Uterine papillary serous and clear cell carcinomas: Comparison of characteristics and clinical outcomes

INTRODUCTION

To assess the rate of disease control and survival after adjuvant treatment in patients with uterine papillary serous (PSC) and clear cell carcinoma (CCC) and compare the results between these two subtypes.

METHODS

The medical charts of 199 patients with de novo uterine PSC or CCC who underwent radiotherapy (RT) following surgery between 2001 and 2019 in three radiation oncology departments were retrospectively evaluated. Adjuvant treatment was decided by a multidisciplinary tumor board. All patients were planned to undergo adjuvant 4-6 cycles of chemotherapy with external beam RT (EBRT) and/or vaginal brachytherapy (VBT).

RESULTS

Median age was 63 years for all, 64 years for PSC, and 59 years for CCC, respectively. Complete surgical staging was applied in 98% of patients. Histopathologic subtype was PSC in 142 (71%) and pure CCC in 57 (29%) patients, respectively. FIGO stage was I in 107 (54%), II in 35 (18%), and III in 57 (28%) patients, respectively. Lympho-vascular space invasion and positive peritoneal cytology (PPC) were present in 42% and 10% of patients, respectively. All patients but 23 (12%) underwent adjuvant chemotherapy. Median follow-up was 49.5 months for all patients, 43.9 months for patients with PSC, and 90.4 months for patients with CCC, respectively. During follow-up, 20 (10%) patients developed pelvic recurrence (PR) and 37 (19%) developed distant metastasis (DM). PSC subtype increased the PR and DM rates, although the latter not statistically significant. The 5-year overall survival and disease-free survival rate was 73% and 69% for all patients, 71% and 66% for patients with PSC, and 77% and 75% for patients with CCC, respectively. The difference was more prominent in patients with stage ≥ IB disease. In multivariate analysis, advanced age and PPC significantly decreased all survival rates.

CONCLUSION

PSC has a worse prognosis than CCC with regard to pelvic and distant recurrence with a trend for decreased survival rates. Therefore, a more aggressive therapy is needed for patients with uterine PSC, particularly in patients with stage ≥ IB disease.

Survival analyses of patients with non-endometrioid endometrial carcinoma

Non-endometrioid endometrial carcinoma seems to be less common with a poor prognosis. Due to the lack of standard treatment options and worse survival rates of non-endometrioid endometrial carcinoma, we aimed to investigate these patients inclusively. In total, 492 women with endometrial cancer who were treated in a gynecologic oncology center were examined. Patients with a final histopathologic diagnosis of non-endometrioid endometrial carcinoma were evaluated in respect of demographic characteristics, prognostic aspects, and survival outcomes. We identified 94 patients with the histopathologic results of non-endometrioid endometrial carcinoma. The performance of the systematic lymphadenectomy and adjuvant treatment rate were 96.9% and 92.6%, respectively. Recurrence of the disease was detected in 32 (34%) women and disease-related mortality occurred in 28 (29.8%) women. Multivariate Cox proportional regression analyses determined tumor size, adnexal involvement, and lymphovascular space invasion as independent predictors of overall survival. Larger tumor size, adnexal, and lymphovascular space invasion are important factors in determining prognosis in non-endometrioid endometrial carcinoma patients according to our findings. Besides, high rates of surgical staging and adjuvant chemotherapy and radiation therapy may contribute to improved survival outcomes; in addition to having potential advantages of providing prognostic information. Therefore, a multidisciplinary therapeutic approach should be planned from the early stages for all patients in this group. Nevertheless, comprehensive prospective studies are necessary to optimize the treatment strategies and support successful treatment modalities.

What is the predictive value of preoperative CA 125 level on the survival rate of type 1 endometrial cancer?

Background/aim

To investigate the utility of preoperative serum cancer antigen 125 (CA 125) levels in type 1 endometrial carcinoma (EC) as a marker for determining poor prognostic factors and survival.

Material and methods

All patients with endometrial cancer, who had been treated between 2012 and 2020, were retrospectively reviewed, and finally, 256 patients with type 1 endometrium carcinoma were included in the study. The relationship between the clinicopathological characteristics, CA 125 level, and survival rates were analyzed. The cut-off value for the preoperative serum CA 125 level was defined as 16 IU/L.

Results

The median serum CA 125 levels were significantly higher in patients with deep myometrial invasion, lymph node metastasis, lymphovascular space invasion, cervical stromal and adnexal involvement, advanced stage, positive peritoneal cytology, recurrence, and adjuvant therapy requirement. Serum CA 125 cut-off values determined according to clinicopathologic factors ranged from 15.3 to 22.9 IU/L (sensitivity 61%–77%, specificity 52%–73%). The disease-specific survival rate was significantly higher in patients with CA 125 levels < 16 IU/L (P = 0.047).

Conclusion

The data showed that choosing a lower threshold value for the CA 125 level (16 IU/L) instead of 35 IU/L, could be more useful in type 1 EC patients with negative prognostic factors.

Intra-articular zoledronic acid in a rat osteoarthritis model: significant reduced synovitis may indicate chondroprotective effect

PURPOSE

The aim of this experimental study was to evaluate the effect of intra-articular application of zoledronic acid (ZA) on joint cartilage and synovial tissue following induction of knee osteoarthritis (OA) in a rat model.

METHODS

An OA model was created by anterior cruciate ligament transection (ACLT) in the right knees of 48 adult Wistar albino rats. The rats were randomized into a study and control groups, each including 24 rats, and 10 μg of ZA was injected in 0.1 ml of sterile saline to 24 animals in the study group on the first day to operation and was repeated weekly until the rats were killed. The same volume of sterile saline was injected with the same schedule to the control group. Eight rats from both the study and control groups were killed, each time, on the 4th day, the 3rd week, and the 6th week after the operation. The groups were compared based on the histological scores of synovitis and cartilage destruction and the evaluation of serum markers.

RESULTS

Histological score indicates progression of synovitis was significantly less in the study group (p = 0.047). There was significant increase in the mean Mankin cartilage damage score in the control group (p = 0.021), while no significant change was found in the study group. When the two groups were compared over time, no statistically significant difference was detected in total histological scores, although there was a 47 % less incidence of cartilage tissue damage in the study group and better cartilage structure and tide mark integrity scores were also detected in the study group (p = 0.017 and p = 0.021, respectively).

CONCLUSION

Intra- articular zoledronic acid may suppress synovial inflammation. Furthermore, Zoledronic Acid does not reduce cartilage degeneration in early osteoarthritis models, but may provide some chondroprotective effect in ACLT- induced knee osteoarthritis model in rats.

Analysis and prevalence of inflammatory cells in subtypes of lumbar disc herniations under cyclooxygenase-2 inhibitor therapy

OBJECTIVE

The aim of the present study was to analyse inflammatory cells in lumbar disc tissue under cyclooxygenase-2 (COX-2) inhibitor therapy, to detect their prevalence in different subtypes of lumbar disc herniations and to assess the influence of inflammatory reactions in herniated disc tissue on postoperative outcome.

METHODS

In this prospective study, intervertebral disc specimens were obtained from 50 patients. All the patients were given COX-2 inhibitor therapy (Rofecoxib) 25 mg/day for 10 days before surgery. The herniated disc specimens were routinely fixed in a 10% buffered formaline solution and paraffin-embedded; 5 microm thin sections were stained with monoclonal antibodies CD-68 for macrophages, CD-45 RO for T cells and CD-20 for B cells. The specimens were microscopically examined and classified by two independent examiners in a blinded manner.

RESULTS

CD-68 macrophages were evident in herniated lumbar disc tissue in 40% of the cases, but abundant inflammation was observed in only 18% of the cases. Macrophages were significantly common in sequesters with a prevalence of 80%, and no macrophages were observed in the protrusions. We obtained the best outcome scores in the patients with a sequestrated lumbar disc herniation.

CONCLUSION

Although most of the specimens from all the patients showed no significant inflammatory reaction, maybe due to COX-2 inhibitor therapy, they all needed surgery with no relief of the symptoms despite conservative therapy. Nerve root compression still seems to be the leading pathomechanism.

Lipidized or lipomatous meningioma, which is more appropriate? A case report

Lipoblastic, lipomatous or lipidized meningioma is an unusual extra-axial benign tumor. It shows benign clinical features and has a good prognosis after surgical excision. We present a 54-year-old woman with intracranial lipidized meningioma in the right temporal fossa, discuss the importance of the differential diagnosis among similar tumors and discuss the term 'Lipidized meningioma' in the light of the literature.

Stump appendicitis and chorioamnionitis due to incomplete appendectomy: a case report

Acute appendicitis represents the most common non-obstetric indication for surgical intervention in pregnant women, with a reported incidence of 1 in 1440 pregnancies. Stump appendicitis is a rare clinical situation when there is incomplete appendectomy. A rare case occurred of stump appendicitis and chorioamnionitis complicating after incomplete appendectomy. In this way the literature review suggests that only a few cases have been reported so far. We report a case of stump appendicitis and chorioamnionitis occurring three weeks after an appendectomy performed in another medical center. This will involve the discussion of clinical presentation, diagnosis, surgical management and literature review.

Pregnancy-related peritoneal ectopic decidua (deciduosis): morphological and clinical evaluation

OBJECTIVE

Ectopic decidual reaction (deciduosis) can be seen rarely on the peritoneum during laparotomy for a cesarean section for pregnancy, in addition to the ovary and cervix. The aim of this study was to evaluate the clinical, histopathological, immunohistochemical characteristics of ectopic decidua cases that were incidentally found in the peritoneum during a cesarean section.

MATERIAL AND METHOD

A total of seven cases where decidualization was found in the peritoneal biopsy taken during pregnancy at the Baskent University Medical Faculty Adana Teaching and Training Hospital Department of Pathology were included in this study. The clinical features of the cases were obtained from their clinical folders. The morphological findings were recorded and the peritoneal biopsies were analyzed with keratin Pan Ab-1, calretinin, vimentin, HMB-45 and progesterone receptor antibody for immunohistochemical analysis.

RESULTS

The mean age for the seven cases was 36±4.16. The gestational age was 33 to 39 (mean 37.2) weeks. Microscopic evaluation revealed decidualized cells that were large polygonal and eosinophilic, some with vacuolated cytoplasm, that formed small nodules under the mesothelium of the peritoneum in all cases. Immunohistochemical staining showed positive staining of the cell cytoplasm with vimentin and positive staining of the cell nucleus with the progesterone receptor antibody in the decidual cells. Calretinin, keratin and HMB-45 stains were negative.

CONCLUSION

Pregnancy-related peritoneal deciduosis develops with the effect of progesterone in pregnancy. It disappears without complication in the postpartum period. Immunohistochemistry may help the differential diagnosis of peritoneal deciduosis where problems are experienced differentiating the case from malignant mesothelioma or metastatic tumor.

Detection and importance of micrometastases in histologically negative lymph nodes in endometrial carcinoma

BACKGROUND

Lymph node status is the most important prognostic factor in terms of its relation to long-term survival of endometrial carcinoma (EC) patients. We aimed to investigate the rate of micrometastases in lymph nodes of EC patients that were previously reported as negative with routine histopathology, and the relationship with clinical and pathologic factors.

MATERIALS AND METHODS

With immunohistochemistry, we retrospectively looked at cytokeratin staining of lymph nodes from 47 EC patients, that were previously reported to be negative for lymph node metastases after full surgical staging and routine histopathologic investigation. We also looked at the relationship between micrometastases and clinical, histopathologic factors and recurrence.

RESULTS

Of all 47 patients, seven (14.9%) were found to have micrometastases in their previously negatively reported lymph nodes. Six out of seven of these patients (85.7%) were high-risk EC patients. Among high-risk EC patients, 50% had micrometastases, whereas only one patient out of 35 with low or intermediate risk had micrometastases (2.9%). The difference between these groups was statistically significant (p = 0.001). Grade was also correlated with micrometastases (p = 0.0001). Mean follow-up time was 55.5 +/- 13.3 months. There were two recurrences in the group having cytokeratin micrometastasis, whereas no patients without micrometastases developed any recurrence. While 36 months recurrence-free survival (RFS) was 100% in patients without micrometastases, it was 71% in patients with micrometastases (mean rate 57 months) (p = 0.0004). Both RFS and overall survival were statistically significantly inferior for patients having micrometastases, high-risk status, and lymphovascular space involvement (p < 0.05).

CONCLUSION

It seems reasonable to further analyze negative lymph nodes in high-risk EC patients for micrometastases utilizing immunohistochemistry techniques. Half of this group of patients are still at risk of lymph node metastases even if routine histological findings are negative for metastases. The finding of micrometastases can change therapeutic decisions for the better by incorporating adjuvant treatment options.

Infected tuboovarian hydatid cyst: a rare cause of tuboovarian abcess

Pelvic hydatid cysts, although rare, must be considered when evaluating a pelvic mass in women living in an endemic area. The pelvis may become secondarily involved as a result of a rupture of the cyst in another location or be the only localization of the disease. If the cyst becomes secondarily infected, it may mimic a tuboovarian abscess. A 49-year-old multipara was admitted to the emergency department with the complaint of fever, generalized abdominal pain and distension. Abdominal ultrasound revealed a 4 cm cystic structure in the liver and the gynecological examination was normal. The patient's abdominal pain receded spontaneously, so she was prescribed albendazole and discharged from the hospital. Ten days later, she complained of pelvic pain, pressure and vaginal discharge. The uterus and adnexa were tender on pelvic examination. Ultrasound revealed an 8 cm uniloculated cyst with free floating internal echogenities located between the bladder and the uterus. At surgery a 10 cm right-sided tuboovarian mass was present. A germinative membrane was present inside the abscess and pericystectomy with unilateral salphingo-oophorectomy was performed.

Prenatal diagnosis and postmortem findings of Neu-laxova syndrome

Neu-laxova syndrome is a lethal, autosomal recessive condition associated with ectodermal abnormalities and other characteristic features, including microcephaly, marked intrauterine growth restriction, limb deformities, central nervous system malformations and abnormal facial features, consisting of severe proptosis with ectropion, hypertelorism, micrognathia, flattened nose, malformed ears, and gaping mouth. Here we present a fetus having a dysmorphic face with proptotic eyes, retracted eye lids, depressed nasal bridge and micrognathia at 25 weeks of gestation. The extremities were contracted and no fetal movements were observed during the ultrasonographic examination. The fetus also had microcephaly and the amniotic fluid was increased. The pregnancy was terminated and the abnormalities demonstrated on prenatal ultrasound were confirmed at autopsy.

Osseous metaplasia of the endometrium

Osseous metaplasia of the endometrium is very rare finding, and usually these cases presented with secondary infertility. Other symptoms are pelvic pain, dyspareunia, menstrual irregularities, vaginal discharge and the passage of bony fragments in menstrual blood. Suspicious lesion could see by hysterosalpingography or by ultrasonography; however, conclusive diagnosis and treatment tool is hysteroscopy. The aetiology is unknown, but theories include retained fetal bone and osseous metaplasia of endometrial tissue. We present a patient with osseous metaplasia who had treated with hysteroscopy.

A case of Seckel syndrome with Tetralogy of Fallot

Seckel syndrome, also known as Harper's Syndrome and Virchow-Seckel-Syndrome, was first described by Seckel in 1960, and is a rare (<1:10,000 live births) autosomal recessive trait. The syndrome (OMIM 210600) is a form of primordial dwarfism, characterized by severe intrauterine growth restriction, postnatal dwarfism, severe microcephaly with variable mental retardation, facial anomalies and skeletal abnormalities. Cardiac anomalies have been described in only five case. We report a male newborn with typical findings of Seckel sydrome associated with Tetrology of Fallot. This is the first case reported in concomitance with Tetralogy of Fallot, and might be a new finding of the syndrome. We would like to emphasize that clinicians should perform diagnostic interventions for congenital cardiac defects in Seckel Syndrome.

Epidermoid Carcinoma Involving the Parotid Gland and Orbital Region: Case Report of a Rare Entity

Epidermoid carcinoma (also known as squamous cell carcinoma) of the parotid gland is more prevalent among the elderly, as are other head and neck tumors. In most cases it is observed either as a nodal metastasis of a primary tumor that drains into the parotid area or as a direct extension of a tumor that has originated in the upper dermis. Primary epidermoid carcinomas arising directly from the parotid gland are extremely rare. Similarly, secondary invasion of the orbital region by a neighboring tumor is more common than primary epidermoid carcinoma of the orbit, which is also rare. In this article, we discuss the diagnosis and treatment of a rare case of epidermoid carcinoma simultaneously invading the parotid gland and the orbit.

Epidermoid carcinoma involving the parotid gland and orbital region: case report of a rare entity

Epidermoid carcinoma (also known as squamous cell carcinoma) of the parotid gland is more prevalent among the elderly, as are other head and neck tumors. In most cases it is observed either as a nodal metastasis of a primary tumor that drains into the parotid area or as a direct extension of a tumor that has originated in the upper dermis. Primary epidermoid carcinomas arising directly from the parotid gland are extremely rare. Similarly, secondary invasion of the orbital region by a neighboring tumor is more common than primary epidermoid carcinoma of the orbit, which is also rare. In this article, we discuss the diagnosis and treatment of a rare case of epidermoid carcinoma simultaneously invading the parotid gland and the orbit.

Adult cystic nephroma: a case report and a review of the literature

A 23-year old women who underwent radical nephrectomy due to right renal mass is presented. The histopathological examination is reported as adult cystic nephroma, a rare benign lesion of the kidney. The epidemiology, differential diagnosis, histopathological features, and treatment alternatives are discussed and the literature is reviewed.

Maspin overexpression correlates with increased expression of vascular endothelial growth factors A, C, and D in human ovarian carcinoma

The vascular endothelial growth factor (VEGF) family, including VEGFA, VEGFC, and VEGFD, plays an essential role in the angiogenesis of both pathologic and nonpathologic conditions. Maspin belongs to the serpin superfamily and has been identified as a tumor suppressor because it inhibits motility, invasion, and angiogenesis. Few studies have compared maspin with VEGF in ovarian carcinoma. Therefore, we investigated the expression and correlation of maspin, VEGFA, VEGFC, and VEGFD with the tumorigenesis of the ovary and clinicopathologic variables. Using immunohistochemistry, we examined maspin, VEGFA, VEGFC, and VEGFD expression in 60 ovarian carcinoma tissues (35 serous papillary carcinomas, 18 endometrioid carcinomas, and 7 primary ovarian mucinous carcinomas). Staining of cells was scored as +2 if more than 50% of the cells were positive, as +1 if less than 50% of the cells were positive, and as negative if none of the cells stained positive. Overexpression of maspin, VEGFC, and VEGFD was significantly associated with high tumor grade (P<.001, P=.004, P<.001, respectively), clinical stage (P=.002, .01, and .001, respectively), the presence of ascites (P<.001, P=.03, and P=.001, respectively), and the presence of metastatic lymph nodes (P=.002, P<.001, and P<.001, respectively). Maspin was correlated with VEGFA (P=.01), VEGFC (P<.001), and VEGFD (P<.001). The VEGFA score was positively correlated with high tumor grade (P=.04), lymphovascular space invasion (LVSI) (P<.001), International Federation of Gynecology and Obstetrics (FIGO) stage (P=.009), maspin, VEGFC (P=.003), and VEGFD (P=.003), but it was not correlated with the presence of ascites and metastatic lymph nodes. Maspin, VEGFC, and VEGFD are expressed in ovarian tumors with a poor prognostic parameters, and seem to play a role in ovarian cancer angiogenesis, progression, and lymph node metastases. Our results indicate that in contrast to most other carcinomas, maspin expression is directly associated with the biological aggressiveness of ovarian carcinoma. These results may offer new insights regarding the role of maspin in ovarian cancer and might also affect the diagnosis and treatment strategies.

Mucinous cystadenoma in a female patient with 45,X/46,XY karyotype

The mosaic karyotype of 45,X/46,XY has a wide phenotypic spectrum and there are substantial differences between prenatally and postnatally diagnosed cases. The phenotype varies between normal male to classical Turner syndrome. There is a high risk of gonadal tumor development in the dysgenetic gonads of patients with sex chromosome mosaicism. We report a case of a 24-year-old patient with a pelvic mass and amenorrhea referred to our laboratory for karyotyping. Peripheral blood chromosome analysis showed a mosaic karyotype of 45,X[17]/46,XY[83]. The tumor originated from the left ovary and the right ovary was found to be a streak gonad. The uterus was intact. Pathologic examination of the tumor revealed mucinous cystadenoma. Physical examination of the patient showed signs of Turner syndrome, as short stature (145 cm), short neck and asymmetric shoulders. Her mental state was normal. Y chromosome microdeletion screening involving SRY and ZFY genes was performed and no deletion was found. The patient was informed about the condition during the genetic counseling session.

Basosquamous carcinoma of the lacrimal sac: a case report

A 58-year-old woman, diagnosed with primary obstruction of the nasolacrimal system, underwent external dacryocystorhinostomy and silicone stent implantation. During surgery, an incisional biopsy was obtained from the posterior wall of the lacrimal sac. Pathological examination revealed basal cell carcinoma of the lacrimal sac. Two weeks later, the diseased sac and surrounding tissue were excised, using frozen sections to ensure adequate tumor-free margins. The lacrimal sac tumor was diagnosed as basal cell carcinoma with focal squamous differentiation. No tumor recurrence was detected in 1.5 years of follow-up. The authors recommend that lacrimal sac biopsy should be performed in patients with an enlarged lacrimal sac and nasolacrimal system obstruction.

Congenital intracranial teratoma with massive macrocephaly and skull rupture

OBJECTIVE

Congenital intracranial tumors are rare and only account for 0.5-1.5% of all pediatric brain tumors. Teratoma is the most frequently encountered intracranial tumor at birth. Massive congenital intracranial teratoma is an extremely rare neoplasm with a poor prognosis. They grow rapidly and cause extensive destruction in the brain. Herein we report a massive intracranial teratoma causing skull rupture.

CASE REPORT

A fetus with a congenital intracranial teratoma presenting with a disproportionately enlarged head at 25 weeks of gestation is presented. Since it was the first admission of the mother to a medical expert for a prenatal examination, there was noprevious follow-up data. Prenatal ultrasonography demonstrated a huge, heterogeneous intracranial mass, and midline structures and ventricles could not be observed. No heartbeat was detected. Autopsy was perforated, and histopathologic examination of the samples taken from the intracranial mass revealed an immature teratoma.

CONCLUSION

Although congenital intracranial teratomas are rare, they may reach enormous sizes. Regular follow-up of the fetus may lead to early diagnosis of immature intracranial teratomas and prevent the mother from having further complications either due to intrauterine fetal death orpsychological trauma of giving birth to a heavily malformed baby.

Periorbital necrobiosis lipoidica diabeticorum: case report

Necrobiosis lipoidica diabeticorum (NLD) is a relatively common manifestation of diabetes mellitus that is thought to be related to immune-complex vasculitis. The legs are the most common site for NLD, but other locations, such as the forearms or hands, have been reported. We describe a case of periorbital NLD that was diagnosed on the basis of histopathology.

Endolymphatic sac papillary tumor: a case report and review

Endolymphatic sac papillary tumor (endolymphatic sac adenoma, temporal-mastoid bone adenoma or adenocarcinoma, low-grade adenocarcinoma of potential endolymphatic sac origin, aggressive papillary tumor of the temporal bone, Heffner's tumor) is a rare lesion that involves the temporal bone. This tumor usually appears alone, but in 11-30% of afflicted individuals, it is accompanied by von Hippel-Lindau disease. Endolymphatic sac papillary tumors are destructive tumors that exhibit locally aggressive behavior. They slowly grow into the posteromedial section of petrous temporal bone. The main symptoms produced by these lesions include hearing loss and cranial nerve deficits. Endolymphatic sac papillary tumors develop in two principal patterns that histopathologically form follicular and papillary or solid structures. Those two patterns are usually manifested in the same tumor. Immunochemical analysis of these tumors usually reveals cytokeratin, vimentin, epithelial membrane antigen, and (less frequently) S-100 protein and neuron-specific enolase. Local excision is curative for endolymphatic sac papillary tumors. The currently favored method of treatment consists of excision and long-term follow-up. The role of adjuvant radiotherapy as treatment is controversial. This case report describes an endolymphatic sac tumor in a 22-year-old woman without von Hippel-Lindau disease who had a number of complaints, including deafness in her left ear, complete left-sided facial paralysis, and hoarseness of approximately 8 years' duration.

Histopathological changes in thyroid tissue after fine needle aspiration biopsy

Fine needle aspiration biopsy (FNAB) is a method that is frequently used in the diagnosis for neoplastic and non-neoplastic thyroid lesions. However, despite the contribution of this method to diagnosis, varying degrees of histopathological alterations in thyroid tissue occur due to the trauma caused by the aspiration needle. In this study, we compared the histopathology of the thyroidectomy specimens obtained by FNAB with the specimens obtained without the use of FNAB. A hundred and fifty thyroidectomy specimens obtained by FNAB were compared histopathologically with 150 thyroidectomy specimens (control group) obtained without a FNAB procedure. The thyroidectomy specimens were evaluated for hemorrhage, fibrosis, siderophagia, vascular thrombosis, vascular proliferation, infarction, granulation tissue, cystic degeneration, papillary hyperplasia, nuclear atypia, mitosis, calcification, vascular invasion, capsular distortion (pseudoinvasion), cholesterol clefts, and the presence of metaplasia. The thyroidectomy specimens obtained by FNAB had rates of hemorrhage, siderophagia, granulation tissue, papillary hyperplasia, fibrosis, calcification, capsular distortion, cholesterol clefts (P<0.001), and vascular thrombosis (P=0.001) that were statistically significantly higher than those obtained without FNAB. However, there were no clinically significant differences between the two groups in terms of vascular proliferation, nuclear atypia, mitosis, infarction, and oncocytic and squamous metaplasia. Alterations in thyroid tissue in association with FNAB show a considerable variation. Some of the alterations make diagnosis difficult, even leading to misdiagnosis in favor of carcinoma. Therefore, a thorough knowledge of possible alterations is essential to the differential diagnosis.

Association of ezrin expression in intestinal and diffuse gastric carcinoma with clinicopathological parameters and tumor type

AIM: To investigate the correlation between ezrin expression and types of gastric carcinoma and clinico-pathological variables.

METHODS: We examined ezrin protein expression in 75 gastric carcinoma (53 intestinal types of adenocarcinoma, 22 diffuse types of carcinoma) tissues by immunohistochemistry. The results were compared with clinicopathological parameters such as tumor type, grade of tumor, clinical stage, presence of metastatic lymph node, and depth of invasion.

RESULTS: Ezrin immunostaining was positive in 43 cases (81.1%) of intestinal type and in 9 (40.9%) cases of diffuse type adenocarcinomas (P < 0.001). In gastric carcinomas, the expression of ezrin protein correlated with the status of H pylori and survival. There was no correlation between expression of ezrin with TNM stage and histological grade of gastric carcinomas (P > 0.05).

CONCLUSION: The low expression of ezrin implicates the loss of adhesion in diffuse carcinomas. Furthermore, overexpression of ezrin in carcinomas with H pylori infection may be a genuine specific pathway in which H pylori may cause/initiate gastric carcinoma.

COX-2 and survivin are overexpressed and positively correlated in endometrial carcinoma

OBJECTIVES

To investigate the expressions of survivin and Cyclooxygenase-2 (COX-2), and their possible correlations in the development of endometrial adenocarcinoma (EC). We also looked at their association with classical prognostic factors in EC. To our knowledge, this is the first time survivin expression is investigated in terms of its relation to COX-2 in the developmental pathway of EC.

METHODS

Archived tissue samples of 50 EC, 30 endometrial hyperplasia and 20 proliferative endometrium were selected and immunohistochemically analyzed for survivin and COX-2 expression.

RESULTS

Both survivin and COX-2 were overexpressed in hyperplasia and endometrial adenocarcinoma cases compared to proliferative endometrium, which was statistically significant (p=0.01, p=0.02, respectively). Among EC cases, survivin and COX-2 were strongly positive in 38 (76%) and 30 (60%) patients, respectively. Furthermore, we found survivin and COX-2 to be positively correlated, which was also statistically significant (p=0.0001, r=0.46). Neither survivin nor COX-2 expression was correlated with classical prognostic factors of endometrial carcinoma such as myometrial invasion, grade or lymph node metastasis (p>0.05). Neither COX-2 nor survivin had an impact on overall survival (p>0.05).

CONCLUSIONS

Both survivin and COX-2 are overexpressed, and they seem to be early events in the occurrence of EC. Moreover, protein products of these two genes are positively correlated. COX-2 and survivin might share a common molecular pathway or enhance each other's actions in the developmental pathway of EC. Molecular basis of such a relationship should be further investigated in endometrial carcinogenesis.

Microvessel density, VEGF expression, and tumor-associated macrophages in breast tumors: correlations with prognostic parameters

Angiogenesis plays an important role in tumor growth, metastasis, and prognosis. Vascular endothelial growth factor (VEGF) is a potent endothelial mitogen and acts on the angiogenic stimulation of human neoplasias. In infiltrative ductal carcinoma (IDC), VEGF expression is correlated with high vascularity. Tumor-associated macrophages (TAMs) contribute to tumor proliferation, progression and angiogenesis and have a complex role in tumor biology. In this study, the correlations between microvessel density (MVD), VEGF expression, and TAMs and their relations to clinicopathological parameters such as tumor size, metastatic lymph node, mitotic activity index (MAI) and tumor grade were investigated in 48 cases of IDC and 30 infiltrative lobular carcinoma (ILC) cases. MVD showed a significant positive correlation with TAMs, VEGF, metastatic lymph nodes, tumor size and grade in IDC (P < 0.001). In ILC, MVD and tumor size were positively correlated (P = 0.003), while MVD was not correlated with VEGF, TAMs, MAI, metastatic lymph nodes, and grade. These findings are suggestive of angiogenesis stimulation in IDCs by VEGF, driving the macrophages into the tumor area. MVD and TAMs were found to be important prognostic factors in IDCs. On the other hand, however, VEGF did not contribute to angiogenesis in ILCs, and MVD and TAMs did not have any prognostic significance. These results suggest the involvement of factors not related to VEGF in the angiogenesis of lobular carcinoma.

Lobular carcinoma of the breast metastatic to the uterus in a patient under adjuvant anastrozole therapy

This is the first report of breast carcinoma metastatic to the endometrium in a patient on adjuvant anastrozole therapy. We report a case of metastatic lobular carcinoma of the breast in a 63-year-old patient on adjuvant anastrozole therapy for 8 months. She was asymptomatic and metastatic endometrium was diagnosed after transvaginal ultrasound revealed suspicious findings along with elevated Ca 15-3 levels. As further work up showed no other metastatic sites her uterus was taken out along with her ovaries and pelvic lymph nodes. Uterine metastases should be kept in mind in asymptomatic patients on anastrozole therapy.

Wegener's granulomatosis with a possible thyroidal involvement

Wegener's granulomatosis (WG) is an autoimmune disorder characterized by the involvement of many organ systems. In patients with refractory disease, the efficacy of cyclophosphamide, corticosteroids and infliximab has been reported recently. Even in cases with serological response, disease progression has still been observed. Herein, we report a case of WG, most likely accompanied with subacute granulomatous thyroiditis while the patient was on cyclophosphamide, corticosteroid and infliximab therapy. As far as we know, this is the first time that such a copresentation has been observed, suggesting that mechanisms other than T-cell-mediated cytotoxicity may be important in the pathogenesis of granulomatous thyroiditis.

Expression of cyclin H in normal and cancerous endometrium, its correlation with other cyclins, and association with clinicopathologic parameters

Cyclins are known as regulatory proteins in cell cycle. Cyclin H is a part of cyclin H/Cdk7/Mat1 complex, which is necessary for cellular proliferation. This study was designed to investigate the correlation of cyclin H expression with tumorigenesis of the endometrium and clinicopathologic variables. Immunohistochemical staining using labeled streptavidin-biotin complex was performed on formalin-fixed, paraffin-embedded endometrial tissues of the proliferative, hyperplastic, and carcinomatous types. Immunostaining for cyclins A, B1, D1, D3, E, H, and cyclin dependent kinase 2 were evaluated. The expression of cyclins A, D1, D3, and H in hyperplasia was significantly more frequent than those of proliferative phase and less than those of endometrioid adenocarcinoma. The expression of cyclin H was correlated with lymphvascular space invasion and clinical stage in carcinoma but not with myometrial invasion, lymph node metastasis, and menopause status. The expression of cyclin H could be involved in the transformation of the endometrium into malignancy and might be a marker for more proliferative and malignant features. It might be one of the biomarkers for determining proliferative activity in endometrial hyperplasia and endometrioid adenocarcinoma.

Expression of survivin, PTEN and p27 in normal, hyperplastic, and carcinomatous endometrium

We aimed to investigate if expressions of survivin and p27 proteins are involved in the development of endometrioid carcinoma, along with whether there are any correlations between these proteins and loss of wild-type PTEN that is found in up to 80% of endometrial carcinomas. We also studied their correlations with classical prognostic factors and survival in endometrial carcinoma. To our knowledge, this is the first time survivin expression is investigated in endometrial hyperplasia along with endometrioid adenocarcinoma. For immunohistochemical analysis, 29 endometrioid adenocarcinoma, 38 endometrial hyperplasia, and 10 proliferative endometrium tissue samples were selected in the pathology archives. Staining of cells was scored as +2 if >50%, +1 if <50%, and negative if none were stained positive. Survivin expression increased from proliferative to hyperplasia to carcinoma cases. PTEN and p27 expressions decreased in hyperplasia and carcinoma cases with respect to proliferative endometrium. All these differences were statistically significant (P < 0.05). PTEN positively correlated to p27 (P < 0.05); however, neither was correlated with survivin. None of these genes were correlated with classical prognostic factors such as grade and myometrial invasion in endometrioid adenocarcinoma. However, mean survival was statistically significantly higher in PTEN-positive cases (46.6 vs 16.4 months) (P < 0.05). Survivin overexpression might be one of the important mechanisms in the development of endometrioid adenocarcinoma along with lost or decreased activity of PTEN and p27. However, survivin seems to exert its role in ways different from those of PTEN or p27 in the development of endometrioid adenocarcinoma. These findings on the role of survivin in endometrioid adenocarcinoma should be confirmed and the pathways through which survivin acts in endometrioid adenocarcinoma studied further with a larger sample size.

Expression of survivin, PTEN and p27 in normal, hyperplastic, and carcinomatous endometrium

We aimed to investigate if expressions of survivin and p27 proteins are involved in the development of endometrioid carcinoma, along with whether there are any correlations between these proteins and loss of wild-type PTEN that is found in up to 80% of endometrial carcinomas. We also studied their correlations with classical prognostic factors and survival in endometrial carcinoma. To our knowledge, this is the first time survivin expression is investigated in endometrial hyperplasia along with endometrioid adenocarcinoma. For immunohistochemical analysis, 29 endometrioid adenocarcinoma, 38 endometrial hyperplasia, and 10 proliferative endometrium tissue samples were selected in the pathology archives. Staining of cells was scored as +2 if >50%, +1 if <50%, and negative if none were stained positive. Survivin expression increased from proliferative to hyperplasia to carcinoma cases. PTEN and p27 expressions decreased in hyperplasia and carcinoma cases with respect to proliferative endometrium. All these differences were statistically significant (P < 0.05). PTEN positively correlated to p27 (P < 0.05); however, neither was correlated with survivin. None of these genes were correlated with classical prognostic factors such as grade and myometrial invasion in endometrioid adenocarcinoma. However, mean survival was statistically significantly higher in PTEN-positive cases (46.6 vs 16.4 months) (P < 0.05). Survivin overexpression might be one of the important mechanisms in the development of endometrioid adenocarcinoma along with lost or decreased activity of PTEN and p27. However, survivin seems to exert its role in ways different from those of PTEN or p27 in the development of endometrioid adenocarcinoma. These findings on the role of survivin in endometrioid adenocarcinoma should be confirmed and the pathways through which survivin acts in endometrioid adenocarcinoma studied further with a larger sample size.

Primary Amyloidoma of the Thoracic Spine

Amyloidoma is a nodular mass of amyloid with no evidence of generalized amyloidosis. Primary amyloidoma of the spine is very rare and has a predilection for the thoracic region. The tumor-like appearance and behavior make it difficult to diagnose on imaging studies. Despite its rarity and nonspecific radiologic findings, primary spinal amyloidoma should be included in the differential diagnosis of an osteolytic and calcified mass of the spine. We report the case of a 38-year-old woman with amyloidoma involving the thoracic spine and describe the main characteristics of this condition.

Gastrointestinal stromal tumors presenting as pelvic masses: report of two cases

We present two cases of gastrointestinal stromal tumors (GISTs) that presented as pelvic masses. These tumors can present diagnostic problems and they may be difficult to discover preoperatively. GISTs are neoplasms that can be diagnosed utilizing immunohistochemistry, especially detecting CD117 (c-kit) reactivity along with associated histological features. GISTs, should be considered in the differential diagnosis of ovarian tumors especially when imaging studies and rectovaginal examination findings are inconclusive and vague. Histologic diagnosis of these tumors are important considering the efficacy of tyrosine kinase inhibitor therapy after surgery in such cases.

Multiple myeloma of the thoracic spine developed at the previous trauma site: case report

The precise nature of the underlying plasma cell dyscrasias is not well understood. Even today, no causative factor has been found for this disease. It has been suggested that, several factors may act together in the development of this disease. This is a report of a 62-year-old man who initially had a T7 compression fracture and developed a multiple myeloma two years later at that site and at the adjacent vertebral level (T7-T8), respectively. Although the notion that trauma would initiate such a malignancy is speculative, the preceding trauma may be a causative factor in plasma cell dyscrasias.

Case report: solid-pseudopapillary tumour of the pancreas associated with dorsal agenesis

Solid-pseudopapillary tumour of the pancreas is a rare benign or low-grade malignant epithelial tumour; its association with pancreatic dorsal agenesis has been reported only once before. We present the radiological and histological findings of a case of pancreatic solid-pseudopapillary tumour associated with total pancreatic dorsal agenesis. A 49-year-old woman presented with abdominal pain radiating to the back for several months. Radiological findings showed absence of the dorsal pancreas and an 8 cm x 6 cm diameter tumour arising from the head of the pancreas. She underwent successful complete resection of the tumour. Histopathology revealed a diagnosis of solid-pseudopapillary tumour.

Malignant struma ovarii: A case report

Malignant struma ovarii is a rare form of the ovarian germ cell tumors. Hence, diagnosis and management of malignant struma ovarii have not been clearly defined. We present the case of a 34-year-old woman with papillary carcinoma arising in struma ovarii. The malignant component of this tumor was detected after laparoscopic removal, and a re-staging operation was performed afterwards. There was no evidence of clinical malignancy or metastases. In this paper, clinical features, treatment guidelines, diagnostic features, and immunohistochemical characteristics of this tumor are reviewed.

Acute renal failure due to mesangial proliferative glomerulonephritis in a pregnant woman with primary Sjögren's syndrome

The most common form of renal involvement in Sjögren's syndrome (SS) is tubulointerstitial nephritis. Renal dysfunction is usually mild and subclinical. Glomerulonephritis (GMN) is rare in patients with SS. We report a 28-year-old multigravida patient with primary Sjögren's syndrome (pSS) and associated manifestations, who presented with acute renal failure in the 20th week of her fifth pregnancy. The complaints and clinical findings, positive Schirmer's test, findings of dry eye on ophthalmologic examination, and the salivary gland biopsy were compatible with SS. The patient exhibited no other clinical or laboratory findings indicative of other collagenous disease and/or rheumatoid arthritis. She refused renal biopsy, hesitating for fear of fetal loss; thus, based on the clinical and laboratory findings indicating rapidly progressive GMN and vasculitis, prednisolone, plasmapheresis, and one dose of cyclophosphamide were administered during the pregnancy. Hemodialysis five times weekly was performed. At the 28th week of gestation, she underwent a cesarean section due to early rupture of membranes and fetal distress. A healthy male boy was delivered. The renal biopsy performed 2 weeks after labor revealed mesangial proliferative glomerulonephritis. After the fourth cyclophosphamide treatment, her urinary output increased and she was discharged from the hemodialysis program. She remains in follow-up at our outpatient clinic free of hemodialysis for 4 months. This is the first report of mesangial proliferative GMN requiring dialysis in a pregnant pSS patient that has featured good maternal and fetal outcomes.

Epithelial cyst of the soft palate

Epithelial cysts are benign epithelium-lined lesions that contain fluid or semisolid material. This type of cyst is rare in the oral cavity. Most epithelial cysts in this location are situated in the anterior floor of the mouth; the soft palate is seldom affected. Oral examination in a 6-year-old boy revealed a cyst in the soft palate. The lesion was excised under general anesthesia, and histopathological examination identified it as an epithelial cyst. The report discusses this rare location for an epithelial cyst and reviews the pertinent literature.

Primary hepatic carcinoid tumor: dynamic CT findings

Most carcinoid tumors involve the gastrointestinal tract or respiratory system. Primary hepatic carcinoid tumor is a rare entity. A 46-year-old woman presented with abdominal pain, vomiting, and diarrhea. She was diagnosed with primary hepatic carcinoid tumor based on radiologic and laboratory findings, namely a mass in the fifth segment of the liver and markedly elevated levels of 5-hydroxyindole acetic acid in the urine. Histologic and immunohistochemical findings of the resected liver segment showed a malignant carcinoid tumor of the liver. This case is of interest because of the rarity of this neoplasm. This report describes the case and reviews the clinical features, radiologic findings, and treatment in previously reported cases.

Familial cystic nephroma in two siblings with pleuropulmonary blastoma

Cystic nephroma (CN) and pleuropulmonary blastoma (PPB) are rare tumors. In the cases presented here, a 13-month-old boy underwent right radical nephrectomy for CN. From the family history we learned that four years ago the patient's older sister underwent left radical nephrectomy for CN at a different center when she was 4 years old. A lung tumor was detected in the sister one year after nephrectomy. Biopsy from the lung tumor revealed PPB, and the sister died within one year after biopsy. To the knowledge of the authors, these cases represent the second reported familial occurrence of CN and the fourth of CN and PPB.

Fine needle aspiration cytology of ovarian lesions

OBJECTIVE

To assess the diagnostic value of fine needle aspiration cytology (FNAC) in ovarian lesions.

STUDY DESIGN

Sixty-two fine needle aspirations of varied ovarian masses were performed between January 2000 and February 2003. Aspiration material was obtained from fresh tissues at the time of frozen section before dissection of the specimens. The slides were evaluated by a pathologist who was blinded to the gross findings and histopathologic diagnosis.

RESULTS

A total of 62.9% of cases were assessed as malignant and 30.6% as benign. Two false positive and 2 false negative cases occurred. In our series the overall sensitivity and specificity were 95.1% and 90.4%, respectively. Seven benign and 15 malignant lesions could be subclassified specifically.

CONCLUSION

We studied excised specimens, but since ovarian masses are reachable by laparoscopically and ultrasonographically guided aspiration, FNAC can be used for diagnoses of these lesions. If a multidisciplinary approach can be carried out in patients with ovarian lesions, cytopathologic interpretation can provide optimum benefits.