Traces of intact paraben molecules in endometrial carcinoma

Endometrial carcinoma is the most commonly encountered gynecological cancer in women worldwide and is also one of the popular models of the hormone-dependent carcinomas. This study was aimed to evaluate and compare the concentrations of five paraben molecules (methylparaben, ethylparaben, N-propylparaben, benzylparaben, isobutylparaben + N-butylparaben) in the endometrial and myometrial tissue samples of patients diagnosed with endometrial carcinoma and benign gynecologic diseases. A total of 88 patients were included in the study and chemical analysis was performed on 176 tissue samples. The study group comprised of 33 patients with endometrial carcinoma and 6 patients with endometrial intraepithelial neoplasia. The control group comprised of 49 patients. One endometrial and one myometrial tissue samples were collected from each patient. The analyses were performed using ultrahigh-performance liquid chromatography and tandem mass spectrometry (UHPLC-MS/MS). At least one type of paraben molecule was detected in 23.07% (9/39) of the patients in the study group, and in 2.04% (1/49) of the patients in the control group; this difference between the groups was statistically significant (p = .002). N-Propylparaben and isobutyl + N-butylparaben were the most frequently detected (in 7/10 of the samples) paraben molecules in the study. Tumor characteristics (tumor diameter, myometrial invasion, architectural grade, nuclear grade, lymphovascular space invasion, and tumor stage) were comparable between the two groups of endometrial carcinoma (paraben-detected and paraben-undetected groups). In conclusion, paraben molecules were more frequently detected in the endometrial carcinoma tissue samples than in the normal endometrium.

A study detection of the ROS1 gene fusion by FISH and ROS1 protein expression by IHC methods in patients with ovarian malignant or borderline serous tumors

OBJECTIVE

ROS1 is an orphan receptor protein tyrosine kinase which is supposed to undergo genetic rearrangement in carcinogenesis. In the current study, we aimed to investigate the frequency and clinicopathologic features associated with ROS1 gene fusion and ROS1 protein expression in patients with ovarian serous carcinoma or serous borderline tumors.

MATERIALS AND METHODS

Tissue samples of 102 patients with high or low grade serous carcinoma and borderline serous tumors were selected randomly from the archives of Department of Gyneco-pathology, and analyzed for ROS1 gene expression. (Fluorescence in situ hybridization (FISH) method was used to assess ROS1 gene rearrangement, while ROS1 protein expression was analyzed using immunohistochemistry.

RESULTS

The study consisted of 94 cases of high-grade serous carcinoma (92.1%), 2 cases of low-grade serous carcinoma (%2) and 6 cases of serous borderline tumor (5.9%). ROS1 gene rearrangement analysis revealed that 4 patients (3.9%) were FISH-positive; whereas the immunohistochemical analysis yielded only 1 patient (0.9%) exhibiting faint positive expression of ROS1 protein. Given the low incidences of ROS1 gene rearrangement and protein expression, their relationships with clinicopathologic parameters could not be statistically analyzed.

CONCLUSION

Although rare, patients with ovarian serous carcinoma or serous borderline tumor may exhibit ROS1 gene rearrangement and ROS1 protein expression. Further large-scale studies are necessary to explore the clinicopathologic significance of ROS1 gene expression in ovarian serous carcinoma.

The clinical impact of serous tubal intraepithelial carcinoma on outcomes of patients with high-grade serous carcinoma of the ovary, fallopian tube, and peritoneum

Aims

To investigate whether the presence of serous tubal intraepithelial carcinoma (STIC) is associated with clinical outcomes in a nonselected (unknown BRCA status) cohort of patients with a high-grade serous carcinoma (HGSC) of the ovary, fallopian tube, and peritoneum.

Settings and Design

A prospective case-series with planned data collection.

Subjects and Methods

The study was conducted in a total of 131 patients, who underwent primary cytoreductive surgery between 2007 and 2012. Histological examination of the fallopian tubes included the "sectioning and extensively examining the fimbriated end" protocol. The diagnosis of STIC was based on the combination of morphology and immunohistochemistry. The patients were divided into two groups according to the absence or presence of STIC and compared clinicopathologically.

Statistical Analysis Used

Analyses were performed using PASW 18 (SPSS/IBM, Chicago, IL, USA) software. The primary outcome was progression-free survival (PFS), and the secondary outcome was overall survival (OS).

Results

STIC was identified in 20.6% of patients. Median follow-up time was 49.5 months for the STIC-positive group and 38.0 months for the STIC-negative group. Study groups were comparable in terms of clinicopathological characteristics with the exception that patients with STIC had less lymph node involvement (55.0% vs. 65.4%, P = 0.001), and more diagnosis of primary tubal carcinoma (29.6% vs. 3.8%, P = 0.001) compared to those without STIC. No statistically significant differences in terms of PFS (P = 0.462) and OS (P = 0.501) were observed between the groups.

Conclusions

The absolute identification of the origin of tumor cell does not seem to significantly affect the clinical course of the patients with HGSC.

Flexural behavior of 3D para-aramid/phenolic/nano (MWCNT) composites

In this work, the flexure properties of nanostitched and nanoprepreg three dimensional (3D) para-aramid/phenolic composites were studied. Four types of composite were developed. They were called stitched/nano, stitched, base/nano and base. The flexure strength and modulus of the stitched/nano composites were slightly improved compared to those of the base composites due to the addition of the stitching yarn and multiwall carbon nanotubes (MWCNTs). The flexure failure of the base and base/nano structures was matrix peeling and large delaminated areas, whereas the stitched and stitched/nano composites had warp deformation and no visible matrix/fiber damage. In addition, the delaminated areas were severely restricted. The results showed that introducing the stitching fiber and multiwall carbon nanotubes in the base structure improved its out-of-plane failure properties as a form of restricted delamination and they acted as delamination barriers around the regions. Therefore, stitched/nano p-aramid/phenolic composites could be considered as damage tolerant materials.

Determination of HER2 gene amplification in breast cancer using dual-color silver enhanced in situ hybridization (dc- SISH) and comparison with fluorescence ISH (FISH)

BACKGROUND

The two basic methods that are currently accepted to identify the HER2 status are immunohistochemistry and flyorescence in situ hybridization (FISH) . The aim of this study was to perform the dual-color silver in situ hybridization (dc-SISH) technique as an alternative to FISH.

MATERIALS AND METHODS

A total of 40 invasive breast carcinoma cases were assessed for HER2 gene amplification by FISH and dual- color SISH.

RESULTS

Significant correlation was found in the HER2 expression results obtained with the two approaches (p=0.001, p<0.05). The concordance rate was 92.3%.

CONCLUSIONS

Foutine practical use of the dc-SISH method, which is much easier to apply, score, and evaluate, has many advantages. HER2 and CEN17 status can be evaluated simultaneously with the newly developed "Dual-Color Probe". All these specifications and the reliable results obtained support the widespread use of SISH technique in clinical practice.

Abstract 3166: Clinopathologic correlation with the LCM based instability profiles for the mitochondrial microsatellite regions in the benign to metastatic transitions of surface epithelium ovarian tumor subtypes

Background: Up to date, genomic and microgenomic changes have been identified in nuclear genome whereas, there is no available data about the mitochondrial genome alterations in paired ovarian tumors. Additionally, genomic factors that involve in the progression to advanced stages of ovarian malignancy is still largely unknown. Current work suggest that the mitochondrial alterations have importance in the progress of carcinogenesis in spesific cell populations at clinical, pathological and molecular pathological levels.

Methods and Findings: We analyzed subtypes of 41 ovarian carcinoma samples including normal and tumor (benign, borderline and malignant) using laser captured microdissection technology. Out of 41 ovarian cases, 19 serous papillary carcinoma, 6 mucinous adenomcarcinoma, 9 endometrioid adenocarcinoma, 5 mixed type ovarian carcinoma, 1 undifferentiated carcinoma and 1 clear cell adenocarcinoma were included in the study. All samples were screened for 5.5kb (MT-D-Loop, MT-CytB, MT-ATPaz6-8, MT-12SrRNA, MT-16SrRNA) of mitochondrial genome by PCR-based sequencing analysis. A total of 91 variations were found. Sixty six percent (60/91) of these variations is shown in MITOMAP and 34% (31/91) is observed as novel variations. Overall, we did not find any correlation in D-Loop variations between pathological prognostic and molecular pathological prognostic factors (CD34,ER,PR,c-erbB-2,p53,MDR1,MDR3). However, the expression of a key component of drug resistance, protein GST (gluthatione S transferase), was detected as 270 in samples with instability; and 165 (median 25-75 percentile) in samples with stability in D-Loop position at 309 for C7TC6 repeats, (p&lt;0.05). Additionally, there was a significant difference in the mitotic index of Ki-67 expression in the samples whom had no changes in CA5 repeats as 37.2+20.00 and 54.3+17.0 in samples with CA5 repeat variations at position 514 (p&lt;0.05).

Conclusion: Our results suggest that our findings will add clinical value for the spesific/novel genetic variations detected in 34% of ovarian tumors. The results of microsatellite analysis in ovarian tumors showed changes of 26% for D310 (C)7-9, 37% for position 16184 (C)8-14. Our data supports the idea that, the variations spesifically in MT-D Loop and MT-CytB gene regions would reflect the preliminary transitional changes in progression of tumorigenesis. The functional use of LCM system and the microgenomic profiles will be definetely helpful for prognostic and therapeutic approaches in the field of mitochondrial oncology .

Citation Format: Ozgul Alper, Gulgun Erdogan, Elif Pestereli, Tayup Simsek, Mualla O. Caliskan, Hakan Gulkesen, Durkadin Demir, Gökhan Görgişen, Seyda Karaveli, Güven Lüleci. Clinopathologic correlation with the LCM based instability profiles for the mitochondrial microsatellite regions in the benign to metastatic transitions of surface epithelium ovarian tumor subtypes. [abstract]. In: Proceedings of the 104th Annual Meeting of the American Association for Cancer Research; 2013 Apr 6-10; Washington, DC. Philadelphia (PA): AACR; Cancer Res 2013;73(8 Suppl):Abstract nr 3166. doi:10.1158/1538-7445.AM2013-3166

Apoptosis and expression of Bcl-2, Bax, p53, caspase-3, and Fas, Fas ligand in placentas complicated by preeclampsia

AIM

To determine whether preeclampsia is associated with an increase in placental apoptosis and altered expression of mediators of apoptosis such as Fas, Fas ligand, caspase-3, p53, Bcl-2 and Bax.

METHODS

Placental samples obtained from 20 women with preeclampsia and 14 normal women were analyzed using the Klenow, Frag-EL DNA fragmentation detection kit for apoptosis. Expression of Fas, Fas ligand, caspase-3, p53 Bcl-2, and Bax was assessed using immunohistochemistry.

RESULTS

The median percentage of apoptotic nuclei in trophoblasts was significantly higher for the preeclampsia group than for the controls (6.9 vs 0.25; p =.001). Fas ligand expression was significantly higher in the decidua among the subjects with preeclampsia compared with controls (1.2 vs 0; p = .023). Otherwise no difference was observed in the expression of Bax , Bcl-2, p53, caspase-3, and Fas between groups.

CONCLUSION

Increased apoptosis in preeclampsia may not be associated with significant alterations in Fas, Fas ligand, caspase-3, p53, Bcl-2 and Bax expression.

Stage I small cell carcinoma of the endometrium: survival and management options

Small cell carcinoma (SCC) of the endometrium is a rare but aggressive disease with early systemic involvement. Patient survival is short. To date, no effective treatment protocol has been established. Surgery, radiotherapy, and chemotherapy have been used either alone or in combination. The case of a patient with stage IB endometrial SCC is presented with an overview based on all reported cases of SCC of the endometrium and its treatment with particular reference to stage I cases.

Neoangiogenesis and expression of hypoxia-inducible factor 1alpha, vascular endothelial growth factor, and glucose transporter-1 in endometrioid type endometrium adenocarcinomas

OBJECTIVE

Hypoxia Inducible Factor-1alpha (HIF-1alpha) is a transcriptional factor that activates multiple genes including Vascular Endothelial Growth Factor (VEGF) and glucose transporter-1 (GLUT-1) in response to hypoxia and promotes neoangiogenesis.

METHODS

Expression of HIF-1alpha VEGF, and GLUT-1 were analyzed by immunohistochemistry and microvessel density (MVD) was determined by CD 34 immunostaining in 100 endometrioid type endometrial adenocarcinoma, FIGO Stages I-IV.

RESULTS

High expression of HIF-1alpha, VEGF and GLUT-1 were significantly more prevalent in advanced stages than early stages (p<0.001). High expression of HIF-1alpha was found in 100% of Stage III-IV patients, whereas 50% of Stage II and 9% of Stage I patients had high HIF-1alpha expression. Similarly, high VEGF expression was determined in 4% of Stage I and 30% of Stage II patients, however 90% of Stage III-IV patients had high expression of VEGF. Comparing the GLUT-1 scores, it was found that increasing stages correlated with high GLUT-1 expression. Additionally, a statistically significant difference was also noted in MVD between stages (p<0.001). The average MVD of Stage I patients was 31.87+/-7.73. It was found 49.24+/-7.60 in Stage II, and 78.74+/-14.48 in Stage III-IV patients. On analyzing expression of HIF-1alpha, VEGF and GLUT-1 and MVD in pairs, statistically significant correlations were found between each other (p<0.001).

CONCLUSION

HIF-1alpha was increasingly expressed from early stages through advance stages of endometrioid adenocarcinoma, paralleled by activation of its downstream genes such as GLUT-1, VEGF and increased angiogenesis. These results highlight the importance of hypoxia and related pathways in progression of endometrial carcinoma.

Primary follicular lymphoma of the cervix uteri: a review

Primary non-Hodgkin's lymphoma of the cervix is a rare disease, of which a subgroup of follicular lymphoma constitutes only 8.5%. There is not an established treatment protocol neither for primary cervical lymphoma nor for its follicular subgroup. We presented a case with Ann Arbor stage IEA (Extra-nodal involvement and absence of weight loss, fever, night sweat) primary follicular lymphoma of the cervix. She was treated with chemotherapy followed by pelvic radiotherapy. Upon relapse with a nodal neck mass, she was treated with rituximab alone. She remained well for 23 months after rituximab. In the 39 months of follow-up, there was no evidence of disease. In the light of our case, we reviewed the reported cases of primary follicular lymphoma of the cervix while discussing their treatment protocols and the cases of primary cervix lymphoma treated with rituximab.

TRAIL death receptor-4 expression positively correlates with the tumor grade in breast cancer patients with invasive ductal carcinoma

PURPOSE

Tumor necrosis factor-related apoptosis inducing ligand (TRAIL) selectively induces apoptosis in cancer cells but not in normal cells, and a number of clinical trials have recently been initiated to test the safety and antitumoral potential of TRAIL in cancer patients. Four different receptors have been identified to interact with TRAIL: two are death-inducing receptors (TRAIL-R1 [DR4] and TRAIL-R2 [DR5]), whereas the other two (TRAIL-R3 [DcR1] and TRAIL-R4 [DcR2]) do not induce death upon ligation and are believed to counteract TRAIL-induced cytotoxicity. Because high levels of DcR2 expression have recently been correlated with carcinogenesis in the prostate and lung, this study investigated the importance of TRAIL and TRAIL receptor expression in breast cancer patients with invasive ductal carcinoma, taking various prognostic markers into consideration.

METHODS AND MATERIALS

Immunohistochemical analyses were performed on 90 breast cancer patients with invasive ductal carcinoma using TRAIL and TRAIL receptor-specific antibodies. Age, menopausal status, tumor size, lymph node status, tumor grade, lymphovascular invasion, perineural invasion, extracapsular tumor extension, presence of an extensive intraductal component, multicentricity, estrogen and progesterone receptor status, and CerbB2 expression levels were analyzed with respect to TRAIL/TRAIL receptor expression patterns.

RESULTS

The highest TRAIL receptor expressed in patients with invasive ductal carcinoma was DR4. Although progesterone receptor-positive patients exhibited lower DR5 expression, CerbB2-positive tissues displayed higher levels of both DR5 and TRAIL expressions.

CONCLUSIONS

DR4 expression positively correlates with the tumor grade in breast cancer patients with invasive ductal carcinoma.

Significance of the RET proto-oncogene polymorphisms in Turkish sporadic medullary thyroid carcinoma patients

Several single nucleotide polymorphisms (SNP) of the RET gene have been identified in medullary thyroid carcinoma (MTC) patients as well as in the general population. However, the relevance of SNP for MTC patients is still controversial, whether these allelic variants play other interacting, predisposing or modifying roles in clinical behavior of MTC. The aim of this work is to elaborate allelic frequencies of the RET proto-oncogene polymorphisms in Turkish sporadic MTC patients and to demonstrate if there is an association between SNP and the clinical disease features, specifically the age at onset of MTC and lymph node involvement at diagnosis. We analyzed the allelic frequencies of SNP of the exon 11, 13, 14 and 15 of the RET proto-oncogene in blood samples from 50 sporadic MTC patients, using the polymerase chain reaction methodology followed by DNA sequencing. The observed allelic frequencies were 24% for G691S polymorphism in exon 11, 29% for L769L polymorphism in exon 13, 5% for S836S polymorphism in exon 14, and 26% for S904S polymorphism in exon 15. These frequencies are similar to those reported in other countries. We did not observe any significant association of all four SNP with the age at onset of MTC. Our results indicate a possible association between the presence of lymph node involvement at the time of diagnosis (extent of disease) and L769L or S836S polymorphism. However, it is not possible to draw definitive conclusions that these two polymorphisms play a significant role in clinical behavior of MTC. Further studies are needed to evaluate the role of this polymorphism in the clinical behavior of MTC.

A case of sciatic neuropathy after caesarean section under spinal anaesthesia

We present a rare case in which a healthy parturient developed a left sciatic neuropathy after spinal anaesthesia for caesarean section. Intraoperatively, a wedge was placed under her right buttock to tilt the pelvis and uterus to the left, to minimise aortocaval compression. Postoperatively, she complained of being unable to move her left foot. Neurologic examination revealed a left lower leg paresis. Electromyography showed denervation potentials on muscles innervated by left sciatic nerve. Seven weeks after surgery the patient had made a full recovery. We conclude that the prolonged lateral tilt position might cause compression neuropathy of the sciatic nerve. After childbirth, re-positioning the patient supine or shortening the time of lateral tilt may reduce the risk of sciatic nerve injury.

Serous papillary adenocarcinoma and adult granulosa cell tumor in the same ovary

Surface epithelial-stromal cell tumors are the most common neoplasms of the ovary but occurrence of a serous adenocarcinoma and an adult granulosa cell tumor in the same ovary is an unusual incident. In the present case report we describe this very uncommon occurrence in the ovary of a 50-year-old woman. The patient suffered abdominal distention and was referred to the state hospital where a 5x3 cm multilocular cystic lesion was observed on abdominal CT. Total abdominal hysterectomy with salpingo-oophorectomy and omentectomy was performed. Microscopy revealed an adult granulosa cell tumor and a serous papillary adenocarcinoma in the left ovary. Immunohistochemical staining with inhibin alpha and pancytokeratin confirmed the diagnosis.

Ret proto-oncogene mutations in apparently sporadic Turkish medullary thyroid carcinoma patients: Turkmen study

OBJECTIVE

Medullary thyroid carcinoma (MTC) frequently occurs in a sporadic form, but a substantial number of cases are hereditary and appear as part of the multiple endocrine neoplasia type 2 (MEN2) syndromes. Germline mutations in ret proto-oncogene have been shown to be the underlying cause of MEN2 syndromes.

DESIGN

We carried out a multi-center study that aimed to perform mutational analysis of so called sporadic MTC patients.

METHODS

Fifty-six MTC patients verified by histopathologic examination were subjected to genetic analysis. Exon 10, 11, 13, 14, 15 and 16 of the ret gene were analyzed by DNA sequencing and restriction enzyme digestion method.

RESULTS

Among 56 apparently sporadic MTC patients, we identified 6 (10.7%) ret germline mutation carriers. Three individuals carried mutations at codon 634 in exon 11, one at codon 618 in exon 10, and two at codon 804 in exon 14. Identification of the predisposition gene mutation has allowed DNA-based strategy for direct mutation detection in patients with apparently sporadic MTCs. A substantial number of patients with apparently sporadic MTC carried germline mutations and 50% of their first degree relatives are expected to have or to develop MTC and/or other endocrine tumors.

CONCLUSIONS

These results indicate the importance of careful genetic surveillance of any patient with apparently sporadic MTCs.

Multiple endocrine neoplasia type 2A/localized cutaneous lichen amyloidosis associated with malignant pheochromocytoma and ganglioneuroma

We hereby present a rare variant of multiple endocrine neoplasia type 2A (MEN2A) associated with a rare skin disease primary cutaneous lichen amyloidosis and discrete malignant pheochromocytoma in both adrenal glands and pancreatic tail, and interestingly accompanied ganglioneuroma located in retroperitoneum in a 34-yr-old female. The presence of composite tumor of pheochromocytoma and ganglioneuroma arising in the adrenal glands has been described previously in MEN2A and in sporadic cases. The patient displayed classical signs and symptoms of catecholamine excess. Biochemical screening proved pheochromocytoma. Computed tomography revealed multiple mass lesions in both adrenal glands. It also showed a large heterogeneous mass that clearly discriminated from right adrenal gland in retroperitoneal location. After surgical exploration, both adrenal glands and the suspicious mass in pancreatic tail were removed successfully together with subtotal resection of the retroperitoneal tumor. Histopathologic examinations confirmed the presence of pheochromocytoma in both adrenal glands as well as pancreatic lesion. A retroperitoneal ganglioneuroma was also present. Symptomatic and biochemical evidence of pheochromocytoma subsided after the operation. Further evaluation for medullary thyroid carcinoma and primary hyperparathyroidism confirmed MEN2A. Mutation analysis of the ret proto-oncogene revealed a missense point mutation at position 634 in exon 11, which gives rise to the substitution of a cysteine codon with a tyrosine residue.

The prevalence of Vitamin D deficiency and effects of ultraviolet light on Vitamin D levels in elderly Turkish population

Vitamin D deficiency is commonly found in the elderly and is associated with osteoporosis and hip fractures. In this study, Vitamin D status of 138 female and 87 male subjects living in old age homes (OAH) and 171 female and 24 male subjects living in own homes (OH) from Central Anatolia were assessed. A questionnaire was applied to collect information about wearing features and degree of sunlight exposure and benefiting from ultraviolet index calculated (BFUI). We have found Vitamin D deficiency in 33.4% among our subjects. Also, 40.1% of subjects living in OAH (54.1% of females and 18.4% of males) and 24.4% of subjects living in OH (27.9% of females and 4.2% of males) were Vitamin D deficient. Vitamin D deficiency was significantly higher in subjects living in OAH than subjects living in OH (P = 0.001) and also higher in females than males (40.7% versus 15.3%, P < 0.001). Subjects with Vitamin D deficiency were older (P < 0.001), BFUI was lower (P < 0.001) and parathyroid hormone (PTH) was higher (P < 0.001) than those having normal level of 25(OH)D. There was a significant negative correlation between 25(OH)D levels and age (P < 0.001, r = -0.248) PTH and 25(OH)D (P = 0.004, r = -0.340), and positive correlation between 25(OH)D and BFUI (P < 0.001, r = 0.340). Vitamin D deficiency is very common in Turkish elderly subjects especially living in OAH and there is a significant low exposure to sunlight among them. Simply by asking clothing habits and exposure to sunlight, we can able to identify risk of Vitamin D insufficiency in elderly subjects.

Expression of c-erbB-2 and p53 in Breast Carcinoma Patients: Comparison with Traditional Prognostic Factors and Survival

We aimed to determine the correlations between standard clinicopathological factors and expression of c-erbB-2 and p53 proteins, and to investigate the significance of these variables in relapse and disease-free survival (DFS) in breast carcinoma patients. Data from 200 patients who had undergone mastectomy for breast carcinoma were evaluated. Significant correlations were found between c-erbB-2 positivity and high histological grade (grade 3) tumour, p53 positivity and high grade tumour, and age < 60 years and oestrogen receptor negativity. Twenty-six patients (13%) developed a recurrence. Disease relapse was more frequent in patients who had axillary lymph node (ALN) metastasis, high grade tumour, c-erbB-2 positivity and p53 positivity; these variables were also associated with a shorter DFS. The effects of ALN metastasis and p53 positivity were significant. In conclusion, ALN metastasis and p53 positivity were important factors for predicting disease relapse in mastectomy-treated breast carcinoma patients; other clinicopathological criteria and c-erbB-2 positivity were not predictive.

Proliferating activity in differential diagnosis of benign phyllodes tumor and cellular fibroadenomas: is it helpful?

Benign phyllodes tumors and fibroadenomas are two types of fibroepithelial tumors of breast that are usually difficult to differentiate. The purpose of this study is to evaluate the proliferative activity of these tumors and to find out if it helps in differential diagnosis. Thirty-one benign phyllodes tumors and twelve cellular fibroadenomas were retrieved from the archives of Pathology Department of Akdeniz University, School of Medicine. Proliferating activity of epithelial and stromal cells were evaluated by using labeling index (LI) of proliferating cell nuclear antigen (PCNA) and Ki-67 antigen by immunohistochemistry. The results were compared with other clinicopathologic findings. There was not any significant difference between the proliferating activity of phyllodes tumor and cellular fibroadenomas. Mean LI of PCNA was 28.01 (+/-22.85) in stromal cells and 56.57 (+/-30.98) in epithelial cells of phyllodes tumor where it was 28.92 (+/-24.02) and 62.53 (+/-32.56) in fibroadenomas. Ki-67 indices were 0.05 (+/-0.19) in stromal cells, 2.65 (+/-12.53) in epithelial cells of phyllodes tumors and 0.0 (+/-0) in stromal cells, 0.43 (+/-0.63) in epithelial cells of fibroadenomas. There was no correlation between the diameter of tumors and proliferating activity in both groups. Proliferating activity, determined by immunohistochemistry with PCNA and Ki-67 antibodies did not reveal significant difference between phyllodes tumor and fibroadenoma.

Magnetic resonance imaging and computerized tomography images in a case of pituitary abscess

A 29-year-old male patient with clinical manifestations of panhypopituitarism and diabetes insipidus is presented. The clinical and laboratory evaluation of the pituitary reserve confirmed a total pituitary insufficiency. Computed tomography (CT) scan demonstrated a low-density lesion suggesting a pituitary tumor with suprasellar extension, and magnetic resonance imaging (MRI) revealed a pituitary mass with decreased signal intensity on T1-weighted images and capsular contrast enhancement after gadolinium injection. The surgical procedure was the treatment of choice. During surgery a large amount of purulent material was removed. With light microscopy, chronic non-specific inflammation and a pituitary abscess capsule were demonstrated in the tissue. The results of the cultures revealed coagulase negative staphylococcus. The post-operative course was uneventful and, as the patient was pituitary-deficient, he was on replacement therapy and was being followed-up. Pituitary abscess is an exceptional lesion in the literature and despite the advent of CT and MRI, its preoperative diagnosis still remains difficult. However, the presence of an intrasellar expansive process with liquid center and contrast enhanced outline should suggest the possibility of an abscess. Sellar round cystic mass isointense or hypointense to grey matter on T1, high intensity signal on T2, or opposite pattern with a peripheral rim enhancement following gadolinium injection, and diabetes insipidus may all be suggestive of a pituitary abscess.

Iodine status and thyroid volumes of school age children from Northern Cyprus

In an epidemiological study carried out in eight different inland and coastal areas from northern part of Cyprus Island 625 School Age Children (SAC) aged 9 and 10 years, underwent thyroid ultrasonography for determination of thyroid volume (TV). Urinary iodine concentration (UIC) was measured from morning urine samples taken from all of the children. Mean TV was 3.2+/-1.0 ml, 3.3+/-0.8 ml and 3.8+/-1.1 ml, 3.7+/-1.1 ml for 9- and 10-year-old girls and boys respectively. None of the SAC had TV exceeding recommended upper limits for their age and gender. Median UIC of the whole group was 120 microg/l (11-900 microg/l) and only 12.6% of the SAC had UIC below 50 microg/l indicating adequate iodine intake. In this first epidemiological survey conducted in the northern part of the Cyprus Island, iodine status was found to be satisfactory and goiter does not pose a public health problem at the time of the study. Periodical surveys are required especially for the regions which have marginally adequate values and for a coastal region with a significantly higher median value of UIC compared to the others (ie 458 microg/l) (p<0.001).

Adrenal function during tuberculous infection and effects of antituberculosis treatment on endogenous and exogenous steroids

SETTING

To date, few studies have been published on the frequency of adrenal disorder during active tuberculosis and whether rifampicin treatment has an adverse effect on adrenal function.

OBJECTIVE

We evaluated endogenous and exogenous steroid metabolism in patients with active tuberculosis before and during treatment to observe whether the functions were affected by tuberculosis and rifampicin.

DESIGN

Basal hormone levels and Synacthen stimulation test were obtained in 22 patients with active tuberculosis before and 20-30 days after antituberculosis treatment including rifampicin. Exogenous steroid metabolism was assessed by 1 mg overnight dexamethasone suppression test before and during antituberculosis treatment.

RESULTS AND CONCLUSION

No significant differences were found on basal plasma cortisol or adrenocorticotropic hormone levels, but significant decrements were found on basal dehydroepiandrosterone sulfate (P < 0.05) and urinary free cortisol levels (P < 0.01) before and after commencing antituberculosis treatment. After Synacthen stimulation, only one patient had insufficient increment in plasma cortisol levels. This patient was diagnosed as a case of Addison's disease. Although nine patients (42%) showed sufficient suppression of cortisol secretion on the dexamethasone test before treatment, none had sufficient suppression with dexamethasone after antituberculosis treatment. We found less mean maximum adrenal cortisol responsiveness to Synacthen stimulation during the course of antituberculosis treatment (P < 0.01). Although impairment of adrenal function is a rare condition in active tuberculosis, rifampicin may have a significant effect on steroid metabolism.

The effectiveness of a modified hydrochloric acid-quartz-pumice abrasion technique on fluorosis stains: a case report

Endemic dental fluorosis is a form of enamel hypoplasia characterized by moderate-to-severe staining of the tooth surface. Since 1916, numerous investigators have used hydrochloric acid alone on fluorosis stains. More recently, 18% hydrochloric acid-pumice microabrasion has been used to achieve color modification. The main disadvantage of this procedure is the high concentration and low viscosity of hydrochloric acid, which can cause damage to oral and dental tissues. To eliminate this problem, quartz particles can be mixed with the hydrochloric acid. The quartz particles prevent the hydrochloric acid from flowing uncontrollablely by altering it to a gel-like form. A modified 18% hydrochloric acid-quartz-pumice abrasion technique was used to remove fluorine stains from vital teeth in a teenager.

The treatment of nonvital immature teeth with calcium hydroxide-sterile water paste: two case reports

Death of the dental pulp before completion of root development results in a tooth with an open apex. During endodontic treatment, the open apex makes obturation difficult, because there is no apical stop against which the filling can be packed and condensed. For many years, open apices have been treated by root canal fillings or by periapical surgery with or without a reverse seal. Currently, the conservative approach is preferred over surgical management, to avoid the physical and psychological trauma of surgery to a young patient. Two patients were treated by calcium hydroxide-sterile water paste to promote the apexification of the nonvital teeth with an incompletely formed apex. Normal endodontic preparation of the canal had been carried out in the immature tooth. Radiologic examination after 6 to 9 months showed that the apex of the maxillary incisors was completed by newly formed tissue.

Adrenal autotransplantation after total adrenalectomy: delayed determined function

Adrenal autotransplantation after bilateral total adrenalectomy has been utilized to eliminate the need for replacement therapy and to prevent the late occurrence of Nelson's syndrome in some patients with Cushing's disease. It is possible to follow these cases up closely today, owing to the highly developed hormonal evaluation and imaging techniques. In this study, two patients who underwent bilateral total adrenalectomy and cortex autotransplantation are presented. The autografts were found functional and the patients had not required any steroid replacement therapy.

Localized non-Hodgkin's lymphoma of the adrenal and thyroid glands

A case of immunoblastic lymphoma, involving only the thyroid and the adrenal glands, is presented. The patient had clinical symptoms and findings of Addison's disease, and computed tomography (CT) demonstrated bilateral adrenal tumoral enlargement. He also had euthyroid diffuse multinodular goiter. The diagnosis of the patient was based on the cytological examination of the aspiration materials from both endocrine glands. The patient received "m-BNCOD" chemotherapy regimen and replacement therapy for Addison's disease. At the end of three courses, a partial response was obtained.

The clastogenic effect of pyrimethamine (Daraprim) on human chromosomes in lymphocyte cultures

In this study the clastogenic effect of pyrimethamine (Daraprim), a folic acid antagonist used for the treatment of toxoplasmosis and malaria on human chromosomes, was investigated. Pyrimethamine was added to in vitro lymphocyte cultures at six different concentrations: 0.05 (normal therapeutic dose), 0.1, 0.2, 0.4, 0.8, and 1.6 mg/ml. No proliferation was observed in any of the cultures containing 1.6 mg/ml pyrimethamine. The results of the cytogenetic evaluations show that the frequency of breaks and gaps increase significantly in dose-dependent manner. Thus, pyrimethamine has a clastogenic effect on human chromosomes.