A Single-Center Retrospective Analysis of Kaposi's Sarcoma: Is There a Relationship Between Emmprin/CD147 Expression and Biological Behavior?

OBJECTIVES

Emmprin (CD147/BSG) protein is estimated to play a key role in cell migration and chemoresistance in viral carcinogenesis. However, there are very limited studies investigating the CD147 in the oncogenesis of Kaposi's sarcoma-associated herpesvirus. This study aims to reveal the relationship between CD147 expression with histopathological parameters, disease pattern, and recurrence in Kaposi's sarcoma (KS).

METHODS

The study included 67 patients diagnosed with KS between January 1982 and September 2023. Clinical and histopathological features were analyzed retrospectively. HHV-8, CD31, and CD147 expressions were evaluated by immunohistochemistry.

RESULTS

Sixteen (24%) female and 51 (76%) male patients with median age of 64 (10-86) were included in the study. CD147 was positive in 57 (85%) cases and associated with nodular pattern (P = .001), presence of solid/fibrosarcomatous area (P = .005), and high mitotic activity (P = .035). The disease relapsed in 17 (27%) of the 63 patients with median 2 (0-12) years follow-up. While a 5-year relapse-free survival was 48.5% in the CD147 diffuse positive group, it was 83.4% in focal positive and 100% in negative cases (P = .029).

CONCLUSION

Our study exhibited the relationship between CD147 overexpression and recurrence in KS, but the inhomogeneity of the treatment groups and the small number of patients should also be considered. These findings may provide insight into the pathogenesis of KS and the development of targeted therapies in the future.

Epstein-Barr Virus-Positive Leiomyosarcoma in Immunocompetent Patients

OBJECTIVE

Epstein-Barr Virus-Associated Smooth Muscle Tumor (EBV-SMT) is a rare tumor with a higher rate of occurrence in unusual locations in the setting of immunodeficiency. In this study, we evaluated a cohort of ordinary leiomyosarcomas (LMS) for the presence of EBV and described the clinicopathological features deviating from routinely diagnosed cases of EBV-SMT.

MATERIAL AND METHOD

The sections of tissue microarrays including 93 classical LMS occurring in various locations were hybridized with EBER and stained for LMP1 antibody using the Leica Bond Autostainer. EBV real-time PCR assay was performed in 2 EBER-positive cases.

RESULTS

Among the 93 LMS cases, 2 non-uterine cases (2.2%) were positive for EBER and negative for LMP1, and were referred to as `EBV-positive LMS`. Both were females in their 6th decade without immunosuppression. EBV real-time PCR assay revealed the presence of EBV in one of the cases. Tumors were located in the pancreas and chest wall. Morphologically, tumors were rather myxoid, multinodular, and composed of long fascicles of spindle cells with intermediate- to high-grade features. High mitotic activity and focal necrosis were present, whereas no accompanying lymphocytes were detected. One of the patients developed metastatic disease after 3 years.

CONCLUSION

EBV-positive LMS occurring in immunocompetent patients has features distinct from classical EBV-SMT seen in immunosuppressed patients.

Adamantinoma with a Prominent Spindle Cell Component Mimicking Intraosseous Synovial Sarcoma: Clinicopathological Features of Six Tumors

Introduction. Adamantinoma is sub-classified into classic/biphasic, osteofibrous dysplasia-like, and de-differentiated type. We present six adamantinomas with a prominent spindle cell component mimicking intraosseous synovial sarcomas. Methods. Six patients were either referred with a diagnosis of intraosseous synovial sarcoma or wherein synovial sarcoma was a differential diagnosis. Three tumors were tested for SS18 gene rearrangement by FISH and two for SS18::SSX fusion by RT-PCR technique. Results. There were three males and three females with an average age of 20.6 years. Radiologically, the lesions were expansile and showed lytic and/or sclerotic components, involving the cortex and/or medulla. Five lesions occurred in the tibia and two in the fibula. Two tumors displayed soft tissue extension and two occurred as multifocal lesions. Two patients were diagnosed with synovial sarcoma and a single patient with sarcomatoid carcinoma, elsewhere. Two "in-house" patients were initially diagnosed with synovial sarcomas. On review, all tumors were cellular comprising monomorphic spindle-shaped cells arranged in sheets and fascicles (n = 6), including a "herringbone-like" pattern (n = 3), focal tubules (n = 1), cohesive nests (n = 5), cords (n = 2), including pseudocystic component (n = 2). Immunohistochemically, tumor cells were positive for p63 (6/6), p40 (4/4), EMA (2/3), AE1/AE3 (5/6), various keratins (2/2), and TLE1 (2/4). Three tumors tested for SS18 rearrangement were negative, while two tumors tested for SS18::SSX fusion were negative. Conclusions. Adamantinomas with spindle cell morphology display overlapping features with synovial sarcoma. A clinico-radiological index of suspicion immunostains (p63 and p40) and molecular test for t(X; 18) translocation are useful in an exact diagnosis, which has treatment-related implications.

Comprehensive clinicopathologic characteristics of intraabdominal neurogenic tumors: Single institution experience

BACKGROUND

Neurogenic tumors are rare but represent an important consideration in the differential diagnosis of abdominal mesenchymal tumors. Reports on their incidence, pathological features and clinical characteristics are scarce.

AIM

To advance the overall knowledge on the histologic, immunohistochemical, clinical and radiologic characteristics of neurogenic tumors through this case series.

METHODS

An established database of a nationwide tertiary referral center, covering a 15-year period (2005 and 2020), was retrospectively re-evaluated. Diagnoses of neurogenic tumor cases were confirmed by two experts following review of the macroscopic, histological and immunohistochemical records along with findings from analysis of archived tissue sections for each included patient. Tissue microarrays were constructed for cases lacking necessary immunohistochemical studies. Clinical data and follow-up information were collected from the hospital records and the patients themselves, when available.

RESULTS

The study included 19 cases of intraabdominal neurogenic tumors, representing 12 women and 7 men, between 18 and 86 years of age (median: 51 years). Final confirmed diagnoses were 12 schwannomas, 2 diffuse submucosal neuro-fibromatoses, 2 ganglioneuromas, 2 malignant peripheral sheath nerve tumors, and 1 mucosal Schwann cell hamartoma. Sizes of the tumors were variable, with a median diameter of 4 cm; the two largest (> 10 cm) were schwannomas. The majority of cases were asymptomatic at presentation, but the most frequent symptom was abdominal pain. Gastrointestinal tract lesions were detected with endoscopy and extra-luminal lesions were detected with cross-sectional imaging. All cases were S100-positive and CD117-negative; most cases were negative for desmin, epithelial membrane antigen, smooth muscle actin and CD34. In all but 5 cases, the Ki67 proliferation index was ≤ 1%.

CONCLUSION

Re-evaluation of 19 cases of abdominal neurogenic tumors demonstrated con-siderable variability in clinicopathologic characteristics depending on location, dimension and histological features.

Stereotactic ablative radiotherapy for bone metastasis of gastrointestinal stromal tumor: Case report and review of the literature

Background

Gastrointestinal stromal tumors (GISTs) are the most common mesenchymal tumors of the gastrointestinal tract. These tumors are rare and only make bone metastases at a rate of 5%.

Case summary

A 31-year-old male with a GIST presented with solitary bone metastasis at the right iliac bone. We performed stereotactic ablative radiotherapy (SABR) and achieved excellent local control. Herein, our case is presented, and a short review of the literature is carried out.

Conclusion

SABR should be considered as a treatment option in GIST with bone metastasis.

Primary diffuse pleural rhabdomyosarcoma in an adult patient

Rhabdomyosarcoma is an aggressive malignant tumor of childhood, originating from immature cells that are destinated to form striated skeletal muscle. It usually arises in the head and neck or the extremities. Primary diffuse pleural rhabdomyosarcoma is exceptionally rare. Herein we report a case of primary diffuse pleural rhabdomyosarcoma in a 48-year-old man. The diagnosis was confirmed by percutaneous pleural biopsy. Chemotherapy (cisplatin, ifosfamide, adriamycin, vincristine) was initiated due to the large volume of the tumor. After 3 months, computed tomography of the thorax showed stable radiological findings.

Intralesional curettage and cementation for low-grade chondrosarcoma of long bones: retrospective study and literature review

Background

Various treatment strategies for low-grade chondrosarcomas with variable outcomes have been reported in the literature. The aim of this study was to assess the oncological and functional outcomes associated with intralesional curettage followed by adjuvant therapy comprising high-speed burring, thermal cauterization, and bone cementation with polymethylmethacrylate.

Methods

We performed a retrospective review of 21 consecutive patients with intramedullary low-grade chondrosarcoma of long bones treated by intralesional curettage and adjuvant therapy comprising high-speed burring, thermal cauterization, and cementation at our institution from 2007 to 2012.

Results

The average age of the patients was 48.7 (range, 18–71) years. There were 7 male and 14 female patients. The mean follow-up period was 58.4 (range, 26–85) months after surgery. The treated lesions were located in the proximal humerus (n =10), proximal tibia (n =6), and distal femur (n =5). At the average follow-up time point of 58.4 (range, 26–85) months, no patient had developed local recurrence and no distant metastases were observed. The average Musculoskeletal Tumor Society score among all 21 patients was 95% (84–100).

Conclusions

The combination of intralesional curettage, application of high-speed burring, thermal cauterization, and cementation is an effective treatment strategy for low-grade intramedullary chondrosarcoma of long bones. Excellent oncological and functional results can be obtained.

Giant cell tumour of humerus: an unexpected lesion in a skeletally immature patient with Hodgkin's disease

Giant cell tumour (GCT) of bone is a benign aggressive tumour of the bone. It typically presents in persons aged 20 - 40 years. It is rare in adolescents and children. In most cases, GCT of bone occurs in the metaphyseal and epiphyseal regions of long bones. However, in children with open physes, GCT of bone may be centered in the metaphysis and may abut the physis. GCT is most commonly found in the distal femur, proximal tibia, and distal radius. It is not reported after treatment of a cancer in childhood. To the best of authors' knowledge, the coexistence of giant cell tumour of the bone and Hodgkin disease has not been reported in the literature. We report an atypical case of giant cell tumour of humerus in a skeletally immature child treated for Hodgkin's disease (HD), which had initially presented as a bone cyst radiologically.

Cutoff level to detect heterozygous alpha 1 antitrypsin deficiency in Turkish population

BACKGROUND

Alpha 1 antitrypsin (AT) deficiency is a hereditary disorder leading to the defective defence system against neutrophil elastasis in lung and accumulation of insoluble heterodimer AT molecules in hepatocytes. Knowledge of the prevalence of AT deficiency in each country is important to organize the public health policy. The aim of this study is to determine the prevalence of AT deficiency in Turkish population and to define the cutoff value of AT level in serum to detect heterozygous AT deficient subjects.

MATERIALS AND METHODS

Serum samples from 1,203 healthy blood donors were used, attending the Blood Bank of Hacettepe Medical Faculty. Isoelectric focusing method for determining PIM, PIS, and PIZ alleles and rate immune nephelometry for measuring the level of AT in serum were used.

RESULTS

Out of 1,203 healthy blood donors enrolled, 1,164 (%96.8) had normal variant PI MM allelee, 9 (%0.7) PI MZ, 7 (%0.6) PI MS, 6 (%0.5) MF, and 17 (%1.4) PI M? (unidentified variants with existing standards). Most individuals (89.6%) with low AT level (cutoff <100 mg/dl) in serum were positive for PI MM allele. The cutoff value to investigate PI MZ was 100.5 mg/dl, which had PPV and NPV of 5.0 and 99.9%, respectively. AT deficiency is a rare hereditary disorder in asymptomatic healthy Turkish blood donors. Although the cutoff value of 100.5 mg/dl for AT level in serum was able to detect heterozygous AT deficiency in the healthy population, this finding should be conformed to case-control studies.

The frequency of HLA class I and II alleles in Turkish childhood acute leukaemia patients

In this study, blood samples were taken from 200 patients with childhood acute leukaemias, including acute lymphoblastic leukaemia (ALL) and acute myeloid leukaemia (AML), and from 100 healthy volunteers (controls). The frequency of the human leucocyte antigen (HLA)-DRB1*04 allele was significantly higher, and the frequencies of the HLA-A23 and HLA-B7 antigens were significantly lower, in patients with ALL compared with controls. Among patients with AML, the frequency of the HLA-B49 antigen and the HLA-DRB1*15 allele were significantly higher, whereas the frequencies of the HLA-A11 and HLA-B38 antigens were significantly lower compared with controls. The frequency of the HLA-DRB1*04 allele was also significantly higher in male patients with ALL and AML, whereas the HLA-DRB1*13 allele was found significantly less frequently in male AML and female ALL patients than in controls. To date, this is the only study to evaluate the associations between HLA molecules and leukaemia in a Turkish population with acute childhood leukaemia.

Primary intracranial myxoma of the lateral skull base: a rare entity in clinical practice

Myxomas are rare benign tumors arising from mesenchymal tissues throughout the body. These tumors are usually seen in the atrium of the heart and the jawbone. Involvement of the skull base with intracranial extension is extremely rare, and only a few cases of primary intracranial myxomas have been described in the literature. A rare case of primary myxoma of the temporal bone is presented in this article. The patient underwent a skull base surgery with a pre-diagnosis of possible chondrosarcoma. The tumor pathology revealed a diagnosis of myxoma with bone and meningeal involvement. Despite the radical surgery, the tumor showed a local recurrence in three years. A second surgery with subtotal petrosectomy was required. In the article, the etiology, histological and radiological findings as well as treatment options of this rare entity were briefly discussed under the highlights of the relevant literature. Such a localization and intracranial extension of myxomas is extremely unusual in clinical practice; the diagnosis therefore requires a high degree of suspicion and detailed histopathological examination. The differential diagnosis frequently includes chondrosarcomas, chordoma, metastatic tumors of the skull, hemangiopericytoma, meningioma and other neoplasms of the dura and skull base in this location.

Antiangiogenic response after 70% hepatectomy and its relationship with hepatic regeneration and angiogenesis in rats

BACKGROUND

The aim of this study was to evaluate the antiangiogenic response and its relation to regeneration and angiogenesis after 70% hepatectomy in a rat model.

METHODS

Sixty-four Wistar albino rats were included in the study. Animals were allocated into 8 groups (n = 8). After a 70% hepatectomy, liver regeneration, angiogenesis, and antiangiogenic response were evaluated in the remnant liver on days 0, 1, 2, 3, 5, 7, 10, and 14. Regeneration and angiogenesis were determined with immunoreactivity to proliferating cell nuclear antigen and vascular endothelial growth factor. Antiangiogenic response was evaluated by detecting collagen 18 m RNA with reverse transcriptase polymerase chain reaction.

RESULTS

We showed that liver regeneration peaked at day 1, whereas angiogenesis in the periportal and perisinusoidal areas reached their peak values on days 3 and 7, respectively. Both regeneration and angiogenic activity around perisinusoidal hepatocytes returned to basal activity on the day 10. Antiangiogenic response first appeared on day 5, reached a peak on day 10, and returned to basal values on day 14.

CONCLUSION

Collagen18 mRNA expression is present in the normal liver during the regenerative process. We suggest that the stimulus that causes the cessation of regeneration process may come from hepatocytes, and collagen 18 produced by hepatocytes may modulate this event by inhibiting the angiogenesis.

Effects of vascular bundle implantation on autograft, fresh-frozen allograft, and xenograft incorporation in a rabbit model

This study examined the effects of vascular bundle implantation into a bone graft. Vascularized and nonvascularized autografts, allografts, and xenografts were placed inside defects in the proximal tibia in rabbits. Evaluation using radiographs, magnetic resonance imaging, bone scintigraphy, and microscopy showed autografts fused more rapidly than allografts and xenografts, and the majority of the vascularized grafts were incorporated completely. Autografts emerged as the gold standard. These findings indicate vessel implantation enhances and accelerates vascularization, new bone formation, and incorporation in autografts, allografts, and xenografts.

Differentiation-inducing liposoluble vitamin deficiency may explain frequent secondary solid tumors after hematopoietic stem cell transplantation: minireview

Secondary cancers are among the most threatening long-term health problems of hematopoetic stem cell- transplant (HSCT) patients. There are several lines of evidence indicating the possibility of a prolonged Vitamin A deficiency for solid tumor-type secondary cancers: I- Solid tumors such as oral cavity, head/neck region squamous carcinomas, skin cancers and melanomas, where lowered Vitamin A concentrations and chemo-preventing activity of its derivatives (retinoids) are most explicitly proven, arise much more frequently than others. II- Early monitorings: A significant retinol deficiency in HSCT patients is detectable along with a severity of mucositis and the vulnerability to infection. III- Monitoring of other liposoluble vitamins: Vitamin D, a differentiation-inducing vitamin like Vitamin A, showed a sustained decrease. Another similarity of these two vitamins is that they also depend on intestinal absorption and are decreased due to bowel injury by conditioning agents and chronic graft-versus-host disease. IV- Peroxidative reactions and inflammation can directly exhaust retinol levels despite sufficient intake. Considering the similar inhibitory role of Vitamin D analogs (deltanoids) on squamous carcinomas, skin tumors and melanomas, we propose that animal studies and extended vitamin surveillance studies in HSCT patients may unfold a preventive strategy against long-term complications.

FISH detection of chimerism in pediatric hematopoietic stem cell transplantation

Allogeneic hematopoietic stem cell transplantation (HSCT) is a well-established curative therapy for various malignant and non-malignant diseases. Successful outcome after allogeneic HSCT has been associated with donor chimerism (DC). However, the detection of residual host cells or mixed hemopoietic chimerism (MC) has indicated that donor chimerism is not obligatory following HSCT. More recently, fluorescence in situ hybridization (FISH) analysis has been applied to engraftment studies for the identification of polymorphic or sex chromosomes. In this study, chimerism status was evaluated in 48 sex-mismatched HSCT pediatric patients (17 women/31 men, mean age: 9.02 +/- 3.95 years, range: 2-19) by FISH and the effect of DC or MC on outcome and long-term disease-free survival was documented. The stem cell source was bone marrow in all cases. All of the donors were human leucocyte antigen-identical siblings. FISH was performed on 156 specimens between days +13 and +1878. Donor chimerism was found in 47.9% (23/48) and MC was found in 52.1% (25/48) of the patients. Fifteen of 48 (31.25%) patients died, of whom 12 (80%) were MC and three patients (20%) were DC. The difference in chimerism status (MC or DC) was statistically significant between those patients who died and those still alive (chi(2) = 6.813; P = 0.009).

The etiologic distribution of thrombophilic factors in chronic portal vein thrombosis

GOALS

We aimed to prospectively investigate the full etiologic contributors to portal vein thrombosis.

BACKGROUND

Portal vein thrombosis in the absence of liver disease is a rare cause of portal hypertension with a different clinical course and management strategy. The etiologic distribution of this interesting clinical picture is important as far as diagnostic and management issues are concerned.

STUDY

After the application of exclusion criteria, 59 patients were included in the study who had normal liver functions, normal liver histology and studied the thrombophilia factors of both acquired factors and congenital factors like protein C, protein S, antithrombin levels with the mutations.

RESULTS

In all, 23.7% of the patients were found to have acquired thrombophilia factors like myeloproliferative disorders and cyst hydatid disease, whereas 22.1% of the patient population was found to harbor no identifiable cause of thrombophilia, which we termed as idiopathic. One or more causes of thrombophilia were identified in 46 patients. There were 27 patients with protein C deficiency, 18 patients with protein S deficiency. The antithrombin deficiency was found in 17 patients. The factor V Leiden mutation was found in 7 patients. There was 1 patient with homozygote mutation, whereas the remaining 6 patients were heterozygotes. There were 3 patients with prothrombin mutation who were heterozygote for this mutation.

CONCLUSIONS

Complete investigation of thrombophilia is crucial to delineate the outline of thrombophilic risk factors to estimate the rethrombosis risk and for further management concerns.

An unusual tumor of the neck and mediastinum: lipoblastomatosis resulting in paraparesis

Lipoblastomatous tumors are quite rare neoplasms deriving from embryonic white fatty tissues, most often seen in infancy and childhood. Lipoblastoma is the focal and well-circumscribed type, whereas lipoblastomatosis is the more infiltrating type of lipoblastomatous tumors. We present a 14-month-old male infant presenting with a mediastinal mass showing paraparesis, who had previously undergone the removal of the cervical part of this mediastinal mass. We removed the mediastinal part of the mass with a posterolateral thoracotomy which proved to be a lipoblastomatosis. We emphasize that this very uncommon tumor located at the neck and mediastinum should be included in the differential diagnosis of infants having gait disturbance.

The effect of temporary hemiepiphyseal stapling on the growth plate: a radiologic and immunohistochemical study in rabbits

The purpose of this study was to investigate the effect of temporary hemiepiphyseal stapling on the bone geometry and proliferative activity of the physis in immature rabbits. Proximal medial epiphyseal stapling of the right tibia was performed in 46 6-week-old New Zealand white rabbits. The rabbits were assigned randomly into two groups. In group 1, the staples were inserted extraperiosteally and the rabbits were killed at the end of 3 weeks. In group 2, the staples were fixed subperiosteally (group IIA) or extraperiosteally (group IIB), the staples were removed at the end of 3 weeks, and the rabbits were killed at the end of 6 weeks. The articular line-diaphysis angle (ALDA) was significantly increased with 3 weeks of stapling. After the removal of staples, while ALDA continued to worsen in group IIA, it improved in group IIB. Bone was observed to bridge the physis in group IIA. However, the proliferative activity of the physis continued. Temporary hemiepiphyseal stapling is a safe and effective method for control of physeal growth of long bones before skeletal maturity. However, it is of paramount importance not to disturb the periosteum during stapling.

Anterior Abdominal Wall Synovial Sarcoma

Synovial sarcoma usually arises in the extremities and in close proximity to large joints. Primary synovial sarcoma of the anterior abdominal wall is rare. A 17-year-old girl was admitted to the hospital with a palpable abdominal mass, and there was a 9.5 cm x 7.5 cm x 6-cm lobulated, cystic, and semisolid lesion of in the external oblique abdominal muscle shown on the abdominal magnetic resonance image. She was then operated and pathology was consistent with synovial sarcoma. The presence of synovial sarcoma in extraarticular sites such as the abdominal wall argues against an origin from arthrogenous mesenchyme.

Vascular malformation in the infrapatellar (Hoffa's) fat pad

A 16-year-old girl presented with pain and swelling of her right knee for 2 years. Magnetic resonance imaging disclosed a mass in the infrapatellar fat pad. Arthroscopic removal of the lesion led to a histopathologic diagnosis of vascular malformation, which has not been reported exclusively in this location.

Bilateral multiple pulmonary tuberculous nodules mimicking metastatic disease

We present CT findings of a young woman who has bilateral pulmonary nodules mimicking metastases. Clinical presentation with active multiple pulmonary macronodules without cavitation responsive to treatment is an atypical manifestation of pulmonary tuberculosis. We reviewed the causes of multiple pulmonary nodules, role of radiological findings in differential diagnosis and parenchymal manifestations of pulmonary tuberculosis in this report.

Spleen damage in endotoxaemic mice: the involvement of nitric oxide

The association between Escherichia coli endotoxin-induced organ damage and nitric oxide-related mechanisms was investigated in the spleen of male Swiss albino mice (20-40 g) by using (1) Pt/Ir electrochemical sensor connected to an amperometric detection system (NO-501, InterMedical Co., Japan), (2) nitrotyrosine immunohistochemistry, (3) conventional light microscopy and (4) immunoblotting techniques in parallel. 1 h before endotoxin injection, animals were pretreated with either nitric oxide synthase inhibitor, L-N(G)-nitroarginine methyl ester (L-NAME, 20 mg kg(-1), i.p.) or inducible nitric oxide synthase expression inhibitor, dexamethasone (5 mg kg(-1), i.p.) or the inhibitor of murine inducible nitric oxide synthase in vivo, 2-amino-5,6-dihydro-6-methyl-4H-1,3-thiazine (AMT, 1 mg kg(-1), i.p.). 5 h after endotoxin treatment, electrochemically detected concentration of nitric oxide was significantly elevated (nM, endotoxin: 716.6 +/- 178.2, n = 10 vs saline: 209.4 +/- 127.8, n = 9, P = 0.0312, unpaired Student's t-test) and remained so throughout the 30 min monitorization period. Neither dexamethasone nor AMT blocked the endotoxin-induced overproduction of nitric oxide indicating that the enhanced inducible nitric oxide synthase activity cannot be the only explanation. When dexamethasone and L-NAME combination was used to block both the constitutive and the inducible isoforms, nitric oxide production was virtually abolished, indicating a significant contribution from the constitutive isoform of nitric oxide synthase. The results of nitrotyrosine immunohistochemistry and the conventional light microscopy were also in agreement with the amperometric method while immunoblotting revealed the expression of both the endothelial and the inducible isoforms of nitric oxide synthase were induced endotoxaemic animals. Thus, conclude that endotoxin-induced splenic damage in endotoxaemia can be explained by enhanced production of nitric oxide due to the induction of both endothelial and inducible nitric oxide synthases while causal relationship and the roles of other deleterious mediators such as oxygen-derived free radicals are yet to be established.

Capsaicin effectively prevents apoptosis in the contralateral testis after ipsilateral testicular torsion

OBJECTIVE

To evaluate the effect of afferent nerve blockage by administration of capsaicin on apoptotic changes in the contralateral testis in rats undergoing ipsilateral testicular torsion.

MATERIALS AND METHODS

Twenty male albino rats were randomly divided into four groups. In groups 1 and 2, rats underwent a sham operation and testicular torsion, respectively, after the intraperitoneal administration of 0.9% NaCl. Similarly, in groups 3 and 4 the rats underwent a sham operation and testicular torsion, respectively, after an intraperitoneal capsaicin injection. The testes were untwisted 24 h later and the contralateral testes harvested. Apoptosis was assessed in paraffin-embedded sections stained for nuclear DNA fragmentation. Fifteen cells were counted in each seminiferous tubule and the apoptotic cells recorded. A score was calculated for each group and the results compared using the Kruskal-Wallis analysis of variance and Mann Whitney U-tests, with P<0.05 considered to be significant.

RESULTS

The mean apoptotic score of group 2 was significantly higher than that of the other groups. There was no difference between the apoptotic scores of groups 1 and 3, 1 and 4, and 3 and 4.

CONCLUSION

Capsaicin effectively prevented apoptosis in the contralateral testes of rats that had undergone testicular torsion.

Capsaicin in albino rats prevents contralateral testis from the damaging effects posed by ipsilateral testis that underwent torsion

OBJECTIVE

To evaluate the effect of capsaicin, a powerful neurotoxin selective to afferent nerves, on contralateral testicular damage in ipsilateral testicular torsion.

METHODS

Forty male albino rats were randomly allocated into five groups. No operation was performed in group one. After intraperitoneal administration of 0.9% NaCl, rats underwent a sham operation in group 2 and testicular torsion in group 3. In groups 4 and 5 rats underwent sham operation and testicular torsion, respectively after intraoperitoneal capsaicin injection. Contralateral testes were harvested on the fifteenth day of the experiment and mean seminiferous tubular diameters and mean testicular biopsy scores were recorded for each testis. The values were compared through analysis of variance (ANOVA) with Turkey-Kramer multiple comparisons test and p values less than 0.05 were considered to be significant.

RESULTS

Mean testicular biopsy scores and mean seminiferous tubular diameters of group 5 was significantly higher than the group 3. There was no difference between the groups 1, 2, 4, and 5 when these two parameters are concerned.

CONCLUSION

Capsaicin effectively prevents contralateral testicular damage encountered following ipsilateral testicular torsion. The inhibition of afferent impulses from the ipsilateral testis under distress prevents contralateral testicular injury, and provides additional data to support the role of an autonomic reflex arc in contralateral testicular injury.

Fibrocartilaginous mesenchymoma of the distal femur: case report and literature review

A case of a 9-year-old boy with fibrocartilaginous mesenchymoma located in the distal femur is presented. Fibrocartilaginous mesenchymoma is a rare tumor. There have been 17 cases reported since 1984. The presenting complaint was pain and local discomfort. Radiological examination showed lytic and sclerotic lesions located in the distal femur. Magnetic resonance imaging showed that there was no soft tissue expansion. Differential diagnosis included fibrocartilaginous dysplasia, dedifferentiated chondrosarcoma, desmoplastic fibroma, fibrosarcoma and low-grade osteosarcoma. The diagnosis of the tumor in a state hospital would not have been possible. Wide resection of the tumor and resection arthrodesis with an intramedullary nail has yielded good results. The patient has been disease free for 4 years. Pathological diagnosis of this very rare tumor may be challenging; the treatment should be wide resection of the tumor.

Cost-effectiveness of cefepime + netilmicin or ceftazidime + amikacin or meropenem monotherapy in febrile neutropenic children with malignancy in Turkey

Infection remains the major cause of morbidity and mortality in immunocompromised children with malignancy. In addition, the economic impact of antibiotic treatment should always be evaluated, especially in developing countries. In our center between January 1998 and January 1999, 73 children with hematological malignancies [acute lymphoblastic leukemia (ALL), acute myeloid leukemia (AML)]; 9 children with solid tumors (rhabdomyosarcoma, neuroblastoma) had 87 febrile neutropenic episodes (related to chemotherapy). These children were randomized prospectively into three treatment groups. The first group (n: 28) received cefepime plus netilmicin, while the second group (n: 29) was treated with ceftazidime plus amikacin and the third (n: 30) with meropenem as monotherapy. The aim of the study was to compare the success rates and cost of fourth generation cephalosporin plus aminoglycoside and monotherapy of meropenem with ceftazidime plus amikacin, which is the standard therapy for febrile neutropenia. Microbiologically documented infections were 29.9%, clinically documented infections were 9.2% and 60.9% of the febrile neutropenic episodes were considered to be FUO. Gram-positive microorganisms were the most commonly isolated agents from blood cultures [MRSA (Methicillin Resistant Staphylococcus aureus) in 6 patients and MSSA (Methicillin Sensitive Staphylococcus aureus) in 4 patients]. The success rates were 78.5%, 79.3% and 73.3 % for the 1st, 2nd and 3rd groups respectively. In 4 patients (4.5%) fever responded only to amphotericin-B therapy. There was no statistically significant difference between the three treatment regimens with respect to efficacy, safety and tolerance (chi2 test, p>0.05), but while the third and fourth generation cephalosporins + aminoglycosides were comparable for cost, the monotherapy regimen was the most expensive. The main determining factors for the choice of treatment of febrile neutropenic children, especially in a developing country, are cost, presence of indwelling catheter and the bacterial flora of the unit, as well as efficacy.

Importance of proliferation markers in gastrointestinal carcinoid tumors: a clinicopathologic study

BACKGROUND/AIMS

Carcinoid tumors are common tumors in the gastrointestinal tract. Certain criteria such as the depth of invasion, the localization, the tumor size, the mitotic index and the pattern of ploidy are used to determine the potential biological behavior of these tumors some of which might be malignant. The goal of this study was to assess the prognostic significance of proliferation markers (Ki67 and PCNA) in carcinoid tumors by using immunohistochemistry.

METHODOLOGY

An immunostaining in 37 carcinoid tumors arising in various locations of the gastrointestinal tract was performed. The best stained area was selected and 1000 neoplastic cells were counted in order to determine the proliferation index in each case.

RESULTS

The results of proliferation index were compared with the depth of invasion, the embryologic type, the tumor size, the presence of metastases and disease-free survival by using statistical methods. The Ki67 tumor proliferation index in the tumors > 2.1 cm was significantly different from the tumors < or = 2 cm (P = 0.032).

CONCLUSIONS

The presence of significant correlation between Ki67 positivity and the tumor size might suggest that Ki67 antibody can be useful for the determination of potential behavior of gastrointestinal carcinoid tumors.

Results of rhabdomyosarcoma treatment in a developing country

Fifty-one children (median age: 4.5 years; 4 months-16 years) diagnosed with rhabdomyosarcoma were treated in our center between 1980-1999. The primary sites were head and neck in 31.4%, the genito-urinary system in 21.6%, and extremities in 9.8% of the patients. The histopathologic subtypes were embryonal in 80.4%, alveolar in 9.8%, and undifferentiated in 9.8%. The majority of the patients were considered group III (47%) and group IV (25.5%) according the criteria of the Intergroup Rhabdomyosarcoma Study (IRS). Primary total tumour resection was performed in only 27.5% of the patients. The patients were treated with assigned regimens of IRS II and IRS III protocols. Radiotherapy was applied to 92.1% of the patients. Thirty-four patients (66.7%) were lost to follow up, and of the remaining 17 patients, 7 patients (41.2%) died, relapse occurred in 9 patients (52.9%) and 10 patients (58.8%) are alive. The percentage of cases lost to follow up during the first 10 years and the following 9 years of the study were 77.4% and 50%, respectively. In compliance with cancer treatment remains a major problem in developing countries.

Ossifying fasciitis

A case of ossifying fasciitis occurring in the left femoral region of a 57-year-old male is reported. The patient complained of pain in his left lower extremity which was the site of previous catheterization. During a left femoropopliteal by-pass, a firm and cylindric mass measuring 5 x 3 x 2.5 cm in size was found and extracted from the left groin. Histologically, a reactional lymph node and an irregularly shaped lesion extended into the perinodal fat tissue which is composed of proliferating fibroblasts with occasional mitotic activity. Within this fibroblastic proliferation, immature woven bone composed of osteoid with calcification and chondroid differentiation were seen. Metaplastic bone is an uncommon finding in cases of nodular fasciitis, parosteal fasciitis, cranial fasciitis and florid reactive periostitis. Ossifying fasciitis is known as an uncommon variant of nodular fasciitis. It is an uncommon post-traumatic benign lesion of subcutaneous tissue with an unclear etiology of ossification which is neither related with a bony structure nor contains any muscle tissue. This lesion has been reported only once previously, in the femoral region after a trauma history of catheterization.

Skeletal muscle metastasis from carcinoma of the bladder

Metastasis to skeletal muscle from carcinoma of the bladder is extremely rare. To the best of our knowledge, there is no reported case in the English literature. In this report, we describe a 41-year-old man with bladder carcinoma with metastasis to the right deltoid muscle.

The effects of bosentan, aminoguanidine and L-canavanine on mesenteric blood flow, spleen and liver in endotoxaemic mice

The modulatory effects of a non-selective endothelin receptor antagonist, bosentan, were investigated together with those of relatively selective inducible nitric oxide synthase inhibitors, aminoguanidine and L-canavanine, on mesenteric blood flow decrease, liver and spleen injury elicited by endotoxaemia. Swiss albino mice (20-40 g) were administered intraperitoneally bosentan (3, 10 or 30 mg kg(-1)), aminoguanidine (15 mg kg(-1)) or L-canavanine (20 or 100 mg kg(-1)) 10 min before they received saline or Escherichia coli endotoxin (10 mg kg(-1)). After 4 h, the mice were anaesthetized, mesenteric blood flow values were measured, spleen and liver weight/body weight ratios were determined and the organs were examined histopathologically. Endotoxin decreased mesenteric blood flow (ml min(-1), saline: 3.0 +/- 0.2; endotoxin: 2.2 +/- 0.2: n = 10, P < 0.05), increased the weight of liver (g per kg body weight, saline: 47.5 +/- 2.0; endotoxin: 60.8 +/- 1.9: n = 10, P < 0.05) and spleen (g per kg body weight, saline: 3.9 +/- 0.5; endotoxin: 8.6 +/- 0.9; n = 10, P < 0.01) while it inflicted significant histopathological injury to both organs. Bosentan was ineffective at 3 mg kg(-1) but at 10 and 30 mg kg(-1) doses, it abolished all the deleterious effects of endotoxin without exception. Aminoguanidine blocked most of the effects of endotoxin except those on spleen. In contrast, L-canavanine blocked only the endotoxin-induced increase in liver weight but itself increased spleen weight and failed to block any other effects of endotoxin. Thus, it can be speculated that the beneficial effects of aminoguanidine are produced largely by mechanisms other than selective inducible nitric oxide synthase inhibition since L-canavanine was not fully effective. The beneficial effects of endothelin inhibition by using bosentan in endotoxaemia can be further exploited for the understanding and the therapy of sepsis-related syndromes.

Giant benign cystic peritoneal mesothelioma: US, CT, and MRI findings

Benign cystic peritoneal mesothelioma (BCPM) is a rare tumor, primarily affecting young women; approximately 130 cases have been described mainly in the pathological and surgical literature. We present imaging findings of a giant BCPM in a male patient and discuss the radiological differential diagnosis with a brief review of the literature.

Acute lymphoblastic leukemia: dental health of children in maintenance therapy

The dental health of 41 children aged 4-16 years who were in maintenance therapy from acute lymphoblastic leukemia (ALL) was examined in relation to the period of time in maintenance. There was no significant difference in dental experience and salivary flow rate between the control group and patients with leukemia. Performed treatment index (PTI) and required treatment index (RTI) scores reflected that children, who were in maintenance therapy had insufficient dental care and needed more dental treatments. A statistically significant difference in salivary pH was found between the children, who were in maintenance therapy for 12-24 months and less than 12 months and also the control group; but the pH scores of all groups were observed in normal limits.

Leukemic children: clinical and histopathological gingival lesions

The relation between leukemia and gingiva was investigated in the present study. An extensive tumor infiltration in the gingiva was established in 1 of 2 patients with acute leukemia (AML). An inflammatory cell infiltration in various degrees was noticed in total 28 patients with leukemia (L). Various degrees of epithelium hyperplasia in all patients existing in 14 patients with medium intensity and occurring in 14 patients with light intensity of hyperplasia were observed. An increase in the keratinization of epithelium, in 3 patients with medium intensity and 1 patient with light intensity was found. It was also seen that there were fungal infections in 3 patients with medium intensity, in 6 patients with light intensity and existing in a total 26 patients with acute lymphoblastic leukemia (ALL).

Prognostic significance of depth of invasion in cancer of the larynx

To determine the prognostic significance of depth of invasion in laryngeal cancer, the depth of invasion of tumor was measured with an ocular micrometer on the laryngectomy specimens of 94 surgically treated patients with T1, T2, and T3 laryngeal cancer and was expressed in millimeters. There was a significant negative correlation between the depth of invasion and disease-free survival. The tumors with no clinical involvement of regional lymph nodes in neck (NO neck) had significantly less depth of invasion than those with involvement (N+ neck). The tumors with pathologically confirmed cervical lymph node metastasis had significantly more depth of invasion than those without metastasis. For tumors with a depth of invasion equal to or greater than 3.25 mm, the rate of cervical metastasis in this study has always been significantly higher than for those with a depth of invasion less than 3.25 mm (P < .05). The mean depths of invasion for cases with and without recurrence were not significantly different. According to the multivariate analysis, depth of invasion (P = .047) and patient age (P = .113) significantly affected the disease-free survival independently. The depth of invasion did not significantly affect the recurrence and the interval between surgery and the development of recurrence (P > .15). The depth of invasion should be measured in every laryngectomy specimen. The depth of invasion influences the cervical metastasis and disease-free survival significantly but does not affect the recurrence rate. The depth of invasion plays an independent role in determining the disease-free survival.

Effect of intratympanic steroid application on the development of experimental cholesteatoma

By introducing certain irritants into the middle ear it is possible to produce cholesteatoma. Propylene glycol, the main agent used for this purpose, produces a long-standing inflammation that causes hyperplasia and migration of the epithelium through an intact tympanic membrane. In the present investigation topical prednisolone was used in order to inhibit the production of cholesteatoma. The results indicate that there is a marked decrease in inflammation and hence experimental cholesteatoma production when prednisolone is administered into the middle ear.

Oxidative DNA base damage and antioxidant enzyme levels in childhood acute lymphoblastic leukemia

We have investigated the levels of several antioxidant enzymes and the level of oxidative DNA base damage in lymphocytes of children with acute lymphoblastic leukemia (ALL) and in disease-free children. Children with ALL had just been diagnosed with the disease and had received no therapy prior to obtaining blood samples. A multitude of typical hydroxyl radical-induced base lesions in lymphocyte DNA of children were identified and quantified by gas chromatography-isotope dilution mass spectrometry. Higher levels of DNA base lesions were observed in patients with ALL than in children without the disease. The levels of the antioxidant enzymes glutathione peroxidase, catalase and superoxide dismutase in lymphocytes of ALL patients were lower than in lymphocytes of controls. These findings are in agreement with earlier observations in various types of adulthood cancer. Some of the identified DNA base lesions are known to possess premutagenic properties and may play a role in carcinogenesis. The results may indicate a possible link between decreased activities of antioxidant enzymes and increased levels of DNA base lesions due to oxidative damage, and support the notion that free radical reactions may be increased in malignant cells.

The effects of chemical sympathectomy on contralateral testicular histology, fertility and fecundity in unilateral abdominal testes

OBJECTIVE

To evaluate the effects of abdominal testis on ipsilateral and contralateral testicular histology, fertility and fecundity in rats which were chemically sympathectomized neonatally.

MATERIALS AND METHODS

The study comprised 60 male albino rats, 30 receiving a placebo and 30 a chemical sympathectomic agent neonatally. When 21 days old, the two groups of 30 rats were each divided into three groups and underwent a control operation or abdominal fixation of one or both testes. After they were 8 weeks old, each male rat was housed with two fertile female rats for 25 days, after which their testes were harvested. Females were observed for an additional 25 days and any pregnancies and the number of offspring were recorded. Mean seminiferous tubular diameters and mean testicular biopsy scores were determined for each testis.

RESULTS

Although fertility and fecundity rates and mean testicular biopsy scores were not significantly different, chemical sympathectomy prevented the decrease in mean seminiferous tubular diameters which occurred in the contralateral testis.

CONCLUSION

Chemical sympathectomy protected contralateral testicular histology to some degree. Therefore, the sympathetic system may play a role in contralateral testicular deterioration.

An unusual presentation: primary tuberculosis of the middle ear cleft

Tuberculosis rarely affects the middle ear cleft; therefore, except for those working in close association with respiratory physicians, the disease is a curiosity and not often considered in the differential diagnosis of otorrhea. The diagnosis is thus made too late, with resulting complications such as irreversible hearing loss and facial nerve paralysis. A case report and review of the literature are presented, emphasizing that tuberculosis should be considered in the differential diagnosis of chronic ear infection.