Comparison of liver resection and living donor liver transplantation in patients with hepatocellular carcinoma within Milan criteria and well-preserved liver function

Background and Aim

Liver resection (LR) and liver transplantation (LT) are curative treatments for hepatocellular carcinoma (HCC). The main purpose of this study was to compare the survival of LR and LDLT in patients with HCC within the Milan criteria.

Materials and Methods

The results of the LR (n=67) and LDLT (n=391) groups were compared for overall survival (OS) and disease-free survival (DFS). Twenty-six of the HCCs in the LRs met the Milan and Child A criteria. Also, 200 of the HCC patients in the LDLTs met the Milan criteria, of which 70 also met the Child A criteria.

Results

Early mortality was higher in the LDLT group (13.9% vs 1.47%; p=0.003). The 5-year OS was higher in the LDLTs than the LRs, but not statistically significant (84.6% vs 74.2%; p=0.287). However, 5-year DFS was better in the LDLT group (96.8% vs 64.3%; p<0.001). When the LRs (n=26) and the LDLTs (n=70) that met both Milan and Child A criteria were compared, 5-year OS was similar (81.4% vs 74.2%; p=0.512), but DFS was better in the LDLTs (98.6% vs 64.3%; p<0.001).

Conclusion

LR can be justified as the first-line treatment for HCC patients who meet Milan and Child A criteria in terms of early mortality and OS.

Thymic Seminoma with Regressive Changes Obscured by Granulomatous Reaction

Primary thymic seminoma is an exceedingly rare tumour. There are few case reports about mediastinal thymic seminoma accompanied by secondary changes. We report a case of a 29-year male admitted to our hospital because of chest pain and dyspnea for 8 months. Computed tomography of the thorax revealed hypodense, solid masses showing calcification and cystic degeneration in the anterior mediastinum. Histopathological examination of the resected specimen revealed a diagnosis of thymic seminoma with regressive and reactive changes. The present case was unique in its presentation as a primary seminoma showing combination of cystic degeneration, follicular hyperplasia, fibrosis, calcification and granulomatous reaction in one case. High level of suspicion is necessary to identify seminomas in a thymic lesion accompanied by secondary changes. Excluding the possibility of metastasis from testicular seminoma is very important before making this diagnosis. Key Words: Thymus, Seminoma, Granuloma, Calcification, Cyst.

Long-term effects of orchiopexy and orchiectomy on the testes of rats with testicular torsion

INTRODUCTION

Ischemia/reperfusion injury occurs after testicular torsion, levels of free oxygen radicals and inflammatory cytokines are increased in both the torsional and contralateral testis, leading to testicular injury.

OBJECTIVE

The present study investigated whether orchiopexy or orchiectomy after testicular torsion was superior in terms of fertility potential in the long term.

STUDY DESIGN

Following 720°, 4 h left testicular torsion, orchiectomy or orchiopexy was performed on 84 rats, which were then sacrificed and evaluated for testicular function at day 1, at 3 months and 6 months (n = 14 per group). An additional 14 rats were in the control group.

RESULTS

Follicle stimulating hormone (FSH), luteinizing hormone (LH), and testosterone levels were significantly lower in the orchiopexy group than the orchiectomy and control groups after 3 months. However, there were no significant differences in hormone parameters among the three groups after 6 months. The hormone levels, Johnsen score, seminiferous tubule diameter, and inducible nitric oxide synthase (iNOS) expression at 3 and 6 months were not significantly different between the orchiectomy group and controls. Histopathological analyses at 3 and 6 months indicated significant decreases in Johnsen score and seminiferous tubule diameter in the ipsilateral testis in the orchiopexy group. At 3 months, the level of iNOS expression in the contralateral testis was significantly lower in the orchiopexy group than in other groups. At 6 months, however, it was not significantly different between the orchiopexy and control groups. There were no significant differences in iNOS expression at 3 or 6 months in the orchiectomy group compared to controls.

DISCUSSION

The ipsilateral testis in the orchiopexy group began to atrophy at 3 months, and the degree of atrophy became more evident at 6 months. The level of iNOS expression was low in the bilateral testis at 3 months in the orchiopexy group, and sperm in the contralateral testis were not yet functionally healthy. The level of iNOS expression in the ipsilateral testis decreased further at 6 months in the orchiopexy group, while that in the contralateral testis returned to the normal level.

CONCLUSION

Testicular functions were restored faster after orchiectomy compared to orchiopexy following testicular torsion. However, follow-up of the rats for 6 months demonstrated that orchiopexy or orchiectomy procedures conducted on the testicular torsion had no effect on future fertility potential after 4 h of torsion.

Bronchiectasis: Retrospective Analysis of Clinical and Pathological Findings in a Tertiary-Care Hospital

BACKGROUND

Bronchiectasis is still a challenging chronic lung disease in developing countries. Patients with bronchiectasis can also have pulmonary hypertension. There are sparse data on the prevalence of pulmonary hypertension in patients with bronchiectasis. Materials and methods. Archived H&E-stained slides of 141 patients histopathologically diagnosed with bronchiectasis were reevaluated. Cases were categorized into 4 subgroups based on histology: tubular, varicose, follicular, and cystic. In addition, concomitant histopathological changes were also reevaluated. For patients with available CT sections, main, right, and left pulmonary artery (PA) diameters and PA/aorta ratio were measured with regard to pulmonary hypertension.

RESULTS

Of the cases, 70% (n = 89) were female and 30% (n = 52) were male, with a mean age of 36.58 in females and 33.84 in males. Histopathologically, 43% (n = 68) of the cases showed follicular, 37% (n = 59) showed varicose, 35% (n = 56) showed tubular, and 28% (n = 45) showed cystic bronchiectasis morphology. All cases showed chronic inflammation, fibrosis, muscle destruction, and cartilage destruction. Aspergillus were present in 11% of the cases showing cystic morphology. Approximately 17% of the cases (n = 24) were found to have neuroendocrine cell proliferations. In cases with medial hypertrophy, a statistically significant increase in the left pulmonary artery diameter was radiologically determined.

CONCLUSIONS

Medial hypertrophy was found to be significant with regard to indicating a radiological increase in left pulmonary artery diameter. Vascular changes observed in bronchiectasis cases and the presence of neuroendocrine cell proliferations should be specified in pathology reports, and aspergilloma should be carefully investigated in cases with predominant cystic morphology.

Solitary Bone Cyst Like Areas in Myositis Ossificans: A Breast Mass in a Child

Myositis ossificans is an extraosseous, benign tumor-like condition characterized by prominent heterotopic ossification. Cystic degeneration in myositis ossificans is an uncommon entity. Case report: A 13-year-old girl presented with a large and painful breast lump. Physical examination revealed a mobile, hard mass, clinically resembling a fibroadenoma. The mass was excised and diagnosed as myositis ossificans with central bone cyst like changes. Conclusion: Our case represents the first myositis ossificans case with central bone cyst like changes in a child.

Clinicopathological Features of Two Extremely Rare Hepatocellular Carcinoma Variants: a Brief Review of Fibrolamellar and Scirrhous Hepatocellular Carcinoma

PURPOSE

We aimed to distinguish between fibrolamellar hepatocellular carcinoma and scirrhous hepatocellular carcinoma histopathologically.

METHODS AND RESULTS

In this review, fibrolamellar hepatocellular carcinoma and scirrhous hepatocellular carcinoma two specific and rare variants of hepatocellular carcinoma, which are difficult to diagnose histopathologically are discussed.

CONCLUSION

The clinical, radiological, gross, histopathological, immunohistochemical, and molecular features of these two tumors, which are defined by the World Health Organization (WHO), are mentioned.

Cytoprotective effects of molsidomine against methotrexate-induced hepatotoxicity: an experimental rat study

Introduction and aim

Methotrexate (Mtx) is an antineoplastic and immunosuppressive drug that may cause hepatotoxicity, whereas molsidomine (Mol) is a vasodilating and antioxidant agent. This study aimed to investigate the potential protective effects of Mol in Mtx-induced liver toxicity in rats.

Materials and methods

Forty Wistar albino rats were equally divided into five groups: control, Mol, Mtx, Mol–Mtx, and Mtx–Mol. Following treatment, the animals were sacrificed, and liver tissue samples were histopathologically evaluated using Roening grading and Bcl-2 antibody staining. Tissue oxidants, antioxidants, and serum transaminases were measured and statistically compared across all groups.

Results

No hepatic fibrosis or steatosis was observed in any of the groups. In the Mtx group, grade 2 liver injury and score 2 Bcl-2 antibody staining were observed; however, in the Mol–Mtx group, these were lower (grade 1, score 1). There were no statistically significant differences in serum transaminase levels among groups. Malondialdehyde levels were higher in all rats that received Mtx, but no differences in myeloperoxidase levels were observed among the groups. Levels of tissue antioxidants, including superoxide dismutase, glutathione (GSH) peroxidase (GSH-Px), and reduced GSH, were significantly higher in the Mol-treated and Mol pre-treated groups. Catalase (CAT) levels were elevated in all Mol-treated groups, but only in that group were CAT levels statistically significantly higher than in the control group.

Conclusion

Our results suggest that some oxidant levels could increase following Mtx administration in the liver, possibly contributing to liver damage, whereas Mol could mitigate the histopathological and biochemical effects of hepatotoxicity. However, molecular studies are required to understand the exact mechanisms of these alterations.

The Role of CD90 in the Differential Diagnosis of Pleural Malignant Mesothelioma, Pulmonary Carcinoma and Comparison with Calretının

Pleural Malignant Mesothelioma (MM) is a fatal disease that has been associated with asbestos exposure. Differential diagnosis between the pleural infiltration of pulmonary carcinomas and MM is rather difficult particularly for epitheloid type mesothelioma.We aimed to investigate the utility of CD90, a cancer stem cell marker, in the differential diagnosis of MM and lung carcinoma, its prognostic significance and compare its value with that of Calretinin. Ninety pathology specimens including MM (n:30), pulmonary adenocarcinoma (n:30) and pulmonary squamous cell carcinoma (n:30) were used in this study. Immunohistochemical comparision of CD 90 and Calretinin was made in all groups. Calretinin was positive in 20 cases with MM (64.5 %), and was negative in 10 (32.3 %). CD 90 was positive in 25 of these cases (80 %) and negative in 5 (16 %). On the other hand pulmonary adenocarcinomas and squamous cell carcinomas showed positivity with CD90, 63,6 % and 73 %, respectively. We think that CD 90 has no place in the differential diagnosis between mesothelioma and pulmonary carcinoma because of the low specificity in spite of the high sensitivity.