CD47 expression in urothelial carcinoma and its correlation with histopathological findings

BACKGROUND

The incidence of bladder cancers (BCs) is increasing day by day in both males and females with increased smoking. New treatment protocols are required due to the long follow-up times and high recurrence rates. CD47 (integrin-associated protein) is a membrane receptor that is effective in normal and pathophysiological events such as apoptosis, proliferation, adhesion, and immunity. Phagocytosis of both normal and tumor cells is prevented, by binding to the ligand signal regulatory protein-1 (SIRP-1)α on macrophages. Anti-CD47 antibodies can eliminate the binding and may be effective in treatment.

METHODS

The study included 194 cases with urothelial carcinoma (UC) who underwent transurethral resection (TUR) of the bladder and had been followed up for one year. Cytoplasmic and membranous staining was preferred for CD47-positive staining. Staining results were compared with tumor grades, pathologic tumor stage, recurrence, and metastasis grade.

RESULTS

The prevalence and intensity of CD47 staining in BCs were evaluated in this study. High-grade tumors were stained more pronouncedly compared with low-grade tumors and normal epithelium. The prevalence of CD47 staining was significant in pT2 (Pathological tumor stage 2, invades of muscularis propria) tumors, and its correlation with pTa (Pathological tumor stage a, noninvasive papillary carcinoma) tumors was significant ( P < 0.001). In the intensity evaluation, there was a significant difference between pTa and pT2 and between pT1 (Pathological tumor stage 1, invades lamina propria) and pT2 ( P = 0.003).

CONCLUSION

CD47 is expressed strongly in high-grade tumors. The prevalence and intensity of CD47 staining are high in pathologic tumor stage, recurrence, and distant metastases and are considered poor prognostic markers. We believe that anti-CD47 antibodies can be used as an alternative to the current treatment or in combination with other medications, and the systemic side effects that may occur with intravesical treatment can be prevented.

PSA change after antibiotic treatment should not affect decisionmaking on performing a prostate biopsy

BACKGROUND

To investigate the effect of antibiotic treatment on PSA when deciding on prostate biopsy.

METHODS

A total of 206 patients with an elevated PSA level (2.5-30) were included. Mp-MRI could be done on 129 patients. Patients were given ciprofloxacin (500 mg, b.i.d. p.o.) for 4 weeks and PSA measurements were repeated. Systematic prostate biopsy was performed regardless of PSA changes on all patients. Additionally, cognitive biopsies were performed from PI-RADs III, IV, and V lesions.

RESULTS

: Prostate cancer was detected in 36.4% of patients. 53.3% had Gleason score of 3+3, 46.7% had Gleason score ≥ 3+4. PSA values decreased in 56.3% and in 43.7% and remained the same or increased but cancer detection rates were not different: 34.5% vs. 38.9%, respectively (p = 0.514). PSA change in whole group was significant (6.38 ng/mL vs. 5.95 ng/mL, respectively (p = 0.01). No significant PSA decrease was observed in cancer patients (7.1 ng/mL vs. 7.05 ng/mL, p = 0.09), whereas PSA decrease was significant in patients with benign pathology (6.1 ng/mL vs. 5.5 ng/mL, p = 0.01). In patients with PI-RADs IV-V lesions, adenocarcinoma was present in 33.9% and 30.4% with or without PSA decrease, respectively (p = 0.209). Clinically significant cancer was higher in patients with after antibiotherapy PSA values >4 ng/mL regardless of PI-RADs grouping (p = 0.08). Addition of any PSA value to PI-RADs grouping did not have any significant effect on the detection of cancer.

DISCUSSION

PSA change after antibiotic treatment has no effect in detecting cancer and should not delay performing a biopsy.

Comparison of Scoring Systems in Predicting Success of Percutaneous Nephrolithotomy

Background:

Scoring systems are useful to inform the patients about the success and complication rates of the operation prior the surgery.

Aims:

To determine the applicability of the popular scoring systems (Guy’s, stone size, tract length, obstruction, number of involved calices, and essence/stone density and Clinical Research Office of the Endourological Society) by means of examining preoperative data of patients treated with percutaneous nephrolithotomy.

Study Design:

Cross sectional study.

Methods:

We retrospectively reviewed files of the patients who had undergone percutaneous nephrolithotomy in our center between 2011 and 2015. Excluded from the study were patients aged <18 years, and those who were not assessed preoperatively with computed tomography. Preoperative computed tomography images of all patients were assessed by a single observer, and patients were graded based on three scoring system. Demographic data were analyzed along with perioperative data (operation, fluoroscopy, length of hospital stay, changes in hematocrit values, location, and number of access sites, stone-free and complication rates).

Results:

A total of 298 patients who had been treated with 300 procedures were enrolled into the study. Mean age, stone burden, number of stones, and density were 48.1±12.9 years, 663.5±442.8 mm², 1.8±1.1 and 888.3±273 HU respectively. Scores of the cases based on Guy’s, stone size, tract length, obstruction, number of involved calices, and essence/stone density, and Clinical Research Office of the Endourological Society scoring system were calculated as 2, 7.6, and 222.1 points respectively. 81.6% of the patients were stone-free. Complications were detected in 30 (9.9%) patients. Based on receiver operating characteristic curve analysis a positive correlation was detected between success rate and scoring systems, i.e., Guy’s (p=<0.001, r=-0.309), stone size, tract length, obstruction, number of involved calices, and essence/stone density (p=<0.001, r=-0.295), and Clinical Research Office of the Endourological Society (p=<0.001, r=0.426). The Clinical Research Office of the Endourological Society scoring system had the highest predictive value. The sensitivity rates rates for Guy’s, Clinical Research Office of the Endourological Society and Stone scoring system were as 78.78%, 80% and 82.34% respectively.

Conclusion:

All of scoring systems predicted correctly the success of the percutaneous nephrolithotomy procedures. The Clinical Research Office of the Endourological Society scoring system had the highest predictive value.

A Modified Antegrade Stenting Technique for Laparoscopic Pyeloplasty in Infants and Children

OBJECTIVE

There are 2 critical steps of stent placement during laparoscopic pyeloplasty (LP) in children. Introduction to the ureteropelvic junction and passing through the ureterovesical junction. We aimed at overcoming those 2 steps by creating a modified technique.

METHODS

Consecutive 27 children undergoing transperitoneal laparoscopic dismembered pyeloplasty by a single surgeon were prospectively enrolled into this study. The modifications of our technique are using an Amplatz dilator and a closed tip stent.

RESULTS

The mean age of the children was 6.7 (range 4 months-17 years). The mean time of stent insertion was 2.7 ± 2.0 (2-6) min and the operative time was 128.3 ± 17.6 (90-180) min. The mean number of days of hospital stay was 2.0 ± 0.4 (1-3). After a mean follow-up period of 20.3 ± 4.2 (14-30) months, no operative failure was detected.

CONCLUSION

Our modified technique is a completion of the current armamentarium for stent placement during LP in infants and children.

Impact of percutaneous renal access technique on outcomes of percutaneous nephrolithotomy

BACKGROUND AND PURPOSE

Percutaneous nephrolithotomy (PCNL) is regarded as the gold standard for the treatment of patients with renal stones larger than 2 cm in diameter. Creating a percutaneous renal access is the initial and probably the most important step in performing a PCNL. Two primary methods of obtaining proper percutaneous renal access under fluoroscopic guidance are described: The "triangulation" and the "eye of the needle" techniques. In this article, we compare these two techniques in terms of success and complication rates.

PATIENTS AND METHODS

From October 2010 to May 2011, 80 patients with simple renal stones were prospectively randomized into two groups according to the percutaneous renal access technique used for PCNL. Patients in group 1 (n=40) were assigned to the eye of the needle technique, and patients in group 2 (n=40) were assigned to the triangulation method. Patients needing multiple access points were excluded from the study. The preoperative, operative, and postoperative follow-up findings were thereafter analyzed and compared.

RESULTS

No significant difference between the two groups was detected in terms of patient demographics (mean patient age, body mass index, stone size, or stone location). The operation time, fluoroscopic screening time (FST), and duration of hospitalization were similar in both groups (P=0.52, P=0.32, P=0.26, respectively). Patients in group 1 had a larger drop in hematocrit postoperatively than patients in group 2 (7.6 ± 3.7 vs 4.8 ± 2.1, P=0.001). The blood transfusion rate (7.5%) was similar in both groups, however. Although the complication rate was higher in group 1 than group 2, no significant difference was detected (20% vs 15%, P=0.76).

CONCLUSIONS

The present study demonstrates that PCNL can be performed safely using two different percutaneous access techniques. The two techniques studied in this trial had similar FSTs, operation and hospitalization times, success rates, and complication rates.

Comparison of fine-needle aspiration and open biopsy of testis in sperm retrieval and histopathologic diagnosis

This study aimed to compare the diagnostic value of testicular fine-needle aspiration (FNA) with open biopsy in infertile males with azoospermia or severe oligozoospermia and to evaluate the reliability of testicular sperm extraction by FNA. A total of 76 testes of 40 patients, 34 with azoospermia, four oligozoospermia and two patients who underwent orchidectomy as a result of cancer of prostate were included. Detailed clinical and laboratory examinations were performed and two semen analyses were obtained from each patient. A 20-ml 26 gauge 13-mm needle was used for FNA and smears were stained with May-Grunwald-Giemsa and Papanicolaou stain. An open biopsy was performed in each patient after FNA and the samples were stained with haematoxylen-eosin. Smears and histological stains were examined and compared under light microscopy by the same pathologist. In 69 of the 76 testes (90%) FNA cytology results agreed with the histology. In four testes, the aspirate was unsatisfactory and in three testes, spermatocytic arrest was found cytologically while subsequent biopsies revealed diffuse fibrosis. In 15 of 16 patients (93.7%) with normal and hypospermatogenesis, spermatozoa had been extracted by FNA. Spermatozoa could not be obtained after neither FNA nor open biopsy in the remaining 24 patients. Testicular FNA in infertile males is a simple, reliable and minimally invasive diagnostic tool. It is as effective as open biopsy for testicular sperm extraction and good results can be achieved in experienced hands.

Salivary duct carcinoma ex pleomorphic adenoma: analysis of the findings in fine-needle aspiration cytology and histology

Salivary duct carcinoma (SDC) is an uncommon and highly aggressive neoplasm that reveals histopathologic features resembling infiltrating duct carcinoma of the breast and prostate. SDC arising on the basis of preexisting pleomorphic adenoma (PA) is very rare. This report describes the fine-needle aspiration (FNA) cytology of a case of SDC ex PA. FNA smears were cellular with cells with large, pleomorphic nuclei, some prominent nucleoli, and finely vacuolated cytoplasm. The neoplastic cells were forming groups, sheets, and papillary structures and a cribriform pattern was present in some sheets. Mitotic figures were frequently seen. Necrosis was prominent in the background. Histologic sections of the tumor revealed areas of comedo carcinoma, papillary carcinoma, and infiltrative carcinoma as well as multiple foci of PA. The presence of a cribriform pattern, tumor cells resembling breast ductal carcinoma cells, and a necrotic background are helpful features for an accurate cytodiagnosis of SDC.

Fine-needle aspiration cytology and immunocytochemistry of Hodgkin's disease, suppurative type

We describe 3 cases of Hodgkin's disease (HD) of unusual suppurative type, which were diagnosed on fine-needle aspirates. The smears were dominated by neutrophils, macrophages, and cellular debris. Only a few large, atypical cells of Hodgkin and Reed-Sternberg type were observed. The differential diagnoses of such smears include infectious mononucleosis, tuberculosis, metastatic lymph node involvement, non-Hodgkin's large-cell anaplastic Ki-1-positive lymphomas, T-cell-rich B-cell lymphomas, and peripheral T-cell lymphomas of mixed type. Immunocytochemistry identified the large atypical cells as CD 30 (BerH2)-positive and negative for CD 45 (LCA) in cytospin material from 2 patients, which allowed a conclusive diagnosis of HD.

Fine needle aspiration (FNA) cytology in tuberculous lymphadenitis

Sixty-three lymph node aspirates were screened and 32 aspirates revealing granulomatous lymphadenitis with or without caseation necrosis were re-evaluated. The most characteristic morphological features among these cases were epithelioid cell clusters with or without caseation necrosis. When clusters were thick, careful observation of the periphery of the clusters helped to find epithelioid cells. Caseation necrosis revealed a typical macroscopic and microscopic appearance. Ziehl-Neelsen staining was negative in all smears and histological sections. Polymerase chain reaction (PCR) amplification technique was applied to 23 of the cases in which the cytological diagnoses were consistent with tuberculosis. Mycobacterium tuberculosis was demonstrated in 19 (82.60%) cases.

IN CONCLUSION

(i) it is necessary to perform several aspirations from different sites of the enlarged lymph node; (ii) the diagnosis of 'granulomatous lymphadenitis, consistent with tuberculosis' can be given, even though the acid-fast stains are negative; (iii) additional techniques such as PCR give supportive information; (iv) an open biopsy is recommended if there is a discrepancy with the clinical impression.

Fine needle aspiration cytology of hepatoblastoma. A report of two cases

BACKGROUND

Hepatoblastoma is the most common primary hepatic tumor in children. The literature contains few examples of fine needle aspiration (FNA) cytology of these tumors.

CASES

A 5-month-old and 4-month-old underwent ultrasonography-guided FNA for the preoperative investigation of hepatic masses. The smears were stained with May-Grünwald-Giemsa and Papanicolaou stain. Alcohol-fixed smears were used for immunocytochemistry. All smears revealed cells with round/oval nuclei, prominent nucleoli and vacuolated cytoplasm, arranged in groups and acinar structures. The groups were embedded in a myxoid stroma. alpha-Fetoprotein was positive in all, and vimentin was positive in some tumor cells. The cytologic findings resembled the histologic counterpart in one case, and the other case agreed with the clinical/radiologic prediagnosis. Immunocytochemistry was supportive.

CONCLUSION

FNA cytology can be diagnostic in many other childhood tumors as well as hepatoblastomas. Detailed descriptions of cytomorphologic features of hepatoblastoma will help FNA to be used confidently on these tumors.

Brush technique in ocular surface cytology

New techniques are being searched for the evaluation of cellular morphology and population of ocular surface. Impression cytology is one of the most preferred techniques in ocular surface sampling in dry eye, keratitis, and conjunctivitis. We evaluated and compared the efficacy of impression and brush cytology in 63 patients. All of the samples collected by the brush technique were sufficient for diagnosis: 88% of the slides revealed abundant cells and 12% adequate number of cells. In 21% of the samples observed by impression cytology the cell number was inadequate for diagnosis. In 58% of them the cells were abundant and in 21% few cells were observed. This study proved the value of brush cytology in collecting ocular surface cells.

Histologic alterations in the thyroid gland after fine-needle aspiration

To evaluate the histologic alterations due to the fine-needle aspiration (FNA), a comparative study between 20 aspirated and 20 nonaspirated thyroidectomy specimens was performed. The most common findings in the aspirated group were hemorrhage (80%) and vascular proliferation and/or vascular thrombosis (45%). In one of the aspirated cases with the cytologic diagnosis of follicular neoplasm, histologic sections revealed prominent vascular and endothelial proliferation. Fibrosis, cystic degeneration, and infarction were other histologic findings in the aspirated group. Hemorrhage was seen in 45% and cystic degeneration in 25% of the nonaspirated cases. Fifty percent of the nonaspirated cases did not have any additional findings. In conclusion, knowledge of previous FNA application and awareness of possible histologic alterations due to the needling is necessary while evaluating the histologic sections of the thyroidectomy specimens.

Ultrastructural findings and SOD levels in experimental optic nerve injury: effect of thyroid-releasing hormone on the degenerative and regenerative processes

We performed pressure on the left optic nerves of 24 pigs and injected intravenous thyroid-releasing hormone (TRH) to 12 of these pigs in order to evaluate the degeneration and regeneration in the optic nerves. The histopathologic, ultrastructural and biochemical examinations of the optic nerves were made at the 24th hour, 7th, 15th and 30th days. Although the light-microscopic examinations were normal, ultrastructural changes of the uncompressed optic nerves were interesting. Histopathologic and ultrastructural investigation of the compressed optic nerves showed significant degenerative changes in the non-TRH-applied group. Ultrastructural comparison yielded lighter degenerative changes in the TRH-applied group but there was no clue showing the stimulation of regeneration. We observed increased superoxide dismutase (SOD) levels in the nontraumatized optic nerves due to the cellular stress. The SOD values were found to be low in highly damaged left compressed optic nerves indicating the prevention of SOD enzyme synthesis.