35 years and increased with age. Fatty infiltration in the SAN started at a younger age than that reported in the literature. In cases where the cause of death could not be determined, we could not detect lethal pathological features. However, we think that examination of the CCS will improve the quality of autopsy diagnosis.

Preliminary evidence of an association between the functional c-kit rs6554199 polymorphism and achalasia in a Turkish population

BACKGROUND

C-kit-positive interstitial cells of Cajal (ICC) of the lower esophageal sphincter are reduced in achalasia. Two functional gene polymorphisms (rs2237025 and rs6554199) within the c-kit gene may affect its transcriptional activity. In this pilot study, we hypothesized that these polymorphisms would be associated with achalasia.

METHODS

Genomic DNA was extracted and real-time PCR reactions were used to determine the rs2237025 and rs6554199 c-kit polymorphisms in 88 Turkish patients with achalasia and 101 healthy controls.

KEY RESULTS

The frequency of the T allele of rs6554199 was significantly higher in patients with achalasia [odds ratio (OR): 1.55; 95% confidence interval (CI), 1.03-2.34; P = 0.038] compared with the G allele. Under a dominant model of inheritance, the carriage of at least one T allele was significantly more frequent in patients with achalasia (80.7%) than in controls (65.3%; OR: 2.21; 95% CI, 1.13-4.33; P = 0.022). No association of the c-kit rs2237025 polymorphism with achalasia was detected.

CONCLUSIONS & INFERENCES

Despite the small sample size and the possibility of a false positive finding, our preliminary data support the hypothesis that the T allele of the c-kit rs6554199 polymorphism may be associated with achalasia in the Turkish population. These findings need to be replicated in other racial-ethnically diverse populations.

Serum levels of soluble receptor for advanced glycation endproducts (sRAGE) are higher in ulcerative colitis and correlate with disease activity

Interaction of the receptor for advanced glycation endproducts (RAGE) with its ligands results in expression of inflammatory mediators, activation of NF-κB, and induction of oxidative stress, all of which have been implicated in the pathogenesis of inflammatory bowel diseases (IBD). Soluble receptor for advanced glycation endproducts (sRAGE) has recently emerged as a reliable biomarker of inflammation in numerous RAGE-mediated disorders.

OBJECTIVE

To assess sRAGE levels in adult patients with IBD.

METHOD

Serum was collected from adult patients with Crohn's disease (CD, 56 patients), ulcerative colitis (UC, 60 patients), and healthy controls (HC, 113 subjects). Levels of sRAGE were determined by enzyme-linked immunosorbent assay.

RESULTS

Serum sRAGE levels were elevated in IBD compared to HC and were higher in UC patients compared to CD and HC. Levels of sRAGE were significantly higher in the serum of UC patients with active disease compared to patients with inactive disease, but no association with the Montreal Classification was evident. Serum sRAGE was lower in CD patients with biological therapies.

CONCLUSIONS

These findings suggest that serum levels of sRAGE are altered in patients with intestinal inflammation and may reflect distinct immunoinflammatory pathogenesis of UC and CD.

High prevalence of TSHR/Gsα mutation-negative clonal hot thyroid nodules (HNs) in a Turkish cohort

Whereas the majority of hot thyroid nodules are caused by somatic TSH-receptor mutations, the percentage of TSH-receptor mutation negative clonal hot nodules (HN) and thus the percentage of hot nodules likely caused by other somatic mutations are still debated. This is especially the case for toxic multinodular goiter (TMNG). 35 HNs [12 solitary hot nodules (SHN), 23 TMNG] were screened for somatic TSHR mutations in the exons 9 and 10 and for Gsα mutations in the exons 7 and 8 using DGGE. Determination of X-chromosome inactivation was used for clonality analysis. Overall TSHR mutations were detected in 14 out of 35 (40%) HNs. A nonrandom X-chromosome inactivation pattern was detected in 18 out of 25 (72%) HNs suggesting a clonal origin. Of 15 TSHR or Gsα mutation negative cases 13 (86.6%) showed nonrandom X-chromosome inactivation, indicating clonal origin. The frequency of activating TSHR and/or Gsα mutations was higher in SHNs (9 of 12) than in TMNGs (6 of 23). There was no significant difference for the incidence of clonality for HNs between TMNGs or SHNs (p: 0.6396). Activating TSHR and/or Gsα mutations were more frequent in SHNs than in TMNG. However, the frequency of clonality is similar for SHN and TMNG and there is no significant difference for the presence or absence of TSHR and/or Gsα mutations of clonal or polyclonal HNs. The high percentage of clonal mutation-negative HNs in SHN and TMNG suggests alternative molecular aberrations leading to the development of TSHR mutation negative nodules.

The effect of laser-activated Acidulated Phosphate Fluoride on enamel submitted to erosive solution only: an in vitro preliminary evaluation

AIM

The purpose of this in vitro study was to evaluate the potential effect of laser therapy on the prevention of erosive demineralisation either alone or combined with acidulated phosphate fluoride gel on human enamel. It was hypothesized that such a treatment would decrease enamel solubility.

STUDY DESIGN

Efficacy of 2940 nm Er:YAG laser with preset parameters--alone or combined with APF (Acidulated Phosphate Fluoride) gel--was tested on freshly extracted human permanent molars.

MATERIALS AND METHODS

Ten sound human third molars were sectioned into 5 surfaces (2 x 3 mm) with hard tissue microtome and were randomly allocated into different treatment groups as follows. The Vicker's hardness of each surface was obtained at the baseline. Group 1, negative control group: no treatment. Group 2, positive control group: only 1.23% APF gel (Denti-Care gel, Medicom) 1 minute application. Group 3: irradiated with surface modification mode (2940 nm, 1.2j/cm², 10 Hz, 300 μm) Er:YAG laser. Group 4: Er:YAG laser application following 1.23% APF gel. Group 5: 1.23% APF gel following Er:YAG laser application. The demineralisation process was obtained by immersion of specimens in a soft drink for 10 minutes and then the Vickers hardness was reevaluated.

STATISTICS

For statistical analyses within groups the Kruskal Wallis test was used, while for comparing groups the paired sample t test (significance p<0.05) was used.

RESULTS

The difference in microhardness values of each group obtained following the treatments was not statistically significant (p>0.05). Beside, no statistical difference was found in Vickers value related to the application of fluoride prior or after laser therapy. Conclusion Er:YAG laser irradiation alone or combined with APF decreased the enamel solubility but combined treatment did not show any significant additional effect.

Adenoid cystic carcinoma of the Bartholin's gland: case report and systematic review of the literature

Adenoid cystic carcinoma (ACC) of the Bartholin's gland is a rare malignancy of the female genital tract. Seventy-nine cases have been reported in the literature. A 40-year-old women presented to our clinic with twice locally recurrent ACC of Bartholin's gland of the left vulva despite hemivulvectomy. Adjuvant radiotherapy was delivered after the third resection. There was no local recurrence after three years follow-up, although she developed lung metastases that remain under control with oral cyclophosphamide. Our case confirms the literature review, which indicates a slow growing tumor with frequent local recurrences (30%) and distant metastases (31%). Adjuvant radiotherapy and/or chemotherapy should be considered in the management of ACC of Bartholin's gland.

Ovarian enlargement associated with massive oedema

Massive ovarian oedema is a rare entity described as accumulation of oedema fluid within the ovarian stroma, separating normal follicular structures. Our case was a 27-year-old woman who presented with a large solid pelvic mass after recurrent episodes of self-limited abdominal pain. On physical examination, she had left abdominal tenderness with minimal rebound and guarding. With a diagnosis of malignant ovarian tumor, an exploratory laparotomy was done and a twisted ovarian mass was found which was excised completely. Histopathological evaluation of the mass revealed massive oedema of the ovary. Massive ovarian oedema should be suspected in women at the fertile age range with solid enlargement of the ovary.

Squamous cell carcinoma developing in a huge dermoid cyst of the ovary in an 80-year-old woman--case report

A case of an 80-year-old patient with squamous cell carcinoma originating from a huge septated dermoid cyst of the right ovary is reported. There were bilateral dermoids in the patient. The tumor sizes were 30 x 40 x 20 cm and 4 x 3 x 5 cm in the right and left ovary, respectively, confirmed by ultrasound and computed tomography. Squamous cell carcinoma arose in the solid part of a huge dermoid cyst of the left ovary. Total abdominal hysterectomy and bilateral salpingo-oophorectomy, omentectomy and appendectomy were performed. The tumor was confined to the right ovary. The patient was categorized as FIGO Stage IA. She recovered uneventfully and there was no evidence of recurrence in the early-stage case during one year of follow-up. The clinical and pathological features, treatment modalities and prognosis of squamous cell carcinoma are described.

Bilateral metastatic breast cancer as the first manifestation of ovarian cancer: case report

BACKGROUND

Breast metastasis from primary ovarian cancer is extremely rare. The rarity of this finding may be the reason for its common misinterpretation as primary breast carcinoma.

DESIGN

Case report.

SETTING

A university hospital.

RESULTS

A case of a patient with primary ovarian papillary serous cystadenocarcinoma who initially presented with a solitary bilateral breast mass and abdominal distention is reported.

CONCLUSIONS

Blood-borne metastasis from the ovary to the breast can show a varied clinical picture that should be differentiated from that of primary breast carcinoma.

Benign glandular cells in posthysterectomy vaginal smears: the incidence is higher than expected

In this study, we have investigated the frequency and clinical significance of glandular cells in posthysterectomy vaginal smears. The slides of vaginal cuff smears of 290 patients were reviewed. The glandular cells were categorized into three groups: (1) squamous metaplastic-like cells; (2) columnar endocervical-like cells; and (3) small round cuboidal cells. Glandular cells were found in 39 (13%) of the 290 vaginal smears. Group 1 type cells were seen in 76% (n = 30), group 2 type cells in 38% (n = 15) and group 3 type cells in 47% (n = 19) of the smears. In 19 (48%) of the smears combination of two or three groups were seen. The presence of glandular cells showed a strong association with inflammation/repair as a background finding in the smears. No correlation could be found between the presence of atrophy and history of chemotherapy or radiotherapy. Apart from these there was a prominent increase in reporting benign glandular cells after the application of the current Bethesda 2001 reporting criteria in our laboratory. As a result our study showed that the finding of glandular cells in posthysterectomy vaginal smears is more frequent than expected and most of them could be related to inflammatory and regenerative processes in the absence of a clearly identified underlying cause.

BCL-2 and P53 expression in endometrial carcinoma

Our aim was to compare the results of bcl-2 expression in endometrial carcinoma with clinicopathological prognostic factors along with p53 accumulation. In addition, p53 expression was compared to different subtypes of endometrial carcinoma. Immunohistochemical staining was performed on formalin-fixed, paraffin embedded tissue sections by using Bcl-2 Supersensitive Mouse Anti-Bcl-2 Oncoprotein (Biogenex AM287-5M) for bcl-2 immunostaining and Supersensitive Mouse Anti-p53 Suppressor Gene Product (1801) (Biogenex AM 240-5M) for p53 immunostaining. 9 out of 9 cases of proliferative endometrium, 5/5 cases of endometrial hyperplasia without atypia, 5/5 cases with atypia, and 21/35 cases of endometrial carcinoma showed bcl-2 protein expression. Bcl-2 expression was not related to age, surgical stage, or histopathological features, nor was there an inverse correlation between bcl-2 and p53 expression in endometrial carcinoma. p53 expression was detected in 3/4 cases of serous papillary carcinoma, whereas only 5/31 cases of endometrioid carcinoma showed p53 expression. Bcl-2 expression decreased in endometrial carcinomas, and mechanisms other than p53 may play a role in the regulation of bcl-2 expression in endometrial carcinoma. Abnormal p53 protein expression is an important event in the development of serous tumors, which may explain partly why they are more aggressive than their endometrioid counterparts where p53 expression does not play a major role.

Adrenomedullin in cirrhotic and non-cirrhotic portal hypertension

AIM: Adrenomedullin (ADM) is a potent vasodilator peptide. ADM and nitric oxide (NO) are produced in vascular endothelial cells. Increased ADM level has been linked to hyperdynamic circulation and arterial vasodilatation in cirrhotic portal hypertension (CPH). The role of ADM in non-cirrhotic portal hypertension (NCPH) is unknown. plasma ADM levels were studied in patients with NCPH, compensated and decompensated cirrhosis in order to determine its contribution to portal hypertension (PH) in these groups.

METHODS: There were 4 groups of subjects. Group 1 consisted of 27 patients (F/M: 12/15) with NCPH due to portal and/or splenic vein thrombosis (mean age: 41 ± 12 years), group 2 consisted of 14 patients (F/M: 6/8) with compensated (Child-Pugh A) cirrhosis (mean age: 46 ± 4), group 3 consisted of 16 patients (F/M: 6/10) with decompensated (Child-Pugh C) cirrhosis (mean age: 47 ± 12). Fourteen healthy subjects (F/M: 6/8) (mean age: 44 ± 8) were used as controls in Group 4. ADM level was measured by ELISA. NO was determined as nitrite/nitrate level by chemoluminescence.

RESULTS: ADM level in Group 1 (236 ± 61.4 pg/mL) was significantly higher than that in group 2 (108.4 ± 28.3 pg/mL) and group 4 (84.1 ± 31.5 pg/mL) (both P < 0.0001) but was lower than that in Group3 (324 ± 93.7 pg/mL) (P = 0.002). NO level in group 1 (27 ± 1.4 μmol/L) was significantly higher than that in group 2 (19.8 ± 2.8 μmol/L) and group 4 (16.9 ± 1.6 μmol/L) but was lower than that in Group 3 (39 ± 3.6 μmol/L) (for all three P < 0.0001). A strong correlation was observed between ADM and NO levels (r = 0.827, P < 0.0001).

CONCLUSION: Adrenomedullin and NO levels were high in both non-cirrhotic and cirrhotic portal hypertension and were closely correlated, Adrenomedullin and NO levels increased proportionally with the severity of cirrhosis, and were significantly higher than those in patients with NCPH. Portal hypertension plays an important role in the increase of ADM and NO. Parenchymal damage in cirrhosis may contribute to the increase in these parameters.

Adenocarcinoma, adenoacanthoma, and mixed adenosquamous carcinoma of the endometrium

PURPOSE

To determine the frequency of endometrial adenocarcinoma (AC) with squamous cell differentiation and to compare the histopathologic and clinical characteristics of patients with adenoacanthoma (AA) and adenosquamous carcinoma (AS) to evaluate possible prognostic differences.

MATERIALS AND METHODS

Two hundred forty patients with endometrial carcinoma (72.2% AC, 21.25% AA, 6.25% AS) treated at the Department of Gynecologic Oncology of Marmara University Hospital, between January 1986 and December 1997, were reviewed. The diagnoses of the diseases were made with fractional D&C, and the definitive therapy for all patients was carried out at the same hospital. Extrafascial hysterectomy + BSO with or without pelvic and para-aortic lymph node dissection, and omentectomy according to the FIGO staging and grading system were performed.

RESULTS

AC and AS had median ages around 60 years with a similar percent distribution of postmenopausal patients (around 74%). AA had an earlier median age of 51 years which reflects an incidence of only 50% postmenopausal patients. There was a tendency for AA to be of low-grade malignancy (72%), 51% of AC were of low-grade, while only 20% of AS were low-grade tumors. There was no difference for any of the three pathological entities in survival by FIGO stages. Over 80% of the tumors were Stage I and about 10% were Stage II, with less than 10% in Stages III and IV.

CONCLUSION

Considering the more modern and uniform approaches in therapy for these tumors, there seems to be no differences in prognosis for adenocarcinoma with or without squamous elements. The neoplasms AC, AA and AS should be regarded, and consequently approached, as any low-grade adenocarcinoma of the endometrium.

Leiomyosarcoma of the broad ligament: case report and literature review

A 56-year-old woman with leiomyosarcoma of the broad ligament discovered in the outpatient clinic in Marmara University Medical School is presented. Treatment consisted of total abdominal hysterectomy and bilateral salpingo-oophorectomy. After a one-year disease-free interval, the patient underwent a repeat laparotomy and recurrence of the previously excised malignant tumor was removed. The patient received external radiotherapy to the pelvis with linear accelerator.

Expression of structural proteins and angiogenic factors in cerebrovascular anomalies

OBJECTIVE

The goal of this study was to describe the expression of matrix proteins and angiogenic factors in cerebrovascular malformations.

METHODS

Forty-six cerebrovascular malformations were immunohistochemically investigated with a battery of staining for five structural proteins (collagen IV, collagen III, smooth muscle actin, fibronectin, and laminin), and three angiogenic factors (vascular endothelial growth factor [VEGF], basic fibroblast growth factor [bFGF], and transforming growth factor alpha [TGFalpha]). The lesions consisted of 34 arteriovenous malformations (AVMs), 10 cavernous malformations (CMs), and 2 venous angiomas. Expression intensity for each histological layer in the abnormal vessel wall was graded and compared.

RESULTS

AVM endothelia and subendothelia expressed more laminin and collagen IV than the same layers of CMs. Conversely, CMs expressed more fibronectin than AVMs. CM endothelia exhibited more prominent staining for smooth muscle actin than AVM endothelia. AVMs and CMs expressed VEGF in the endothelium and subendothelium, and TGFalpha in endothelial and perivascular layers. However, unlike AVMs, CMs expressed bFGF in the endothelium as well. The brain tissue intermingled within AVMs also expressed growth factors. Modified glial cells in the brain tissue adjacent to CMs expressed bFGF and TGFalpha, but not VEGF. Venous angiomas did not express the studied growth factors and mainly consisted of structural proteins of angiogenically mature tissue.

CONCLUSION

Expression characteristics of structural proteins reveal that AVMs and CMs have different immunohistological properties. This study provides strong confirmation of previous findings of VEGF and bFGF immunoexpression in AVMs and CMs. It adds new information on TGFalpha expression in these malformations and on expression of the angiogenic factors in venous angiomas.

Large-cell calcifying Sertoli cell tumour of the testis: associated organ anomalies

A case is reported of unilateral, focal large-cell calcifying Sertoli cell tumour (LCCSCT) of the testis associated with complex endocrine disorders and cardiac myxomas. It is believed that there are two distinct groups of patients with this tumour: those who have complex dysplastic syndromes and bilateral and multifocal tumours; and those without any syndromes but who have unilateral and focal tumours. The presented case differs in that, although the patient has a unilateral focal tumour, unique organ anomalies, such as renal agenesis and inferior vena cava duplication, are also present. These anomalies with LCCSCT have not been reported before.

A randomized comparison of the 3 Papanicolaou smear collection methods

The purpose of this study was to compare the effectiveness of 3 cervical smear sampling devices for obtaining acceptable yields of endocervical cells in Papanicolaou smears. In a randomized, controlled clinical trial, we collected 346 smears over a 6-month period, 110 with the Cervex brush, 125 with the cotton swab plus Ayre spatula and 111 with the Cytobrush plus Ayre spatula. The Cytopathology Laboratory, blinded to the Papanicolaou smear method, screened the smears using the Bethesda system guidelines. Statistical analyses were performed using the Pearson X2 and analysis of variance tests. There was an increased detection of endocervical cells in the Cytobrush plus Ayre spatula and the Cervex brush methods, compared with the cotton swab plus Ayre spatula group (p = 2.39 x 10(-6), p = 4.49 x 10(-7) respectively). There was no statistically significant difference between the Cytobrush-Ayre spatula and the Cervex brush sampling methods were equally effective in obtaining endocervical cells in Papanicolaou smears.