- [Show abstract] [Hide abstract] ABSTRACT: The intercellular bridges are essential structures in maintaining the histologic organization of the epithelium, while providing a very efficient way to exchange molecules between cells and transduction of the cell-to-cell and matrix-to-cell signals. Derangement in those important structures' physical integrity and/or function, which can be assessed by the presence or absence of several intercellular bridge proteins including claudin-4, E-cadherin, and β-catenin, was found to be related to several phenomena in the path to the neoplastic transformation. However, these proteins have not been studied in the wide variety of the skin neoplasms, in detail. Herein, we immunohistochemically assessed the expression patterns of these 3 intercellular bridge proteins on a total of 86 epidermal and eccrine adnexal tumors including basal cell carcinoma, squamous cell carcinoma, poroma, spiradenoma, syringoma, and hidradenoma. We observed a selective and distinct claudin-4 expression in the ductal-type cells of all cases of spiradenomas. Similarly, in the poromas, syringomas, and hidradenomas, claudin-4 was only positive in the luminal cells of microcystic structures, although not as conspicuous as in the spiradenomas. On the other hand, E-cadherin and β-catenin were positive in almost all types of the tumors, in a way which was not contributory to differentiate from each other. In conclusion, we think that claudin-4 can be helpful at least in making a reliable differential diagnosis of spiradenoma when overlapping morphologic features do not allow to further subclassification in the overwhelming variety of the adnexal tumors.
- [Show abstract] [Hide abstract] ABSTRACT: There are scarce data regarding the significance of the tumor size, hormonal activity and size of the pituitary tumor of the young; therefore, the study was designed to define the relation of the hormonal status of the large pituitary adenomas. We compared those features with tumors of the elderly (>40) with the young patients, and analyzed the clinicopathologic and proliferative features of pituitary macroadenomas in young adulthood (≤40). 20-year archives of pituitary tumors in our clinics were reviewed and macroadenomas with diameter ≥3cm were included in the study. We identified 46 pituitary adenomas and immunohistochemically stained them with pituitary hormones, p53 and Ki-67. Twenty-four cases were ≤40-year with an age range of 11-40 years (mean 28.0). Twenty-two cases were >40 with an age range of 44-78 years (mean 58.8). In the young patient group, 15 (62.5%) were functional adenomas (6 prolactinomas, six growth hormone [GH], one adrenocorticotrophic hormone [ACTH] adenoma, two multihormonal [GH+ACTH]) and nine (37.5%) were either gonadotrophic or null cell adenomas. In the elderly group, five (22.7%) were functional adenomas (two adrenocorticotrophic hormone [ACTH] adenoma, one prolactinoma, one growth hormone [GH], one multihormonal [GH+ACTH]) and 17 (77.3%) were either gonadotrophic or null cell adenomas. Ki-67 proliferation index in adenomas of the young was approximately two-folds higher than the elderly (2.7% vs. 1.2%). In both groups, rare p53 positivity was identified. In conclusion, pituitary macroadenomas of the young show hormonal expression frequently with relatively high Ki-67 proliferation indices. Copyright © 2015 Polish Neurological Society. Published by Elsevier Urban & Partner Sp. z o.o. All rights reserved.
- [Show abstract] [Hide abstract] ABSTRACT: Mucinous colorectal carcinoma with signet ring cell component is investigated the clinicopathological and prognostic features in this study. 741 patients underwent resection due to colorectal carcinoma in our university hospital between 1994 and 2008 years. Mucinous carcinoma were seen in 99 patients. All pathology slides of mucinous carcinoma patients were re-examined. Lymphatic invasion, necrosis and ulceration have been assessed. Clinicopathologic features, survival times and statistical results were compared with mucinous carcinoma with signet ring cell component and without signet ring cell component in the study. Lymphatic invasion and lymph node metastasis were more frequent in mucinous carcinoma with signet ring cell component than mucinous carcinoma without signet ring cell component. (%32&%16 p=0.019) (p < 0.0001) Mucinous carcinoma with signet ring cell component patients were %31.3 of mucinous carcinoma patients. Mucinous carcinoma patients were T3 and T4 tumours. Signet ring cells appear with extracellular mucin production. Signet ring cell component in mucinous cancer patients increases lymphatic invasion and lymph node metastasis. Distant metastases are more frequent in signet ring cell component patients. There were no statistically significant difference between patients on necrosis, ulceration, depth of invasion and tumor location. 5 years survive in signet ring cell component patients were %46.4 and in mucinous carcinoma without signet ring cell component was %59.4. In conclusion signet ring cell component was evaluated as a poor prognosis factor in mucinous carcinoma patients.
- [Show abstract] [Hide abstract] ABSTRACT: Background/aims: The normal oral mucosa is usually tolerant to its special microenvironment. Epithelial integrity and a wellmanaged immune system are important in sustaining harmony. A close look at the role played by adaptive immunity during recurrent aphthous ulcerations may throw some light into the pathogenesis. Materials and methods: In this report, we provide a concise review of oral epithelial barrier function and present data on the possible pathogenetic mechanism of aphthous ulceration using immunohistocemical signs of nuclear factor kappa beta pathway activation on fourteen cases of mucosal aphthous ulcerations. Results: We strongly support the hypothesis that oral aphthous ulcerations develop as a result of loss of epithelial barrier function and that nuclear factor kappa beta signaling pathway seems to be involved in this type of injury. Conclusion: Interventions that strengthen the mucosal barrier function or modulate inappropriate activation of nuclear factor kappa beta signaling pathway can be considered in the treatment of oral aphthous ulcerations.
- [Show abstract] [Hide abstract] ABSTRACT: Fat necrosis (FN) of the breast is a benign nonsuppurative inflammatory process of the adipose tissue. The radiologic appearance ranges from benign to suspicious for malignancy; therefore, it is very important to know the distinguishing radiologic features of FN on different modalities. Mammography is more helpful in identifying FN than ultrasonography in most of the cases, and MRI may also be used to rule out malignancy as an adjunct to mammography and sonography. Even when modern diagnostic modalities are used, biopsy may still be unavoidable for some cases. In conclusion, an accurate history and familiarity with the radiologic findings are crucial to recognizing FN and avoiding unnecessary interventions. © 2013 Wiley Periodicals, Inc. J Clin Ultrasound, 2013;
- [Show abstract] [Hide abstract] ABSTRACT: Purpose: To evaluate the role of diffusion-weighted magnetic resonance imaging (DWMRI) in differentiating benign and malignant thyroid nodules using a 3 Tesla (T) MRI scanner. Materials and methods: Twenty-eight nodules in 25 patients and 14 healthy control cases were included in the study. DWMRI was acquired with 6 b values with a 3T MRI scanner. The apparent diffusion coefficient (ADC) values of the nodules were calculated from reconstructed ADC map images and were compared with the final histopathological diagnoses. Results: The mean ADC value of the benign nodules was 1548 ± 353.4 (×10(-6) mm(2) /s), and the mean ADC of the malignant nodules was 814 ± 177.12 (×10(-6) mm(2) /s). The normal thyroid tissue had a mean ADC value of 1323.43 ± 210.35 × 10(-6) mm(2) /s (958-1689 × 10(-6) mm(2) /s) in the healthy control group. The ADC values were significantly different among the three groups (P = 0.001). An ADC value of 905 × 10(-6) mm(2) /s was determined to be the cutoff value for differentiating benign and malignant nodules, with 90% (55.5-98.3) sensitivity and 100% (81.3-100.0) specificity. Conclusion: This study suggests that the ADC values of nodules measured with a 3T MRI scanner could help in differentiating benign thyroid nodules from malignant nodules.
- [Show abstract] [Hide abstract] ABSTRACT: Prevention of secondary infection is currently the main goal of treatment for acute necrotizing pancreatitis. Colon was considered as the main origin of secondary infection. Our aim was to investigate whether prophylactic total colectomy would reduce the rate of bacterial translocation and infection of pancreatic necrosis. Forty-two Sprague–Dawley rats were used. Pancreatitis was created by ductal infusion of sodium taurocholate. Rats were divided into four groups: group-1, laparotomy + pancreatic ductal infusion of saline; group-2, laparotomy + pancreatic ductal infusion of sodium taurocholate; group-3, total colectomy + pancreatic ductal infusion of saline; and group-4, total colectomy + pancreatic ductal infusion of sodium taurocholate. Forty-eight hours later, tissue and blood samples were collected for microbiological and histopathological analysis. Total colectomy caused small bowel bacterial overgrowth with gram-negative and gram-positive microorganisms. Bacterial count of gram-negative rods in the small intestine and pancreatic tissue in rats with colectomy and acute pancreatitis were significantly higher than in rats with acute pancreatitis only (group-2 versus group-4; small bowel, p = <0.001; pancreas, p = 0.002). Significant correlation was found between proximal small bowel bacterial overgrowth and pancreatic infection (r = 0,836, p = 0.001). In acute pancreatitis, prophylactic total colectomy (which can mimic colonic cleansing and reduction of colonic flora) induces small bowel bacterial overgrowth, which is associated with increased bacterial translocation to the pancreas.
- [Show abstract] [Hide abstract] ABSTRACT: Pseudoepitheliomatous hyperplasia is a reactive epithelial proliferation of mucosal and cutaneous epithelium. The differential diagnosis of pseudoepitheliomatous hyperplasia from squamous cell carcinoma may be difficult. Pseudoepitheliomatous hyperplasia is a benign lesion, which may be treated with conservative local excision, while squamous cell carcinoma is a malignant tumor, which requires agressive surgery. Therefore, the differential diagnosis is essential in order to avoid radical surgery. Immunohistochemical stains may be useful as a diagnostic adjunct in cases where it is difficult to distinguish a benign process from a malignant one. This case report presentes a 75-year old patient with pseudoepitheliomatous hyperplasia at the excision area of a pleomorphic adenoma in the hard palate and relevant diagnostic challenges.
- [Show abstract] [Hide abstract] ABSTRACT: It has been shown that BRAF(V600E) mutation in papillary thyroid carcinomas (PTC) is associated both with pathogenesis and poor prognosis. In this study, we aimed to investigate the relationship of the BRAF(V600E) mutation and the established prognostic factors in a cohort of Turkish patients with PTC. Forty-six cases of papillary thyroid carcinoma have been evaluated for the presence of BRAF(V600E) mutation. BRAF(V600E) has been examined by restriction fragment length polymorphism. BRAF(V600E) mutation status has been compared with well-known histopathological and clinical prognostic parameters such as invasion of thyroid capsule, extrathyroidal extension, and the presence of lymph node and/or distant metastasis. We have found that BRAF(V600E) mutation was present in the majority of our cases (40/46). Considering the stage of the disease, five of the negative cases were in stage 1 while the remaining one was in stage 2. Only one BRAF(V600E) negative case has shown extrathyroidal extension and lymph node metastasis. All four patients with distant metastasis had BRAF(V600E) mutation. Statistical analyses revealed that there are no significant relationship between the BRAF(V600E) mutation and the established prognostic factors. We found a relatively higher BRAF(V600E) mutation rate in classical type PTC than in other similar studies. We think that the limited number of our cases may either weaken or mask some potentially important relationship between BRAF(V600E) mutation and the established prognostic factors.
Article: Melanosis Coli: Case Report[Show abstract] [Hide abstract] ABSTRACT: Melanosis coli is a common condition characterized by dark pigmentation of colonic mucosa. Melanosis coli is thought to be a benign lesion that emerging related with the overuse of the anthraquinone containing laxatives. A complete relation with colorectal carcinoma could not be demonstrated. It is often related with constipation and it is mostly diagnosed as endoscopic or diagnosed in a histopathological research by chance. It is important to recognize the melanosis coli which can be regressed generally in a few months with the cutting of laxatives. Although it is seen as a benign disease, colonoscopic biopsies should be taken from the pigmente and nonpigmente areas because of the suspicion of colorectal adenoma and carcinoma. In this article we aimed to present the following case: A patient applied our hospital with some complaints after being operated with the diagnosis of colon carcinoma and melanosis coli was determined during the investigations and after discontinuation of the use of laxative the patient complaints were regressed.
- [Show abstract] [Hide abstract] ABSTRACT: Myoepithelial cells are an important component of salivary gland tumors and are partly responsible from the diverse histology of them. In this study, we focus on the myoepithelial cell differentiation by using cytological morphology in a various types of salivary gland tumors especially with regard to their contribution to the diagnosis. The relation of myoepithelial cells with stromal matrix and the associated epithelial cells were evaluated. Cytologic slides of one hundred and forty one benign and twenty malignant salivary gland tumors were examined for identification of morphologically different myoepithelial cells such as; spindle-stellate, polygonal-epitheloid, plasmacytoid, basal and clear types. The best examples of myoepithelial cells were detected in pleomorphic adenomas, in some monomorphic adenomas and in the adenoid cystic carcinoma cases. Most of the pleomorphic adenomas were composed more than one type of myoepithelial cells and epitheloid-spindle cell combination was frequent. Basal and clear cell types of myoepithelial cells closely resembled the epithelial cells and their identification was relatively difficult. Identification of myoepithelial cell types was easier when they were associated with stromal matrix material and stood as a secondary layer around tubule-forming epithelial cells. Myoepithelial cell components of various salivary gland tumors may be quite different and identification of myoepithelial cell types may pose difficulties. A confident cytologic identification of myoepithelial cells may be critical part of diagnosing salivary gland tumors.
- [Show abstract] [Hide abstract] ABSTRACT: Fascin is an actin-bundling protein that is important in cell motility. Fascin expression has been shown to have a potential role in tumor progression for some epithelial tumors. However, there are only a few studies related to its expression in mesenchymal tumors. We investigated fascin expression in gastrointestinal stromal tumors. Thirty gastrointestinal stromal tumors, which were very low (n=6), low (n=2), moderate (n=4), and high (n=18) risk, constituted our series. Immunohistochemical expression of fascin was studied in all cases. Immunoreactivity was observed in only five cases, all of which were in the high-risk group. The remaining cases (25/30) showed no immunoreactivity, and the difference did not seem statistically important (p=0.261). Fascin expression was stronger in epithelioid cells than spindle-shaped cells (p=0.003). In addition, gastrointestinal stromal tumors in the small bowel showed higher fascin expression than those in the other localizations (p=0.043). It seems that anatomic localization and the tumor cell type of gastrointestinal stromal tumors show statistically significant differences with regard to fascin expression. Although our series is limited, we think that fascin should be considered as a marker that is worthy of further study for its potential usage as a prognostic indicator in gastrointestinal stromal tumors.
- [Show abstract] [Hide abstract] ABSTRACT: Juvenile hyaline fibromatosis (JHF) is a rare autosomal-recessive hereditary disease, characterized by gingival hypertrophy, flexion contractures of joints, bone lesions, hyaline deposition in the extracellular spaces of the dermis and soft tissues, stunted growth, and skin lesions such as multiple nodules, tumors and pink, pearly papules. No case of JHF with a mandibular bone involvement, exists in the literature. Bone involvement in JHF is an uncommon finding and distinct solitary lesions in the calvarial bones has been reported by some authors. A 21-year-old male patient was referred to Diyarbakir Military Hospital, Department of Dental Service. Clinical findings were consistent with a solid alveolar mass in the right mandibular premolar-molar region and displaced right mandibular molar teeth. Orthopantomographic examination showed impaction of all lower right molars in a mixed radioopaque/radiolucent area. Microscopically, increased nodular connective tissue was seen under the lobulated mucosal surfaces of the resected area. The case presented here had a localized fibrous proliferation that infiltrated bone trabeculae and caused displacement of teeth. Juvenile hyaline fibromatosis should be considered in the differential diagnosis with the other intraosseous radiolucent-patchy opaque lesions of jaw bones. Based on the clinical and histopathological findings, a diagnosis of JHF was made.
- [Show abstract] [Hide abstract] ABSTRACT: The aim of this study was to evaluate and compare the microvascular architectural complexity in oncocytomas and chromophobe renal cell carcinomas (ChRCCs) by fractal box-counting on CD34-labeled slides. The study group consisted of 23 cases (12 oncocytomas and 11 ChRCCs) diagnosed from resections. Capillaries were highlighted by CD34, and digital images from randomly selected, non-overlapping areas were taken. Fractal dimensions of microvasculature were measured according to the "box-counting" method with the aid of image analysis software. Mean fractal dimensions (MFDs) were calculated and compared. Hierarchical cluster analysis was also performed to determine whether natural grouping occurs among the cases. Cluster analysis revealed that the cases tended to aggregate in two partially overlapping groups in which oncocytomas (8/12) and ChRCCs (7/11) predominate, respectively. A slight but statistically important difference was also revealed by the Mann-Whitney U test. Fractal dimension, a variable for measuring the geometrical complexity of highly irregular objects, is used for research in pathology. Although the number of cases is limited in our series, the results indicate an obscure but quantitatively measurable difference, which cannot be assessed by the naked eye. Similar studies investigating larger series are needed before a final conclusion can be made.
- [Show abstract] [Hide abstract] ABSTRACT: Uncontrolled hemorrhage is the leading cause of fatality. The aim of this study was to evaluate the effect of zeolite mineral (QuikClot - Advanced Clotting Sponge [QC-ACS]) on blood loss and physiological variables in a swine extremity arterial injury model. Sixteen swine were used. Oblique groin incision was created and a 5 mm incision was made. The animals were allocated to: control group (n: 6): Pressure dressing was applied with manual pressure over gauze sponge; or QC group (n: 10): QC was directly applied over lacerated femoral artery. Mean arterial pressure, blood loss and physiological parameters were measured during the study period. Application of QC led to a slower drop in blood pressure. The control group had a significantly higher increase in lactate within 60 minutes. The mean prothrombin time in the control group was significantly increased at 60 minutes. The application of QC led to decreased total blood loss. The QC group had significantly higher hematocrit levels. QC application generated a significant heat production. There were mild edematous and vacuolar changes in nerve samples. According to the physiological parameters, we observed that zeolite tends to reduce blood loss, however could not stop bleeding completely. We believe that further clinical trials are needed to conclude that zeolite could be used in the routine practice.
- [Show abstract] [Hide abstract] ABSTRACT: Splenic hamartoma is an uncommon benign lesion and usually determined incidentally. A 44-year-old female patient admitted with abdominal pain. There was not any history of trauma. During the ultrasonographic examina-tion a cystic mass was seen in the upper pole of the spleen. Only anemia was detected biochemically, and all other laboratory findings were normal. The patient underent splenectomy. Grossly, a cystic mass including solid component was seen in the upper pole of the spleen. Histopathologically, cystic component did not have lining epithelium. Solid component included sinus like clefts, broad cordons and areas of prominent endothelial prolif-eration. The lesion was diagnosed as hamartoma. In this report, the clinical and histopathological features of a case of splenic hamartoma with promi-nent endothelial proliferation that may be easily confused with malignancy is presented. ÖZET Maligniteyi taklit eden belirgin endotelyal proliferasyon gösteren kistik splenik hamartoma: olgu sunumu Splenik hamartoma nadir görülen benign bir lezyondur ve genellikle rast-lantısal olarak saptanır. Kırk dört yaşında kadın hasta karın ağrısı şikayeti ile başvurdu. Travma öyküsü yoktu. Batın ultrasonografisi sırasında dalağın üst kutbunda kistik kitle görüldü. Biyokimyasal incelemede sadece anemi saptanmış olup, diğer tüm laboratuvar incelemeleri normaldi. Hastaya sple-nektomi yapıldı. Makroskobik olarak, dalağın üst kutbunda solid komponent de içeren kistik kitle görüldü. Histopatolojik olarak kistik komponentin döşe-yici epitelinin bulunmadığı görüldü. Solid komponent, sinüs benzeri yarıklar, geniş kordonlar ve belirgin endotelyal proliferasyon alanları içermekteydi. Lezyon hamartoma olarak rapor edildi. Bu makalede maligniteler ile karış-tırılabilecek, belirgin endotelyal proliferasyon içeren bir splenik hamartoma olgusunun klinik ve histopatolojik özellikleri sunulmuştur.