Mediastinitis and subcutaneous abscess complicated after EBUS-TBNA of 2R mediastinal lymph node

Endobronchial ultrasound-guided transbronchial needle aspiration (EBUSTBNA) is a minimally invasive diagnostic tool used for the evaluation of mediastinal lymphadenopathy. It is a safe procedure, but complications such as bleeding and infection may occur. We report a case of a patient who developed a subcutaneous abscess abscess and mediastinitis after EBUSTBNA. A 75-year-old male with a history of right nephrectomy due to renal cell carcinoma and lung adenocarcinoma history underwent EBUS-TBNA for the evaluation of a right upper paratracheal lymph node. Two weeks after the procedure, the patient presented to the emergency department with skin induration and erythema on the right clavicular area. A non-contrast neck and thorax CT scan was performed, which revealed an extensive subcutaneous abscess on the right clavicular area, extending to the supraclavicular region. The patient was hospitalized, and empirical intravenous antibiotics were initiated due to deep neck infection. Repeated drainage of the subcutaneous abscess was performed. Bacteriologic examination revealed Streptococcus mitis. The patient showed improvement with antibiotic treatment, and a follow-up ultrasound showed a decrease in the size of the abscess and was discharged approximately four weeks after hospitalization. Although very rare, serious infectious complications may develop after EBUSTBNA, and our case report is an important example regarding its management process.

Diagnostic value of serum signal peptide-CUB-EGF-like domain-containing protein 1 levels in patients with acute appendicitis

OBJECTIVE

Acute appendicitis is one of the most common surgical causes of an acute abdomen among patients admitted to the emergency room due to abdominal pain. The clinical diagnosis of acute appendicitis is usually difficult and is made by evaluating the clinical, laboratory, and radiological findings together. The aim of this study was to investigate the diagnostic potential of signal peptide-CUB-EGF-like domain-containing protein 1 as a biomarker for acute appendicitis.

METHODS

A total of 67 adult patients without any comorbidities who presented to the emergency department with abdominal pain and were clinically diagnosed with acute appendicitis were included in the case group. The patients included in the study were classified into the negative appendectomy group and the acute appendicitis group according to their histopathological final diagnosis. In addition, 48 healthy volunteers without comorbidities were included in the control group. Signal peptide-CUB-EGF-like domain-containing protein 1 levels of patients and the control group were measured.

RESULTS

According to postoperative histopathological examinations of the patients, 7 (10.4%) patients were diagnosed with negative appendectomy, and 60 (89.6%) patients were diagnosed with acute appendicitis. Signal peptide-CUB-EGF-like domain-containing protein 1 levels were higher in the patients with acute appendicitis than in negative appendectomy patients (p=0.012). Signal peptide-CUB-EGF-like domain-containing protein 1 levels were also higher in the case group compared to the control group (p=0.001).

CONCLUSION

The admission signal peptide-CUB-EGF-like domain-containing protein 1 level was significantly higher in adults with acute appendicitis. The SCUBE1 level is a novel but promising biomarker that aids in the diagnosis of acute appendicitis.

The prognostic significance of non-lymphoid immune cells of the tumor microenvironment, including neutrophils, eosinophils, and mast cells in breast carcinomas

BACKGROUND AND OBJECTIVE

The prognostic importance of lymphoid cells in the tumor microenvironment and their effect on treatment response have been demonstrated in many cancer types. However, there are limited studies on non-lymphoid immune cells. Conflicting results have been obtained regarding the effects of these cells on prognosis.

MATERIALS AND METHODS

A total of 331 patients who underwent surgery for breast cancer were included. Patients that received neoadjuvant chemotherapy and those with distant metastasis were excluded. CD 15 immunohistochemistry was performed to detect tumor-infiltrating neutrophils (TINs) and eosinophils (TIEs), while Toluidine Blue histochemistry was performed to detect tumor-infiltrating mast cells (TIMs).

RESULTS

High TINs were statistically associated with low ER expression (p < 0.001), low PR expression (p = 0.001), high Ki-67 proliferation index (p = 0.008), and HER2/TN molecular subtypes (p = 0.001). High TIEs were associated with low ER expression (p = 0.001), high Ki67 proliferation index (p = 0.005), and HER2/TN molecular subtype (p = 0.002). High TIMs were associated with high PR expression (p = 0.024), low Ki-67 proliferation index (p = 0.003), and high survival rate (p = 0.006). TIMs and TIEs were good prognostic factors for overall survival in Luminal A and Luminal B subtypes, while TINs and TIEs were found to be independent risk factors for disease-free survival.

CONCLUSION

The evaluation of components of the tumor microenvironment including TINs, TIEs, and TIMs is easy and practical. High TIMs and TIEs are independent prognostic factors, especially in luminal molecular subtype of invasive breast carcinoma. However, to use this parameter in routine pathology practice, more studies from different centers and standard evaluation are needed.

A new practical method of estimating tumoral microenvironment parameters of possible prognostic significance in patients with invasive breast carcinoma: Combined microenvironment score

BACKGROUND AND OBJECTIVE

In recent years, the tumor microenvironment has become increasingly recognized as an influential factor in breast cancer development and growth. The parameters that form the microenvironment are the tumor stroma ratio and tumor infiltrating lymphocytes. In addition, tumor budding, which shows the ability of the tumor to metastasize, gives information about the progression of the tumor. In this study, the combined microenvironment score (CMS) was determined with these parameters, and the relationship between CMS and prognostic parameters and survival was evaluated.

MATERIALS AND METHODS

In our study, tumor stroma ratio, tumor infiltrating lymphocytes, and tumor budding were evaluated in hematoxylin-eosin sections of 419 patients with invasive ductal carcinoma. Patients were scored separately for each of these parameters, and these scores were summed to determine the CMS. The patients were divided into 3 groups according to CMS and the relationship between CMS and prognostic parameters and the survival of the patients was studied.

RESULTS

The patients with CMS 3 had higher histological grade and Ki67 proliferation index compared to CMS 1 and 2. Additionally, lymphovascular invasion, axillary lymph node and distant metastasis were more common. Disease-free, and overall survival were significantly shortened in the CMS 3 group. CMS was found as an independent risk factor for DFS (HR: 2.144 (95 % CI: 1.219-3.77) p: 0.008), but not an independent risk factor for OS.

CONCLUSION

CMS is a prognostic parameter that can be easily evaluated and does not require extra time and cost. Evaluating the morphological parameters of the microenvironment with a single scoring system will contribute to routine pathology practice and predict patient prognosis.

Tumor Budding is an Independent Prognostic Factor to Predict Overall Survival in Endometrial Endometrioid Carcinoma: A Retrospective Study

Objective. Tumor budding defined as a tumor cell nest away from the main tumor, has been found to be associated with prognostic parameters in many cancer types. We aimed to investigate the relationship between tumor budding and clinicopathological parameters in endometrioid endometrial carcinomas, as well as its prognostic importance. Materials and Methods. One hundred four patients who underwent surgical resection with diagnosis of endometrioid endometrial carcinomas between June 2011 and May 2020 were included. The area where tumor budding was the most prominent was determined, and tumor budding was counted from hematoxylin and eosin-stained section at one high power field (X 200). By performing ROC analysis, the cut off value was obtained in order to divide the patients into low and high tumor budding groups. Results. The cut off value was determined as 1/0.95 mm² according to the ROC analysis. Tumor budding was observed in 24 (23%) patients. Tumor budding significantly associated with poor overall survival (P < .001), distant metastasis (P = .001), presence of angiolymphatic invasion (P < .001), lymph node metastasis (P = .024), cervical invasion (P < .001), high FIGO grade (P < .001), large tumor size (P = .004). In multivarate analysis, tumor budding and age were found to be an independent risk factor for overall survival (P = .003, P = .014 respectively). Conclusion. Tumor budding is a significant morphological parameter independent of other prognostic parameters in endometrioid endometrial carcinomas. Standardizing the assesment and scoring of tumor budding, as well as including this entity in routine pathology reports could light the way for ideas in the risk analysis of patients.

Predicting response to neoadjuvant therapy with glucose transporter-1 in breast cancer

OBJECTIVE

Glucose transporter-1 is a marker involved in energy transport in cancer cells. It has been shown to be a poor prognostic factor in many cancer types, including breast cancer. However, there is no satisfactory parameter predicting treatment in breast cancer patients receiving neoadjuvant therapy. This study investigated the effect of glucose transporter-1 in predicting the treatment response of patients receiving neoadjuvant therapy.

METHODS

In this study, glucose transporter-1 immunohistochemistry was applied to tru-cut biopsy of patients who were diagnosed with breast cancer and received neoadjuvant therapy between 2010 and 2021. A built-in scoring system was used to evaluate both the pattern and intensity of glucose transporter-1 immunohistochemistry staining. The relationship between glucose transporter-1 immunohistochemistry staining and other clinicopathological parameters was examined. In addition, the relationship of glucose transporter-1 with response to treatment was investigated.

RESULTS

A relationship was found between high glucose transporter-1 expression and other clinicopathological parameters (such as estrogen and progesterone receptor negativity, high Ki-67, triple-negative, and Her2 status). Cases with high glucose transporter-1 expression had either a complete or a partial pathologic response. The result was statistically significant.

CONCLUSION

Glucose transporter-1 has the potential to be a biomarker that can be evaluated more objectively as an alternative to Ki-67 labeling index in evaluating the response to treatment in patients receiving neoadjuvant therapy.

High Tumor Infiltrating Lymphocytes Are Associated with Overall Survival and Good Prognostic Parameters in Endometrial Endometrioid Carcinoma Patients

OBJECTIVE

The mortality incidence of endometrial carcinomas (ECs) has increased in recent years. Therefore, recent studies have focused on the cellular and microenvironmental properties of ECs. Tumor-infiltrating lymphocytes (TILs), a component of the microenvironment, have been found to be associated with the prognosis in many tumors. Although TILs were mostly evaluated by immunohistochemical studies in ECs, in our study, the evaluation was done with a light microscope as a practical approach, and we aimed to determine the prognostic importance of TILs in endometrioid ECs.

MATERIAL AND METHOD

104 patients were included in the study. TILs in the stromal area (sTILs) were evaluated on hematoxylin and eosin (HE) stained-sections at X200 objective. The presence of TILs was evaluated as follows; 0-10% as low, 20-40% as moderate, and 50-90% as intense. Then TILs were grouped as low and high.

RESULTS

Tumors with high TILs were more prone to have FIGO (International Federation of Gynecology and Obstetrics) grade 1 tumors, low nuclear grade, early pathological stage, smaller size, no lymphovascular invasion, myometrial invasion below 50%, and no cervical involvement. In the presence of high TILs, the overall survival showed significant increase but no significant correlation was found with disease-free survival.

CONCLUSION

Interest in the molecular properties of ECs has increased in recent years. TIL, which can be easily evaluated in HE sections, is an important parameter in patient selection for molecular tests and determining the prognosis of patients.

Prognostic importance of PD-L1 expression in bladder cancer patients

BACKGROUND

PD-L1/PD-1 molecules are known as important mediators in immune-escape mechanisms of tumors. PD-L1 is highly expressed in various malignancies, including bladder cancer. However, the prognostic value of PD-L1 in bladder cancer patients remains controversial.

AIM

To investigate the prognostic significance of PD-L1 expression in tumor tissues of bladder cancer patients.

SUBJECTS AND METHODS

RNA was isolated from FFPE tumor tissues of 48 bladder cancer patients using the monophasic phenol and guanidine isothiocyanate method. Total RNA was converted to cDNA and gene expression levels were analyzed by qRT-PCR. The differential expression levels of the PD-L1 gene between tumor grade and cancer stage groups were analyzed by independent student's t-test and one-way ANOVA.

RESULTS

Statistically significantly increased PD-L1 expression was observed in the high-grade tumor group (p < 0.05). No significant difference in PD-L1 expression was found among pTa, pT1, and pT2 groups. In addition, the difference in overall survival was not significantly different between groups.

CONCLUSION

The results showed that high PD-L1 expression in bladder cancer was associated with tumor aggressiveness and grade. Despite the inability of the qRT-PCR to show the PD-L1 expression at different locations of tumor tissue, evaluation of PD-L1 mRNA expression by qRT-PCR, which is a highly sensitive and specific assay, appears to be a robust approach. Furthermore, these findings may contribute to a rationale for recommending anti-PD-L1 immunotherapy as an alternative to standard therapy for bladder cancer patients who are most likely to benefit from it.

The clinical value of IMA and SCUBE1 in the diagnosis of acute appendicitis in children

Objectives. This study aims to show the clinical value of ischemia-modified albumin (IMA) and Signal Peptide, Complementary C1r/C1s, Uegf and Bmp1–Epidermal Growth Factor Like Domain Containing 1 (SCUBE1) protein in pediatric appendicitis. Methods. Eighty-one pediatric patients hospitalized in the pediatric surgery ward with acute appendicitis and a control group of 62 pediatric patients with unspecific abdominal pain were included in this prospective case-control study. Thirty-nine patients whose pathology specimens confirmed acute appendicitis made up the final appendicitis group. Results. Patients with appendicitis had higher IMA (p<0.001) and SCUBE1 (p<0.001) levels than the control group. In receiver operating characteristic (ROC) analysis, areas under the curve (AUC) were 0.991 (sensitivity=97.4%, specifity=100%, positive likelihood ratio (+LR) infinity, negative likelihood ratio (-LR)=0.03, positive predictive values (+PV)=100%, negative predictive value (-PV)=98.3% for IMA and 0.803 (sensitivity = 89.7%, specificity =64.5%, +LR=2.53, -LR=0.16, +PV=61.4%, -PV=90.9%) for SCUBE1. Conclusions. The present study shows that IMA may be a reliable marker for a more accurate diagnosis of appendicitis. SCUBE1 can be used to exclude diagnosis if used in combination with other laboratory and clinical data.

Gastric intestinal metaplasia: Long-term follow-up results

Baackground

Precancerous lesions are the most commonly cited factor in gastric cancer etiology. The sequence of events in intestinal-type gastric carcinogenesis is considered to be chronic gastritis, atrophy, intestinal metaplasia (IM), dysplasia, and carcinoma, respectively. Early diagnosis and treatment of advanced precursor lesions and gastric cancer is possible by identifying and monitoring patients with such premalignant lesions.

Aim

In our study, we aimed to evaluate the long-term follow-up results of intestinal metaplasia in our hospital and the rate of progression to malignancy by comparing these patients with patients who have undergone gastroscopy without a diagnosis of intestinal metaplasia.

Material and Method

One hundred and fifty-six followed-up patients out of 700 between the ages of 18 and 85 who were admitted to our hospital between 2009 and 2019, who were diagnosed with IM by pathological examination from biopsy material, and 150 patients who were not diagnosed with IM between 2009 and 2011 were included. The results of the cases were evaluated first retrospectively; then, the patients who were invited for control and underwent endoscopy were evaluated prospectively. IM and control groups were compared in terms of dysplasia and gastric cancer development. In addition, the IM group was compared in terms of 5 and 10 years of follow-up, extensive or local involvement, and complete and incomplete involvement in terms of dysplasia and cancer development.

Results

The follow-up period of the patients ranged from 1 to 10 years, and the mean follow-up interval was 4.2 ± 2.8 (min: 1; max: 10) years. Age, gender, and pathology results of the patients were examined in terms of IM type, localization of IM, pathology accompanying IM, and presence of Helicobacter pylori (Hp) infection and compared with the control group. While gastric carcinoma was detected in three of 156 patients in the IM group, gastric carcinoma was not detected in the follow-up of 150 patients in the control group. IM was most common in the antrum. Incomplete IM was detected in 89 patients, and complete IM in 69 patients. While two of the three patients with gastric carcinoma were localized to the antrum, one patient had incomplete-type IM and two patients had complete-type IM, and Hp was positive in two patients. While dysplasia was detected in nine of the patients diagnosed with IM, it was detected in two patients in the control group. A statistically significant difference was found between the IM and control groups in terms of dysplasia positivity (p = 0.037). On the other hand, no statistically significant difference was found between the IM and control groups in terms of age-group, gender, follow-up time group, and Hp positivity (p > 0.05). There was no significant difference between those who were followed up for 5 and 10 years in the IM group in terms of dysplasia and cancer development.

Conclusion

Therefore, it is considered that patients with intestinal metaplasia may be followed up at longer intervals, except for patients with race, ethnicity, incomplete type, extensive involvement, and a family history of gastric cancer.

An easy and practical prognostic parameter: tumor-stroma ratio in Luminal, Her2, and triple-negative breast cancers

OBJECTIVE

The stroma surrounding the tumor cells is important in tumor progression and treatment resistance, besides the properties of tumor cells. Studies on the tumor stroma characteristics will contribute to the knowledge for new treatment approaches.

METHODS

A total of 363 breast cancer patients were evaluated for the tumor-stroma ratio. The percentage of stroma was visually assessed on hematoxylin-eosin stained slides. The cases of tumor-stroma ratio more than 50% were categorized as tumor-stroma ratio high, and those less than 50% and below were categorized as tumor-stroma ratio low.

RESULTS

Tumor-stroma ratio-high tumors had shorter overall survival (p=0.002). Disease-free survival tended to be shorter in tumor-stroma ratio-high tumors (p=0.082) compared with tumor-stroma ratio-low tumors. Tumor-stroma ratio was an independent prognostic parameter for the total group of patients (p=0.003) and also axillary lymph node metastasis and tumor-stroma ratio was statistically associated (p=0.004). Also, tumor-stroma ratio was an independent prognostic parameter in node-positive Luminal A and B subgroups for overall survival (p<0.001).

CONCLUSION

Tumor-stroma ratio is an independent prognostic parameter that can be evaluated quite easily in all molecular subtypes of all breast cancers and does not require extra cost and time to evaluate.

Laryngeal Cavernous Lymphangioma in an Adult Patient

INTRODUCTION

Lymphangiomas are uncommon congenital lesions of the lymphatic system, and most of them are detected by the second year of life. Although head and neck region is the most common location, laryngeal involvement isextremely rare, and the literature is largely limited to few case reports.

CASE REPORT

A 51-year-old male patient was admitted to the hospital with clinical history of hoarseness. Performed direct laryngoscopy revealed a pedunculated cystic mass located in the right ventricle of the larynx. The mass was totally excised, and the case was reported as cavernous lymphangioma.

CONCLUSION

Isolated laryngeal lymphangioma is extremely rare in adults. The other benign lesions or inflammatory processes in this region can mimic laryngeal lymphangioma. Therefore, this entity should be kept in mind in differential diagnosis especially in adults, to avoid overtreatment.

GLUT-1 Expression in Breast Cancer

OBJECTIVE

Numerous studies have been conducted to predict the prognosis of breast cancers. The effect of glucose transporter protein 1 (GLUT-1), the main carrier protein responsible for glucose transport, was investigated in breast cancer patients.

MATERIAL AND METHOD

170 patients operated for breast carcinoma were included in this study. We analysed the prognostic significance of GLUT-1 immune-expression in 149 patients without neoadjuvant therapy, and in 21 patients with neoadjuvant therapy.

RESULTS

GLUT-1 expression was correlated with poor prognostic factors such as estrogen receptor and progesterone receptor negativity, high Ki-67 proliferation index, and high histological and nuclear grade (p < 0.001). GLUT-1 was expressed at a statistically higher rate in invasive ductal carcinomas, compared to invasive lobular carcinomas (p < 0.001), and was expressed at a higher rate in luminal B, human epidermal growth factor receptor 2 and triple-negative molecular subtypes compared to luminal A subtype tumors (p < 0.001). There was no statistically significant difference between GLUT-1 expression and presence of neoadjuvant therapy. Univariate survival analysis showed high GLUT1 expression was associated with low disease-free survival.

CONCLUSION

GLUT-1 expression was found to be associated with poor pathological prognostic factors in breast carcinoma patients. The results suggest that GLUT-1 expression can be considered as a prognostic marker in breast cancers, and it may be used as a target molecule in personalized treatment approaches.

A rare form of persistent Mullerian duct syndrome: Transverse testicular ectopia with germ cell testis cancer and hernia uteri inguinalis

Persistent Mullerian duct syndrome is a rare form disorder of sexual differentiation characterised by the persistence of Mullerian derivatives (fallopian tubes, uterus and the proximal vagina) in males with an XY karyotype and normal virilisation. We report a case of a 29-year-old man with right transverse testicular ectopia, mix germ cell cancer at ectopic right testis and left-sided obstructed inguinal hernia containing a uterus and fallopian tube. We performed orchiectomy and hysterectomy on the patient.

Tumor Budding is a reliable predictor for death and metastasis in invasive ductal breast cancer and correlates with other prognostic clinicopathological parameters

BACKGROUND AND OBJECTIVE

Breast cancers are the most common type of cancer and the most common cause of mortality in women worldwide. Different prognostic factors are the subject of research to differentiate the prognosis even between cases at a similar stage and identify risky patients earlier and create individual treatment approaches. Tumor budding (TB) has been identified as a poor prognostic factor in many types of cancer, especially colorectal carcinomas. In our study, we aimed to determine the prognostic significance of the TB by evaluating the TB in line with clinicopathological parameters in breast invasive ductal carcinoma cases.

MATERIALS AND METHODS

311 breast carcinoma cases operated in our hospital between January 2010 and April 2020 were included in the study. In hematoxylin-eosin (H&E) sections of the cases, TB was evaluated in a single high-power field (HPF). ROC analysis was performed with overall survival data, and low, and high TB cutoffs were obtained. The relationship of the high TB with clinicopathological parameters was evaluated, and survival analysis was performed.

RESULTS

We determined that high TB in breast invasive ductal carcinoma cases was associated with low survival time, metastasis, axillary lymph node metastasis, angiolymphatic invasion, advanced stage (pT3), high Ki-67 proliferation index, progesterone receptor (PR) loss, and advanced age. Tumor budding was identified as an independent risk factor in overall and disease-free survival analysis.

CONCLUSION

Tumor budding is a prognostic parameter that can be easily evaluated in all centers since it does not cause additional cost to routine pathological examinations. We think it may be helpful to establish a standard methodology in evaluating tumor bud in breast carcinomas and including it in regular pathology reporting.

The protective effects of topiramate on intestinal injury induced with infrarenal aortic occlusion via oxidative stress and apoptosis

Purpose: Prolonged surgical procedures and some clinical conditions such as surgeries of thoracoabdominal aorta, mesenteric ischemia, cardiopulmonary bypass, strangulated hernias and neonatal necrotizing enterocolitis may cause decreased perfusion and injury of relevant organs and tissues. After reperfusion, injuries may get worse, leading to ischemia-reperfusion (I/R) injury. Reperfusion following arterial clamping allows oxygen to ischemic tissues and produce injury by multiple mechanisms, including neutrophilic infiltration, intracellular adhesion molecules, and generation of reactive oxygen radicals. In this study with the analysis of SOD, MDA and Caspase-3 levels, we aimed to investigate the effect of topiramate on the outcome of I/R occured after abdominal aorta clamping on rats.Materials and Methods: Totaly 24 Sprague-Dawley male rats were randomly divided into three experimental groups; the control group (n = 8), I/R (n = 8) and I/R+ topiramate (n = 8). Topiramate (100 mg/kg/day); 50 mg/kg (single dose) was administered intraperitoneally after being diluted with saline 5 days before I/R.Results: The intestinal tissue of the ischemia group displayed hemorrhage, Crypts of Lieberkuhn degeneration, ulceration, vascular congestion and edematous fields as a result of aortic occlusion. We also observed that MDA levels and Caspase-3 positivity increased and SOD levels decreased in the small intestine. However, topiramate administration decreased Crypts of Lieberkuhn degeneration, ulceration, vascular congestion and edematous fields, Caspase-3 positivity, and MDA levels.Conclusion: Our findings suggest that topiramate is effective against aortic occlusion-induced intestinal injury by reducing oxidative stress and apoptosis.

Primary Cutaneous Myxoid Spindle Cell Squamous Cell Carcinoma of the Scalp: A Case Report

Cutaneous squamous cell carcinomas are the second most frequent type of non-melanoma skin cancer. A 78-year-old man with a slow-growing but large nodular lesion on his scalp presented to the hospital. The nodular lesion was excised. Histologically, the lesion was diagnosed as a primary cutaneous myxoid spindle cell squamous cell carcinoma, which is the subject of this case report. Extracellular mucin production is an even less common finding in SCC. We also aim to discuss the histological and immunohistochemical findings for distinguishing MSC SCC from other primary cutaneous and metastatic spindle cell neoplasms with myxoid stroma.

An urban legend: Malignant transformation caused by radiotherapy in patients with presacral ganglioneuroma. The necessity and first-time administration of radiotherapy. Case report and literature review

Ganglioneuromas (GNs) are well-differentiated, rare benign tumors of neural crest origin and are, for the most part, considered to be the benign equivalent of neuroblastomas. There are very few cases of GN reported to be at presacral location in the literature. The standard form of treatment is the total surgical excision. However, total resection of GN is not always possible depending on the neuron, from which it originates, and its localization. Moreover, adjuvant radiotherapy (RT) or chemotherapy is not recommended even though patients are still symptomatic after subtotal resection. This view is based on the urban legend that it undergoes a malignant transformation although it is a benign tumor. Moreover, there are no data indicating that the GN cases reported in the literature have undergone RT. Therefore, articles about the suspicion that GN may undergo spontaneous or malignant transformation after RT are absolutely controversial. Based on our case, we present here, we believe that we will explain the valid necessity of application of RT that we administered for the first time and that with the clarification of this controversial topic, a significant gap will be closed in the literature.

Are there predictors that can determine neoadjuvant treatment responses in rectal cancer?

BACKGROUND/AIMS

This study aimed to determine a predictive bioindicator that would detect the treatment response of patients diagnosed with rectal cancer and treated with neoadjuvant chemoradiotherapy (nCRT).

MATERIALS AND METHODS

The data collected from 37 patients receiving nCRT were retrospectively evaluated. The p53 score and gene instability in MLH1 and MSH2, which are among the DNA mismatch repair (MMR) genes, were evaluated using immunohistochemical methods. The neutrophils-leukocytes ratio (NLR), carcinoembryonic antigen (CEA), and carbohydrate antigen (CA) 19-9 values were obtained as hematological parameters from computer records. The pathologic analysis of the therapy response after nCRT was classified according to the modified grading system by Ryan et al. Results: The changes in the NLR, CEA, and CA19-9 values before and after treatment were statistically significant (p<0.001 and p=0.005). A near significant effect of the decrease of the CEA value in the 5th week after treatment was detected on the pathological response score (p=0.075). The p53 mutation score in those patients with any residue was higher than the total response. Overall, 89.2% of the patients exhibited MMR positivity (stability), and 10.8% of the cases with MRM negativity (instability) had a macroscopic residue. Cases with pathological total response were MRM positive.

CONCLUSION

Consequently, in most of the patients treated with nCRT, the treatment caused tumor and nodal remission. In the prediction of this therapy response, hematological and genetic parameters, such as NLR, P53, MLH1, and MSH2, play a predictive role.

Coexistence of Papillary Thyroid Cancer and Hashimoto's Thyroiditis Developing within an Ovarian Mature Cystic Teratoma

A wide variety of tissues derived from the three germ layers are seen in ovarian teratomas. Microscopically, the most commonly seen tissues are epidermis, skin adnexa, and neural tissues. Thyroid tissue is present in 10% of ovarian mature cystic teratomas. In this case, report, we present a rare case of papillary microcarcinoma derived in the ovarian teratoma and Hashimoto's thyroiditis with the normal level of serum thyroid hormones, which is normal but positive serum antithyroid peroxidase antibodies.

Pathological Findings Observed in the Kidneys of Postnatal Male Rats Exposed to the 2100 MHz Electromagnetic Field

BACKGROUND

The widespread use by young people of modern communication devices such as mobile phones means that they are particularly exposed to electromagnetic fields (EMF) and other problems. However, few studies have researched the effects of long-term exposure to EMF in the kidney. We therefore investigated oxidative stress and apoptosis in long-term exposure to 2100 megahertz (MHz) in a rat model.

MATERIALS AND METHODS

Twenty-four Sprague Dawley rats were divided into a control group (n = 8, no EMF exposure), a group exposed to 2100 MHz for 6 h for 30 d (n = 8), and a group exposed to 2100 MHz for12 h for 30 d (n = 8). Immunohistochemical analysis was performed, using caspase-3 to evaluate apoptosis. Immediately after treatment, reduced glutathione (GSH), malondialdehyde (MDA) in kidney tissue and serum levels of various biochemical compounds were measured to detect oxidative stress.

RESULTS

Deterioration was observed in the brush border in renal tubules of the EMF groups. The results of the immunohistochemical analysis revealed a greater number of positively stained renal tubular epithelial cells in the EMF groups as compared with that in the control group. In the EMF groups, renal MDA levels increased, and renal GSH levels decreased compared with those in the control group, as shown by a biochemical examination (p = 0.00 and p = 0.00, respectively).

CONCLUSION

The findings showed that exposure to 2100 MHz for 6 and 12 h induced oxidative stress-mediated acute renal injury, depending on the length of exposure and dosage.

Helicobacter pylori can be related to carotid intima-media thickness, epicardial adipose tissue thickness and serum neutrophil gelatinase-associated lipocalin (NGAL) levels

BACKGROUND

Helicobacter pylori (HP) affects the cardiovascular system. Our aim in this study was to evaluate, whether an infection with HP causes subclinical atherosclerosis.

METHODS

We included 90 patients with dyspeptic symptoms in this study. The patients underwent an upper gastrointestinal endoscopy and biopsies were taken. The patients were grouped according to histopathologic examination, as HP infection negative (n = 21), HP infection positive (+) (n = 23), HP infection (++) (n = 22), HP infection (+++), (n = 24).

RESULTS

The neutrophilic gelatinase-associated lipocalin (NGAL) and high-sensitive C-reactive protein (hs-CRP) levels and the carotid intima-media thickness (cIMT) and epicardial adipose tissue (EAT) thickness in the HP negative group were significantly lower than the NGAL (p < 0.001) and hs-CRP (p < 0.001) levels and the cIMT (p < 0.008) and EAT (p < 0.008) thickness in the HP (+++) group. There was a strong correlation between the serum NGAL and hs-CRP levels, cIMT and EAT thickness.

CONCLUSION

HP-infection can lead to subclinical atherosclerosis via chronic inflammation. The higher the activity of HP infection, the higher the acceleration of atherosclerosis (Tab. 3, Fig. 2, Ref. 46). Text in PDF www.elis.sk.

F-18 Fluorodeoxyglucose Positron Emission Tomography/ Computed Tomography Findings of Isolated Gastric Tuberculosis mimicking Gastric Cancer and Lymphoma

Introduction

Tuberculosis (TB) infection is still a challenging health issue, especially in developing countries. Diagnosing extrapulmonary infections, especially isolated organ involvement, is difficult in most cases even with the radiological, endoscopic, and histopathological examinations done for accurate diagnosis. Here we describe a case of isolated gastric TB with specific F-18 fluorodeoxyglucose (FDG) positron emission tomography (PET)/computed tomography (CT) findings mimicking gastric cancer/ lymphoma.

Case report

A 20-year-old male patient was admitted to our hospital with abdominal pain in the epigastric region, weight loss, and fever especially at nights for 2 months. Physical examination was normal. Hemoglobin was 9.6 gm/dL; the patient had iron deficiency anemia. Upper gastrointestinal (GI) endoscopy was suggestive of gastric ulcer mimicking malignancy. F-18 FDG PET/CT revealed multiple hypermetabolic malignant lymphadenopathies in the abdomen and diffuse gastric wall thickening as linitis plastica and multiple hypermetabolic peritoneal implants in the omentum. Exploratory laparotomy was done for tissue diagnosis and exploration of the peritoneum for TB infection, lymphoma, and Crohn’s disease to make differential diagnosis. Histopathology revealed granulomatous lymphadenitis with granulomas including giant cells, suspecting TB. Patient was put on antituberculosis treatment (ATT). After treatment, the complaints resolved, and he gained weight. Fusion PET/CT exhibited a complete response to ATT with no residual disease.

Conclusion

According to our knowledge, this is the first report about F-18 FDG PET/CT findings in the diagnosis of isolated gastric TB. F-18 FDG PET/CT may provide help in the diagnosis and follow-up of isolated gastric TB in challenging cases.

How to cite this article: Akdogan RA, Rakici H, Güngör S, Bedir R, Akdogan E. F-18 Fluorodeoxyglucose Positron Emission Tomography/Computed Tomography Findings of Isolated Gastric Tuberculosis mimicking Gastric Cancer and Lymphoma. Euroasian J Hepato-Gastroenterol 2018;8(1):93-96.

Helicobacter pylori can be related to carotid intima-media thickness, epicardial adipose tissue thickness and serum neutrophil gelatinase-associated lipocalin (NGAL) levels

BACKGROUND

Helicobacter pylori (HP) affects the cardiovascular system. Our aim in this study was to evaluate, whether an infection with HP causes subclinical atherosclerosis.

METHODS

We included 90 patients with dyspeptic symptoms in this study. The patients underwent an upper gastrointestinal endoscopy and biopsies were taken. The patients were grouped according to histopathologic examination, as HP infection negative (n = 21), HP infection positive (+) (n = 23), HP infection (++) (n = 22), HP infection (+++), (n = 24).

RESULTS

The neutrophilic gelatinase-associated lipocalin (NGAL) and high-sensitive C-reactive protein (hs-CRP) levels and the carotid intima-media thickness (cIMT) and epicardial adipose tissue (EAT) thickness in the HP negative group were significantly lower than the NGAL (p < 0.001) and hs-CRP (p < 0.001) levels and the cIMT (p < 0.008) and EAT (p < 0.008) thickness in the HP (+++) group. There was a strong correlation between the serum NGAL and hs-CRP levels, cIMT and EAT thickness.

CONCLUSION

HP-infection can lead to subclinical atherosclerosis via chronic inflammation. The higher the activity of HP infection, the higher the acceleration of atherosclerosis (Tab. 3, Fig. 2, Ref. 46). Text in PDF www.elis.sk.

Granular cell tumor of the urinary bladder

Granular cell tumors (GCTs) are extremely rare neoplasms of the bladder. In the literature, there are only a few reported cases. We present a GCT case with clinical, radiological, histomorphological, immünohistochemical findings and its differential diagnosis.

Evaluation of the relationship between c-Kit expression and mean platelet volume in classic Kaposi's sarcoma

BACKGROUND

c-Kit is a proto-oncogene that encodes tyrosine kinase receptor (CD117). Mean platelet volume (MPV) is a useful marker, providing information on platelet function and diameter.

OBJECTIVE

To investigate c-Kit expression and intensity in patients with Kaposi's sarcoma (KS) and to investigate the relation between Ki-67 proliferation and MPV.

METHODS

A total of 32 patients, diagnosed with classic cutaneous KS, were included in this study. We reevaluated the histopathological reports with the preparations, confirmed the diagnosis and then determined the patients' histopathological stages. c-Kit expression and Ki-67 proliferation were investigated immunohistochemically in KS cases, while MPV in all cases was checked.

RESULTS

Although c-Kit expression was detected in 22 cases (68.8%), it was not expressed in 10 cases (31.2%). We detected 8 cases with + (25%), 6 with ++ (18.8%) and 8 with +++ (25%). Ki-67 expression was 5.0% (min-max 1.0-20.0). Relapse was observed in 5 cases (15.6%) out of 32. There was positive correlation between c-Kit expression and MPV (rs=0.598, p<0.001), and between c-Kit intensity and MPV (rs=0.588, p<0.001).

CONCLUSION

c-Kit is highly positive in KS. c-Kit positivity indicates a high risk of tumor growth, invasion and relapse. Furthermore, c-Kit expression stimulates megakaryocytes to release young and large thrombocytes into the periphery. Thus, high MPV, c-Kit expression and immunostaining intensity indicate high invasion and relapse in KS subjects.

The Value of HBME-1 and Claudin-1 Expression Profile in the Distinction of BRAF-Like and RAS-Like Phenotypes in Papillary Thyroid Carcinoma

This study compared the expression profile of HBME-1 and claudin-1 in 90 papillary thyroid carcinomas (PTCs) with respect to the tumor architecture and invasive growth as reflected in 46 BRAF-like, 31 non-invasive RAS, and 13 invasive RAS-like phenotypes. Individual tumors were given an expression score (max 300) by multiplying the percent positive tumor cells by the intensity score (range 0-3). The higher expression of HBME-1 and claudin-1 distinguished BRAF-like phenotype from RAS-like phenotype. The same correlation was also retained for both markers when comparing BRAF-like phenotype with non-invasive and invasive RAS-like phenotypes. The expression scores and positivity rates for both markers did not yield any statistical difference among BRAF-like PTCs. Except the higher positivity rate of HBME-1, invasive RAS-like tumors were not statistically different than their non-invasive counterparts with respect to the positivity rate of claudin-1 and the expression scores of both markers. A central lymph node dissection or selective lymph node sampling was available in 20 specimens. The absence of claudin-1 expression has not been a feature of lymph node metastasis in this series. Despite the limited number of nodal sampling, BRAF-like phenotype and claudin-1 positivity status have been considered the best determinants of positive predictive value and negative predictive value in the prediction of lymph node metastasis among variables, respectively. Adoption of the simplified architectural classification approach to PTCs showed distinct biomarker expression profile in this series; however, immunohistochemistry for HBME-1 and claudin-1 does not seem to be useful in the distinction of invasive RAS-like PTCs from their non-invasive counterparts. Given the overlapping molecular signatures within the RAS-like phenotype, further studies with additional biomarkers are still needed to identify distinct protein expression signatures of non-invasive RAS-like phenotype as this diagnostic category still remains a surgical diagnosis at this time.

Synovial Sarcoma Mimicking Myositis Ossificans

A calcification mass was incidentally found in the soft tissue of a patient who had a history of trauma to the extremity during examination. The patient had no symptom. The pathological analysis of the mass revealed it was an early-phase synovial sarcoma (SS). The diagnosis was made before the onset of symptoms and proper surgical intervention was performed. Therefore, in case of a <1 cm lesion clinically suspicious of myositis ossificans, SS should be taken into consideration as a possible diagnosis.

Chondroid syringomas: an immunohistopatological analysis

BACKGROUND

Chondroid syringoma is a rare benign skin adnexal tumor composed of both epithelial and mesenchymal components, and is known as a cutaneous mixed tumor. Its clinical diagnosis is generally incorrect, and an exact diagnosis can only be made with histopathological investigations. The aim of this study was to determine the clinicopathological findings of the cases diagnosed with chondroid syringoma.

METHODS

In this study, over the period from January 2008 to March 2014, a total of 2661 excised skin lesions were evaluated for the clinicopathological findings, and fifteen cases were diagnosed with chondroid syringoma. Various parameters such as gender, mean age, tumor localization and immunohistochemical markers (pan-cytokeratin, vimentin, S-100 protein, CEA-(M) and p53 were examined.

RESULTS

Of the15 cases diagnosed with chondroid syringoma, 10 (67%) were male and 5 (33%) were female. The mean age of the patients was 46 (range 11-80 years). The chondroid syringomas were positive for pan-cytokeratin (87%), vimentin (100%), S-100 protein (100%), CEA-M (53%) and p53 (80%).

CONCLUSIONS

Chondroid syringomas should be included in the differential diagnosis of a slowly growing, nodular mass in the dermis. Definitive diagnosis of the tumor is made by histopathological examination. Difficult cases may benefit from immunohistochemical examination.

Evaluation of the relationship between c-Kit expression and mean platelet volume in classic Kaposi's sarcoma

BACKGROUND

c-Kit is a proto-oncogene that encodes tyrosine kinase receptor (CD117). Mean platelet volume (MPV) is a useful marker, providing information on platelet function and diameter.

OBJECTIVE

To investigate c-Kit expression and intensity in patients with Kaposi's sarcoma (KS) and to investigate the relation between Ki-67 proliferation and MPV.

METHODS

A total of 32 patients, diagnosed with classic cutaneous KS, were included in this study. We reevaluated the histopathological reports with the preparations, confirmed the diagnosis and then determined the patients' histopathological stages. c-Kit expression and Ki-67 proliferation were investigated immunohistochemically in KS cases, while MPV in all cases was checked.

RESULTS

Although c-Kit expression was detected in 22 cases (68.8%), it was not expressed in 10 cases (31.2%). We detected 8 cases with + (25%), 6 with ++ (18.8%) and 8 with +++ (25%). Ki-67 expression was 5.0% (min-max 1.0-20.0). Relapse was observed in 5 cases (15.6%) out of 32. There was positive correlation between c-Kit expression and MPV (rs=0.598, p<0.001), and between c-Kit intensity and MPV (rs=0.588, p<0.001).

CONCLUSION

c-Kit is highly positive in KS. c-Kit positivity indicates a high risk of tumor growth, invasion and relapse. Furthermore, c-Kit expression stimulates megakaryocytes to release young and large thrombocytes into the periphery. Thus, high MPV, c-Kit expression and immunostaining intensity indicate high invasion and relapse in KS subjects.

The Role of p16, p21, p27, p53 and Ki-67 Expression in the Differential Diagnosis of Cutaneous Squamous Cell Carcinomas and Keratoacanthomas: An Immunohistochemical Study

BACKGROUND

Distinguishing squamous cell carcinoma (SCC) from keratoacanthoma (KA) by histopathological features may not be sufficient for a differential diagnosis, as KAs may, in some cases, imitate well-differentiated SCCs.

AIMS

In this study, we investigated whether the expression of the p16, p21, p27, p53 genes and a Ki-67 proliferation index are useful in distinguishing between these two tumors.

STUDY DESIGN

Cross-sectional study.

METHODS

Immunohistochemistry was used to investigate the expression of the p16, p21, p27, p53 genes and the Ki-67 proliferation index was investigated in well-differentiated SCC with KA-like features (n=40) and KA (n=30).

RESULTS

The results of all of the examined markers, except for p27 (p16, p21, p53, and Ki-67) were found to be significantly different between the SCC and KA samples (p<0.05).

CONCLUSION

In well-differentiated SCC with KA-like features and KA cases where the differential diagnosis is difficult from a histopathological perspective, the use of p16, p21, p53 expression and a Ki-67 proliferation index can be useful for the differential diagnosis of SCCs and KAs.

Split Rib Cranioplasty for Frontal Osteoma: A Case Report and Review of the Literature

INTRODUCTION

Osteomas are benign bone tumors. They generally lead to a local thickness on the frontal bone in calvarium. When they occur on the forehead, they often cause a cosmetic disorder without any neurological symptoms. The significant problem is the repair method of the cranium defect.

CASE PRESENTATION

The rib of a 34-year-old female was split and used for a small cranium defect of 3 × 3.5 cm. The preferred method and the obtained results were presented under the guidance of the literature.

CONCLUSIONS

Along with the technological advancement, different materials are employed according to the size of the cranium defect and the age of the case. The application of split costa cranioplasty for the small cranium defects in the region of patient's face is the method with the least possibility of complications, and its cosmetic and functional results are quite promising.

The role of the adhesion molecule Nectin-4 in the pathogenesis of endometriosis

OBJECTIVE

Nectins are immunoglobulin-like adhesion molecules, and they play important role in cell proliferation and tumor metastasis. The objective in this study was to compare the expression of Nectin-4 in normal endometrium and in ectopic endometriotic tissues.

MATERIALS AND METHODS

Nectin-4 expression was investigated in ovarian endometriosis (n = 20), peritoneal endometriosis (n = 20), endometrium of endometriosis (n = 20), and in a control group (having no endometriosis) (n = 20) by immunohistochemical method.

RESULTS

Nectin-4 expression, when compared with control group, was higher in endometriotic lesions of patients having ovarian endometriosis and peritoneal endometriosis (p = 0.003 and p = 0.009, respectively). This difference was significant in the endometrium of patients having endometriosis (p = 0.011).

CONCLUSION

The authors believe that Nectin-4 molecule may contribute to the pathogenesis of endometriosis. For this reason, the use of medicines developed against this molecule in the treatment of endometriosis may be useful.

Round Ligament Leiomyoma Developing During Pregnancy: A Case Report and Literature Review

Round ligament leiomyoma of uterus is rare. It can be presented as inguinal swelling mimicking the inguinal hernia or lymph node. Surgical excision is its curative treatment. Definitive diagnosis is made by histopathological examination.A32 year old pregnant patient having round ligament leiomyoma as diagnosed histopathologically in Recep Tayyip Erdogan University Hospital in 2014 was presented here as the sixth case in literature.

Comparison of levofloxacin- and moxifloxacin-based triple therapies with standard treatment in eradication of Helicobacter pylori as first-line therapy

AIM

It is recommended that treatments that include clarithromycin should be avoided in eradication of Helicobacter pylori (HP) in cases where clarithromycin resistance is higher than 20%. We aimed to compare levofloxacin- and moxifloxacin-based triple therapies with standard treatment and with each other in eradication of helicobacter pylori as first-line therapy.

MATERIALS AND METHODS

Patients were randomized prospectively as three groups. There were 102 patients in the levofloxacin group, 101 patients in the moxifloxacin group, and 103 patients in the standard treatment group. The patients received levofloxacin 500 mg daily, amoxicillin 1 g b.i.d. and lansoprazole 30 mg b.i.d. for ten days (LAL) in the levofloxacin group; moxifloxacin 400 mg daily, amoxicillin 1 g b.i.d. and lansoprazole 30 mg b.i.d. (MAL) in the moxifloxacin group; and clarithromycin 500 mg b.i.d., amoxicillin 1 g b.i.d. and lansoprazole 30 mg b.i.d. (CAL) in the standard treatment group. At post-treatment week 6, HP was checked by using stool antigen test.

RESULTS

In the eradication of Helicobacter pylori, the success rate as determined by per protocol (PP) analysis was 92% in the LAL group, 91.8% in the MAL group, and 82.4% in the CAL group. A statistically significant difference was found in the LAL and MAL groups compared to the CAL group (p < 0.05). There was no difference between the LAL and MAL groups.

CONCLUSIONS

It was determined that levofloxacin- and moxifloxacin-based triple therapies were more effective than the standard treatment in first-line setting in the eradication of Helicobacter pylori. In addition, no difference was found between levofloxacin- and moxifloxacin-based triple therapies. Currently observed high efficacy may be evaluated in treatment. Although quinolon resistance is not considered a major problem, it appears to be a factor that may reduce treatment success over a period of time.

Inflammatory pseudotumor of the epididymis: a case report and review of the literature

Inflammatory pseudotumors (IPTs) are rare benign tumor-like lesions in the epididymis. They result from myofibrohistiocytic proliferation of the parenchymal organs of the body, such as the lungs and genitourinary system. A 48-year-old male patient presented with a palpable left scrotal mass and developed painless swelling within two months. Scrotal ultrasound revealed a 3 cm solid mass and spermatocele sac in the epididymis. Local excision was performed. Histopathologic and immunohistochemical examination revealed an inflammatory pseudotumor. Only ten cases have been reported in the literature to date. We present our case of pseudotumor of the epididymis as the eleventh case reported in the literature with a brief review.

Cartilaginous Choristoma of the Tonsil: Three Case Reports

INTRODUCTION

Choristoma is defined as the presence of cells in abnormal locations due to defects during embryological development. The word choristoma implies a neoplasm; whereas heterotopia refers to a displaced tissue without necessarily being a swelling or a neoplasm. Literature contains reports of cartilaginous choristoma in the cervix, endometrium, breast tissue, and oral region.

CASE REPORTS

Three cases of cartilaginous choristoma, which were accidentally found during microscopic examination of excised tonsil tissues, are presented.

CONCLUSION

Choristomas may cause difficulty in the differential diagnosis of true neoplasms, since they are rare and may grow. Therefore pathologists should be considered in the differential diagnosis of cartilaginous lesions, because cartilaginous choristomas of the tonsil are a rare entity.

Biochemical and histopathological effects on the rat testis after exposure to electromagnetic field during fetal period

OBJECTIVES

Electromagnetic radiation (ER) emitted from cell phones may exert a detrimental influence on human health and may affect the man reproductive system. We aimed to study the biological and morphological effects on the testes of 60-day-old male rats after ER exposure (900 MHz), which was applied continuously throughout embryogenesis.

METHODS

A total of six pregnant Sprague Dawley rats were included in the study. Three pregnant rats (experimental group) were exposed to radiation from a cell phone set to talking mode for 24 hours a day for 20 days, and the other 3 pregnant rats (control group) were not to exposed to radiation. Newborn male rats were included from the experimental group (n=7) and the control group (n=7). At the end of 60 days, the rats' testes were excised, and testis length, width, depth, and weight were measured. Histopathological examinations were compared and serum testosterone (T) levels were assayed biochemically.

RESULTS

While serum T level (3.51±0.21 ng/ml) of ER Exposed group was significantly lower than the control group (4.04±0.47 ng/ml, p=0.018), Caspase-3 enzyme activity (2.00±0.88) was significantly higher than the control group control (1.00±0.63, p=0.026). Johnsen score (8.4±0.5) of ER group was fairly lower than the control group (9.4±0.5, p=0.010).

CONCLUSION

Our study demonstrated that ER exposure throughout embryogenesis may cause reductions in serum total T levels and in the size and weight of the testes of male rats, while causing modest increase in apoptosis.