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Epstein Barr virus (EBV) related lymphoproliferative diseases may occur in immunocompromised patients or patients with a history of drug use causing immunodeficiency. EBV positive mucocutaneous ulceration in the new classification of lymphoproliferative diseases in 2016 is very rare in children. Involvement occurs in the skin, oral mucosa, and gastrointestinal system. Gastric involvement is very rare in the literature. There is no case of gastric involvement in children. There are no specified modalities in the treatment of EBV positive mucocutaneous ulceration. We presented our pediatric patient with ataxia telangiectasia who presented with abdominal pain and difficulty swallowing and diagnosed with EBV positive mucocutaneous ulceration in the stomach. We started brentuximab vedotin during the treatment process, and complete remission was achieved after 6 cures of treatment. Our patient is the first case of EBV positive mucocutaneous ulceration in the pediatric case series.

Constitutional mismatch repair deficiency (CMMRD) is an autosomal recessively inherited childhood cancer predisposition syndrome results from biallelic germline mutations affecting the key DNA mismatch repair gene: MLH1, MSH2, MSH6, or PMS2. CMMRD is associated with a high risk of developing early onset of central nervous system tumors, hematological, and intestinal tract tumors. Clinical manifestations, genetic screening, and cancer prevention strategies are limited. In this report we present a patient with metachronous Wilms tumor, glioblastoma, and acute T-cell lymphoblastic leukemia. He had cutaneous features of neurofibromatosis type 1 (NF1). Molecular testing revealed a novel homozygous mutation in MSH6 (c.2590G>T; p.G864) that has not been reported previously. CMMRD should be considered in patients with cutaneous features similar to NF1 if tumor is found other than expected tumors in NF, early onset cancer, and strong family history of cancer.

Objective: The COL6A1 is a gene encoding the alpha 1 polypeptide subunit of collagen 6 (COL6A1), an extracellular matrix protein subunit. Programmed cell death receptor-1 (PD-1) and its ligand, programmed cell death receptor ligand-1 (PD-L1) have been shown to have a prognostic significance in clear cell renal cell carcinomas (RCCs). In this study, we evaluated the expressions of COL6A1 and PD-1 in four different RCC subtypes. Materials and methods: A total of 161 radical nephrectomy and nephron-sparing surgery cases with Ra7s from five different health care centers were included in this study. Clinical data of the cases were taken from electronic records of the institutions. The pathological data were collected by an expert uropathologist and re-evaluated with slides obtained from paraffin blocks of the cases. The correlation of COL6A1 and PD-1 expression with sex, age, tumor type, lymphovascular invasion (LVI), World Health Organization/International Society of Urological Pathology (WHO/ISUP) grade, and tumor stage (pT) was analyzed with the Pearson chi-squared test. Results: Patients with sarcomatoid RCC and clear cell RCC had significantly higher COL6A1 scores and intensities than in other types of RCC (p=0.004 and p=0.002, respectively). WHO/ISUP grade and, COL6A1 and PD-1 staining scores also showed positive correlation (r=0.230, p=0.004 and r=0.277, p=0.001, respectively for COL6A1 and r=0.191, p=0.018 and r=0.166, p=0.041, respectively for PD-1). The staining scores and intensities of COL6A1 and PD-1 were not different between the patients with positive and negative LVI (p>0.05). Conclusion: In high-grade RCCs, we found the relationship between immunohistochemical staining scores of COL6A1 and PD-1 proteins and clinical, demographic, and histopathological parameters. Our results proved that COL6A1 and PD-1 are really promising proteins as prognostic parameters and for targeted immunotherapy. Mersin UniversityMersin University [2017-2-AP3-2425] The authors declared that this study has received Mersin University Scientific Research Projects project, AP3; 2017-2-AP3-2425 as financial support.

Erdheim-Chester disease (ECD) is a proliferative disorder of non-Langerhans histiocytes with a higher incidence in the fifth to seventh decades and rarer occurrence in the pediatric population. Although ECD typically involves bone, it can also affect the central nervous system, cardiovascular system, retro-orbital space, retroperitoneal space, and kidneys, lungs, and skin. A 13-year-old Syrian girl who presented with multisystemic involvement was diagnosed with ECD. The B-Raf proto-oncogene V600E mutation was not detected in ECD lesions. Response to the high-dose interferon-α therapy was excellent in this pediatric patient. In this article, pediatric ECD case reports are also reviewed.

Primary cutaneous diffuse large B-cell lymphoma, leg type is a primary cutaneous B cell lymphoma of aggressive behavior and regarded as a unique entity. We reported a 74 years old female patient who presented with rapidly growing nodules with an ulcer on her left leg for four months. Skin biopsy revealed pathologic findings consistent with diffuse large B-cell lymphoma. We want to emphasize that malignant entities should always be in mind in the differential diagnosis of rapidly growing nodules, plaques, and non-healing ulcers.

Worldwide, clinically detected prostate cancer is the second most common malignancy, with an estimated 1.1 million new cases in 2012. Standard active treatments for prostate cancer include radiotherapy and/or radical prostatectomy (RP) (for clinically localized prostate cancer). Also active surveillance is a management strategy to avoid or delay the potential harms caused by radical treatments. At this point, a pathology report plays a major role. Appropriate handling and systematic examination of a RP specimen is essential for the identification of tumor characteristics such as grade, volume, pathological stage, and surgical margin status. Although some minor differences in macroscobic evaluation may be seen among authors, it is essential to paint and sample the entire prostatectomy specimen. Most prostate tumors are heterogeneous and multifocal compared to tumors of other organs. This makes macroscopic assessment of prostatectomy specimen challenging and sampling of a representative material from the main tumor focus difficult. Also determining tumor burden and to interpret all surgical margins total sampling of the material is essential.

Cutaneous leishmaniasis is caused by a flagellated protozoan transmitted by the bite of a female sandfly. The clinical and demographic details of this disease, predominantly affecting immunocompetent individuals, are recognized by the WHO as a Neglected Tropical Disease. We sought to determine the usability of CD1a immunohistochemical staining to detect amastigotes especially in cases where leishmaniasis is suspected but evident amastigotes could not observed. We also evaluated the relationship between CD1a expression and leishmania subtypes. A total of 84 cases diagnosed with leishmaniasis or suspected leishmania on histo-morphological evaluation of skin biopsies were included in the study. Amastigotes were easily detected in hematoxylin eosin in 18 of 84 cases. In 23 cases, amastigotes could not detect in hematoxylin eosin sections. The immunostains for CD1a are demonstrated amastigotes in 60 of 84 cases. However, a small number of amastigotes became visible by positive staining with CD1a in 43.4% of the cases in that amastigotes could not detected in hematoxylin eosin. A statistically significant correlation was found between amastigote amount in hematoxylin eosin and CD1a expression. In addition, a significant correlation was observed between CD1a expression, age and clinical pre-diagnosis of the cases. It was observed that amastigotes were easily detected in hematoxylin eosin in Leishmania Infantum / donovani positive cases in polymerase chain reaction (PCR), and at the same time, it was found that CD1a expression was significantly higher. Using histopathology examination with CD1a staining and/or PCR methods, a diagnosis of leishmaniasis can be established and early treatment initiated. This contributes to reduce transmission and prevalence.

This report presents a case of collision tumors of low-grade B-cell lymphoma and poorly differentiated adenocarcinoma in the caceum of a 63-year-old woman. Lymphoma was diagnosed incidentally after appendectomy for a clinical presentation of acute appendicitis. Imaging follow-up demonstrated mesenteric lymphadenopathy and liver lesions, and all surgically resected regional mesenteric lymph nodes and liver biopsy were found to be infiltrated by both mucosa-associated lymphoid tissue (MALT) lymphoma and adenocarcinoma. Systemic chemotherapy was administered for advanced colonic adenocarcinoma with liver metastases. The occurrence of synchronous lymphoma and adenocarcinoma of the colorectal region is rare, and this is a previously unreported case of a patient that was diagnosed during management of acute appendicitis.

The number of patients with type 2 diabetes using dipeptidylpeptidase-4 (DPP-4) inhibitors is increasing across the world.Although this class of antidiabetic medications is generallysafe and associated with less side effects compared to otheroral antidiabetic medications, they could also cause some sideeffects such as skin rashes. Herein we report a case of type 2diabetes patient who developed a painful maculopapular rashinduced by linagliptin, a widely used DPP-4 inhibitor.A localized painful maculopapular rash developed on thepalmar faces of the patient’s hands almost 1 day after theinitiation of the drug. The patient was using intensive insulintherapy before linagliptin was started. There was no eruptionon the other body parts except the palmar faces of the hands.Following the discontinuation of the drug, the rash disappearedin about four days. The patient had no history of urticaria anddid not use an ACE inhibitor. As far as we know, this is the firstcase report of a skin rash induced by linagliptin in the Turkishliterature. This case report highlights a rare and lesser knownside effect of linagliptin, a new member of DPP-4 inhibitors. Dipeptidil peptidaz-4 (DPP-4) inhibitörleri kullanan tip 2 diyabet hastalarının sayısı dünya genelinde artmaktadır. Bu antidiyabetik ilaç sınıfı genelde güvenli olmakla birlikte diğer oral antidiyabetik ilaçlarla karşılaştırıldığında daha az yan etki ile ilişkili olsa da, deri döküntüleri gibi bazı yan etkilerle ilişkili olabilirler. Burada yaygın olarak kullanılan bir DPP-4 inhibitörü olan linagliptin ile indüklenen ağrılı makülopapüler döküntü gelişen tip 2 diyabetli bir hastayı sunuyoruz. Linagliptin başlandıktan 1 gün sonra hastamızın ellerinin palmar yüzünde lokalize ağrılı makülopapüler bir döküntü gelişti. Linagliptin başlanmadan önce hasta intensif insülin tedavisi altındaydı. Vücudun diğer bölgelerinde herhangi bir döküntü yoktu. Linagliptin kesildikten sonra 4 gün içerisinde döküntü kayboldu. Hastanın ürtiker öyküsü yoktu ve Anjiyotensin dönüştürücü enzim inhibitörü kullanmıyordu. Bildiğimiz kadarıyla bu, Türk literatüründe Linagliptine bağlı deri döküntüsü geliştirdiği rapor edilen ilk olgudur. Bu olgu sunumu, DPP-4 inhibitörlerinin nadir görülen ve daha az bilinen bir yan etkisini vurgulamaktadır.

A 58-year-old male patient was admitted to cardiology clinic with the complaint of color change of his face. On his medical history he had previous myocardial infarction, coronary bypass, ventricular tachycardia. He had left venrticular systolic dysfunction and an intracardiac defibrillator. He did not have any dyspnea and he was Class I symptomatic according to New York Heart Association Classification. He had 35% left ventricular ejection fraction on transtorasic echocardiogram. He was taken amiodarone 400 mg/daily about 5 years, ramipril 2.5 mg/daily, asetil salicylic acid 100 mg/daily, sotalol 160 mg/daily. It was thought that the color change on the face of the patient using amiodarone was related to drug use and directed to dermatology for biopsy (Fig. 34.1).

WOS:000544516800001 PubMed ID: 32597278 Background:Prediction of prognosis in Immunoglobulin A Nephropathy (IgAN) and taking appropriate precautions may reduce annual incidence of chronic kidney disease. This may be possible by close follow-up for the development and progression of interstitial fibrosis (IF) or interstitial fibrosis/tubular atrophy (IFTA) in IgAN patients. Aim:To investigate whether Young's elastic modulus (YM) which measured shear wave elastography (SWE) might be used for follow-up of IF or IFTA in IgAN patients. Methods:Prospective study was approved by Human Research Ethics Committee. Group 1 consisted of patients with IgAN. Group 2 consisted of healthy control participants. Young's elastic modulus which is a value of stiffness along with longitudinal stiffness was used to evaluate tissue elasticity. Specificity, sensitivity, positive predictive value (PPV) of YM for the presence of IF and IFTA were evaluated. Results:Group 1 consisted of 30 participants, and group 2 consisted of 32 participants. Sensitivity and specificity of SWE to diagnose presence of IF for YM > 15 kPa were 89% and 90%, respectively. PPV among the ones whom IF was diagnosed by YM >15 kPa was 91%. Sensitivity and specificity of SWE to diagnose presence of IFTA for YM > 15 were 65% and 51%, respectively. PPV among the ones whom IFTA was diagnosed by YM >15 kPa was 78.1%. Conclusions:YM which measured SWE is highly specific and sensitive in the diagnosis of IF, but not for IFTA in IgAN patients. Therefore, progression for IF in IgAN may be followed by SWE.

A 50-year-old male patient presented to a dermatology clinic with a mass on the neck (Fig. 39.1) and a biopsy was performed from the lesion.

A 71-year-old man presented to the dermatology outpatient clinic because of pigmented lesions on his inguinal area. In the inguinal area, 5 cm diameter, verrucous pigmented lesion was observed dermoscopic examination of this lesion revealed fissures and ridges cerebriform appearance, hairpin blood vessels, and moth-eaten border (Fig. 38.1). Verrucous carcinoma and melanoma were considered and biopsy was taken.

Background Adhesion formation is a common complication of abdominal surgeries. Mesna is a drug with fibrinolytic properties which has been used in surgical field to facilitate tissue dissection. The aim of this experimental animal study was to investigate the effect of mesna on prevention of intra-abdominal adhesion in rats. Materials and methods Twenty-eight Wistar albino rats were used in the study. To create abdominal adhesion, cecum was abraded in all rats. No additional surgical procedure was performed other than adhesion in group 1 (only adhesion). In the other groups, rats were treated topically by administering 0.9% saline (group 2), 40 mg/kg mesna (group 3), and 400 mg/kg mesna (group 4). All rats were sacrificed on postoperative 21st day. Histopathological and macroscopic evaluations of adhesion formation were performed. Results Quantity of adhesion scores (P = 0.022), severity of adhesion scores (P = 0.041), total adhesion scores (P = 0.023), and histopathological adhesion grading scores (P Conclusions This is the first study for mesna on prevention of abdominal adhesion formation in rats. We concluded that dose-dependent reduction of adhesion was achieved by mesna. With future studies, topical administration of mesna during open abdominal surgeries may be used to prevent adhesion formation.

WOS:000388501500004, PubMed ID: 27909615, Objective: Methotrexate (MTX) leads to acute toxic side effects in tissues or organs containing rapidly dividing cells such as seminiferous tubules. In this study, we investigated the protective effects of vitamin C against MTX-induced injury in rat testis.Material and methods: A total of 31 rats were divided into 4 groups, including the control group. The study was completed within 4 weeks and the rats received daily doses of 2 mL/kg SF, 100 mg/kg vitamin C and 10 mg/kg/day MTX i.p according to their groups. The mean seminiferous tubular diameter, germinal epithelial cell thickness, and mean testicular biopsy score were determined by histologic examination of each group.Results: The vitamin C MTX group showed more similarity with the control group. Statistically significant results were achieved between groups as for mean seminiferous tubular diameter, germinal epithelial cell thickness, and mean testicular biopsy score. When compared with the group which received vitamin C after MTX therapy, values for mean seminiferous tubular diameter, germinal epithelial cell thickness, and mean testicular biopsy score were significantly higher in the group which received vitamin C before initiation of MTX therapy.Conclusion: Vitamin C decreased MTX-induced testicular histological injuries, especially when used before MTX therapy.

Intranodal palisaded myofibroblastoma (IPM) is a benign mesenchymal neoplasm originating from smooth muscle cells and myofibroblasts. The inguinal region is the most common site of this rare tumor. As there are only about 89 such cases reported in the literature, the precise etiology and pathogenesis have yet to be explained adequately. It is characterized by spindle cells, amianthoid fibers, and by the proliferation of hemosiderin-containing histiocytes in the lymph node. A nodular lesion was excised from the inguinal region of a 47-year-old female patient with the clinical diagnosis of lymphoma and/or metastase. Macroscopic examination of a section of the lesion demonstrated a solid appearance. Microscopic examination revealed spindle-cell proliferation, amianthoid fibers, hemosiderin pigment, and extravasated erythrocytes. Nuclei of the spindle cells displayed a palisaded appearance. Compressed lymphoid tissue was observed around the lesion. Neoplastic cells were identified by the presence of vimentin, SMA, Cyclin D1, and beta-catenin. The Ki67 index was less than 1%. Histological examination confirmed the diagnosis of IPM. Although IPM is benign, it is frequently confused with metastatic lesions and lymphomas.

Ozel Vizyon Goz Dal Hastanesi, Mersin, Turkiye *Mersin Universitesi Tip Fakultesi, Patoloji Anabilim Dali, Mersin, Turkiye **Hitit Universitesi Tip Fakultesi, Deri ve Zuhrevi Hastaliklar Anabilim Dali, Corum, Turkiye ***Cankiri Devlet Hastanesi, Patoloji Klinigi, Cankiri, Turkiye ****Cankiri Devlet Hastanesi, Plastik Cerrahi Klinigi, Cankiri, Turkiye *****Ankara Universitesi Tip Fakultesi, Biyoistatistik Anabilim Dali, Ankara, Turkiye @Telif Hakki 2014 Turk Dermatoloji Dernegi Makale metnine www. turkdermatolojidergisi.com web sayfasindan ulasilabilir. @Copyright 2014 by Turkish Society of Dermatology Available on-line at www.turkdermatolojidergisi.com Engin Senel, Hitit Universitesi Tip Fakultesi, Deri ve Zuhrevi Hastaliklar Anabilim Dali, Corum, Turkiye Tel.: +90 364 223 03 00 E-posta: enginsenel@enginsenel.com Gelis Tarihi/Submitted: 12.05.2014 Kabul Tarihi/Accepted: 12.05.2014 Yazisma Adresi/ Correspondence: Objective: To assess the demographic, clinical and histopathological features of eyelid tumors. Methods: The records of the patients who have been operated for eyelid tumors at ophthalmology and plastic surgery clinics of our Hospital, between the years of 20112013 were evaluated retrospectively. Results: Fifty-four (40.9%) male and 78 (59.1%) female totally 12 patients of mean age 45 years (4-85) were recruited in this study. The location of tumor was upper lid in 74 (56.1%) patients, lower lid in 58 (43.9%) patients. Malign lid tumor was found in 8 patients of mean age 68.1 years (3 cases squamous cell carcinoma, 5 cases basal cell carcinoma). Benign lid tumours were found in 124 (93.9%) patients of mean age 43.1 years. Most commonly detected lid tumor was melanocytic dermal nevus in 39 cases (29.5%). Papilloma was seen in 36 (27.3%) patients, xanthelesma in 23(17.4%) patients, epidermal inclusion cyst in 14 (10.6%) patients, and seborrheic keratosis in 12 (9%) patients. Most commonly seen lid tumor was melanocytic nevus in females (34.6%) and papilloma in males (35.1%). Conclusion: In our study most commonly detected benign eyelid tumor was melanocytic nevus and most commonly detected malign eyelid tumor was basal cell carcinoma. Most of the eyelid tumours were benign. Benign tumours were most commonly seen between the age of 40-50 years and malign tumours between the ages of 60-70 years.

SUMMARYGastrointestinalStromal Tumors (GISTs) are mesenchymal tumors that are arises from the wall ofthe gastrointestinal tract and is throught to originate from the InterstitialCells of Cajal (ICC), which regulate the motility of the gastrointestinaltract. More rarely neoplasms with histology and immunohistochemistry similar togastrointestinal stromal tumors may ocur outside the gastrointestinal tract andare so-called Extra-gastrointestinal Stromal Tumors (EGISTs). Surgical removal is the gold standard treatment fornon-metastatic Extragastrointestinal stromal tumors. We reported a very rarecase of ekstragastrointestinal stromal tumor arising from the vulva in thisarticle., ÖZETGastrointestinalStromal Tümörler (GİST), gastrointestinal sistem duvarı peristaltizmini düzenleyenİnterstisyel Cajal Hücreleri’nden (İCH) kaynaklandığı düşünülen mezenkimaltümörlerdir. Ekstragastrointestinal StromalTümörler (EGİST) daha nadir görülen, histoloji ve immünohistokimlyasal açıdangastrointestinal stromal tümörler ile benzer ancak gastro intestinal yolakdışında oluşan tümörlerdir. Metastatik olmayan ekstragastrointestinal stromaltümörlerin cerrahi olarak çıkarılması altın standart tedavidir. Bu makalede,nadiren vulvadan köken alan ekstragastrointestinal stromal tümörlü bir olgusunduk.

Erdogan, Kivilcim Eren/0000-0002-4951-8703; kilic bagir, Emine/0000-0002-1447-1060; Celik, Betul/0000-0001-9731-9939; Tatli Dogan, Hayriye/0000-0003-4318-2775; Cakir, Asli/0000-0003-0128-6947 WOS: 000414649400006 PubMed: 28272675 Objective: There is no other screening program close to the success rate of PAP test. Cervical cytology constitutes a large workload so that quality control in cervical cytology is important for the quality assurance of pathology laboratories. Material and Method: In this study, we collected the cervical cytology results from all over Turkey and discussed the parameters influencing the quality of the PAP test. The study was conducted with Turkish gynaecopathology working group and 38 centers (totally 45 hospitals) agreed to contribute from 24 different cities. The study was designed to cover the cervical cytology results during 2013. The results were evaluated from the data based on an online questionnaire. Results: The total number of Epithelial Cell Abnormality was 18,020 and the global Epithelial Cell Abnormality rate was 5.08% in the total 354,725 smears and ranging between 0.3% to 16.64% among centers. The Atypical squamous cells/Squamous intraepithelial lesion ratios changed within the range of 0.21-13.94 with an average of 2.61. When the centers were asked whether they performed quality assurance studies, only 14 out of 28 centers, which shared the information, had such a control study and some quality parameters were better in these centers. Conclusion: There is an increase in the global Epithelial Cell Abnormality rate and there are great differences among centers. Quality control studies including the Atypical squamous cells/Squamous intraepithelial lesion ratio are important. Corrective and preventive action according to quality control parameters is a must. A cervical cytology subspecialist in every center can be utopic but a dedicated pathologist in the center is certainly needed.

Objective:Mesna (i.e. sodium 2-mercaptoethanesulfonate; C2H5NaO3S2) has been used in otological surgery such as cholesteatoma dissection and tympanic membrane lateralisation in atelectatic ears. However, this study aimed to investigate its effect on cholesteatoma formation.Methods:A total of 20 Wistar rats were divided into two groups of 10 animals. The right and left ears of control animals were treated with saline (saline control group; n = 10 ears) and propylene glycol plus saline (propylene glycol control group; n = 10 ears), respectively. In the mesna group, both ears were treated with propylene glycol plus mesna (n = 20 ears). On days 1, 8 and 15, the saline control group had intratympanic injections of 0.2 ml saline and the propylene glycol control and mesna groups had intratympanic injections of 0.2 ml 100 per cent propylene glycol. On day 22, the propylene glycol control group had a single intratympanic injection of 0.2 ml saline and the mesna group had a single intratympanic injection of 10 per cent mesna. Animals were killed 12 weeks after the last injection and the temporal bones were sent for histopathological evaluation.Results:The cholesteatoma formation rate was 88 per cent in the propylene glycol control group, but was significantly lower in the mesna group (p = 0.01). There were no significant differences in granulation tissue formation (p = 0.498), cyst formation in the bulla (p = 0.381), fibrosis (p = 0.072) and epithelial hyperplasia (p = 0.081) among experimental groups.Conclusion:Intratympanic propylene glycol administration is an effective method of promoting experimental cholesteatoma formation. Administration of a single dose of intratympanic mesna inhibited cholesteatoma formation in an animal model.

Cholesteatoma in the urinary system is a rarely seen benign condition. Rosina firstly defined this condition in the year 1953. Histopathologically it is characterized with keratinization, and squamous metaplasia of urothelial epithelium associated with desquamation of keratinized layers. Flank pain is the most common symptom that is caused by elimination of keratinous material. In our case we will discuss cholesteatoma developed in an ectopic kidney which has not been described in the literature before.

Objectives: The aim of this study is to measure the effect of c-myc oncogene and matrix metalloproteinase-2 enzyme expression on metastasis and prognosis of malignant melanoma. At the end of this study, we hope to get information about the prognosis of melanoma, to be helpful for choosing the treatment strategy. Methods: Sixty-three patients treated in our hospital during 2006-2015 were included in this study. All clinical and histological parameters were collected from each patient’s records and survival rate is assessed. Forty-seven suitable tumor specimens were assessed by immunohistochemical stains and analyzed for the c-myc and MMP-2 positivity. All results were evaluated statistically for the effect on melanoma metastasis and survival rate. Results: C-myc positivity and MMP-2 positivity decreases the survival rate of melanoma. MMP-2 positivity increases the risk of death four more times. Conclusions: So this study confirms that we can evaluate c-myc and MMP-2 as a prognostic factor.

Pancreatic involvement of non-Hodgkin lymphoma is extremely rare in childhood and can be overlooked in differential diagnosis of pancreatic masses. In this report we describe a 10-year-old boy who presented with pancreatitis and obstructive jaundice, which was the result of pancreatic involvement of Burkitt lymphoma. [Med-Science 2016; 5(2.000): 694-701]

Hitit Universitesi Tip Fakultesi, Deri ve Zuhrevi Hastaliklari Anabilim Dali, Corum, Turkiye *Cankiri Devlet Hastanesi, Patoloji Laboratuvari, Cankiri, Turkiye **Cankiri Devlet Hastanesi, Goz Hastaliklari Klinigi, Cankiri, Turkiye ***Ankara Universitesi Tip Fakultesi, Biyoistatistik Anabilim Dali, Ankara, Turkiye @Telif Hakki 2014 Turk Dermatoloji Dernegi Makale metnine www. turkdermatolojidergisi.com web sayfasindan ulasilabilir. @Copyright 2014 by Turkish Society of Dermatology Available on-line at www.turkdermatolojidergisi.com Engin Senel, Hitit Universitesi Tip Fakultesi, Deri ve Zuhrevi Hastaliklari Anabilim Dali, Corum, Turkiye Tel.: +90 364 223 03 00 E-posta: enginsenel@enginsenel.com Gelis Tarihi/Submitted: 29.04.2014 Kabul Tarihi/Accepted: 30.04.2014 Yazisma Adresi/ Correspondence: Objective: Epidemiological studies are essential on the prevention and resolution of health problems. The aim of this study was to investigate skin biopsies in Cankiri region. Methods: A total of 2128 patients admitted to our dermatology outpatient clinic and their 2128 lesions were retrospectively analyzed. The demographic characteristics, the localizations and types of lesions were obtained from dermatology and pathology records for the statistical analyses. Pathology slides were retrospectively re-examined and diagnoses were confirmed. Results: Melanocytic nevus was the most common diagnosis of the skin tumors (27%, n=574) followed by cystic tumor, soft fibroma/acrochordon and psoriasis. In general, cheeks and lips were the most common tumor location (21.7%). The youngest population was the patients with molluscum contagiosum (25.00±11.04 years) and the oldest group of patients was the ones with squamous cell carcinoma (SCC) (71.69±12.79 years). The most common malignant tumor was basal cell carcinoma (BCC) (74%, n=92). BCCs were mostly localized on nose (35.9%). SCC was the second most common malignant tumor (26%, n=32). There was no statistically significant difference between two malignant tumor groups in terms of age. Conclusion: Malignant tumor ratios were consistent with the literature in Cankiri region. Increase in epidemiological researches may provide the opportunity to compare with other studies and facilitate health management planning.

PURPOSE Intra-arterial injection of medications are related to mortality and morbidity. It was aimed to investigate the histopathological effects caused by two different intra-arterial doses of sugammadex, a new selective relaxant binding agent used to reverse the effects of steroidal systemic muscle relaxants used in surgeries carried out under general anesthesia. METHODS A total of 15 rabbits were randomly divided into 3 groups. The control group was given 1 mL saline bolus into the central artery of the ear. The other two groups (Group Sgdx2 and group Sgdx16) were given 2 and 16 mg/kg sugammadex, respectively, intra-arterially. RESULTS In control group, histopathological evaluation was in normal limits. The cross-sections belonging to Group Sgdx2 did not have any significant pathological change compared with control group (p > 0.05). Edema and single-cell necrosis were significantly higher in Group Sgdx16 when compared to control group (p < 0.05). In comparison to Group Sgdx2, single-cell necrosis was significantly higher in Group Sgdx16 (p < 0.05). CONCLUSION Being broadly used in anesthesia, sugammadex should be administered with care because when given by intra-arterial route it may cause tissue damage and tissue loss and the patients' arteries should be carefully checked.

BACKGROUND: Hair follicle nevus is a rare, congenital hamartoma with follicular differentiation characterized histologically by numerous, tiny, mature hair follicles. Trichofolliculoma, the histopathological features of which are quite similar to those of hair follicle nevus, is also a hamartoma that differs from hair follicle. Accessory tragus is a relatively common, benign congenital abnormality of the external ear with an incidence rate of 1 to 10 per 1,000 live births. OBJECTIVE: This study seeks to assess the discriminatory value of currently available, histological criteria in the differential diagnosis of hair follicle nevus, accessory tragi and trichofolliculoma. METHODS: Twenty-one patients comprising 9 cases of hair follicle nevus, 8 accessory tragi patients and 4 trichofolliculoma cases, were recruited to perform the study. RESULTS: There were 10 males and 11 females in the study group. No significant difference was observed between the three study groups in terms of age, gender or histopathological parameters such as density of hair follicles, subcutaneous fat score and presence of connective tissue framework. Cartilaginous component was seen in 8 cases that were diagnosed as accessory tragi, while central cyst and radiating hair follicles were seen in 4 cases which were diagnosed as trichofolliculoma. CONCLUSION: The results of our study showed that diagnostic discrimination of these diseases could be made only with the clinicopathologic correlation because of their clinical and histopathological similarities. © 2015 by Anais Brasileiros de Dermatologia.

cysts derived from hair follicles: a series of 20 cases evaluating the spectrum of changes resulting in scrotal calcinosis. Am J Dermatopathol 2007;29:172-5. doi: 10.1097/01. dad.0000246465.25986.68, Yirmi yaşındaki erkek hasta yaklaşık on yıldır skrotumunda mevcut olan ağrısız şişlikler nedeniyle Deri ve Zührevi Hastalıklar polikliniğine başvurdu. Dermatolojik incelemede skrotumda çok sayıda, iyi sınırlı, hassas olmayan, sert subkutan nodüller gözlendi (Şekil 1). Sistemik, metabolik, endokrin hastalık ve ilaç kullanım öyküsü bulunmayan hasta, skrotumda travma ve enfeksiyöz hastalık da bildirmedi. Kalsiyum, fosfor ve parathormon içeren laboratuvar tetkik sonuçları normal olarak saptandı. Hastanın isteği üzerine büyük lezyonlar plastik cerrahi bölümünce eksize edilerek patoloji bölümüne histopatolojik inceleme için gönderildi.

Background and Aims: We aimed to document upper and lower gastrointestinal system polyps in our center according to their types. Materials and Methods:271 gastrointestinal polyps that were histopathologically diagnosed at Çankırı State Hospital during the period 2011-2012 were included in the study. Polyps were noted according to their localization and histopathologic types.Results:69.4% of the patients were males and 30.6% were females, and their mean age was 61.7 years. The mean diameter of the polyps was 8 mm. 233 of the polyps were located in the colon and the remainder in the stomach. Colonic polyps were most commonly seen in the rectum (36.2%), while gastric polyps were most commonly seen in the antrum (6.3%). Colonic polyps were most common in males, while gastric polyps were most common in females. Conclusions:In this study, in which we evaluated upper and lower gastrointestinal polyps separately, our results were found to be similar to those reported in the literature, Amaç:Çalışmadaki amacımız merkezimizde tanı alan üst ve alt gastrointestinal sisteme ait polipektomi materyallerinin histopatolojik tipleri ile birlikte dökümante edilmesidir. Gereç ve Yöntem:Çalışmada Çankırı Devlet Hastanesi Patoloji Laboratuvarında 2011- 2012 yılları arasında histopatolojik tanı verilen 271 adet gastrointestinal polip olgusu retrospektif olarak incelendi. Yerleşim özellikleri ve histopatolojik tiplerine göre polipler kaydedildi. Bulgular: Hastaların %69,4'ü erkek, %30,6'sı kadındı. Yaş dağılımı 2-91 yıl arasında değişmekte olup, yaş ortalaması 61,7 yıl, ortalama boyut 8 mm olarak saptandı. Gastrointestinal sistem polipleri yerleşim bölgeleri açısından değerlendirildiğinde 271 olgunun 233'ü kolon, 38'i mide yerleşimliydi. Kolon yerleşimli poliplerin büyük kısmının rektumda (%36,2), mide yerleşimli poliplerin ise büyük kısmının antrumda (%6,3) oldukları saptandı. Gastrointestinal sistem poliplerinde histopatolojik tipler açısından en büyük hasta grubunu 161 (%59,4) olgu ile tübüler adenom oluştururken, bunu 63 (%23,2) olgu ile hiperplastik polipler takip etmekteydi. Kolondaki polipler erkeklerde daha sık görülürken, mide lokalizasyonlu polipler kadınlarda daha sık saptandı. Tartışma:Üst ve alt gastrointestinal sisteme ait polipleri ayrı ayrı değerlendirdiğimiz çalışmamızda genel olarak tüm sonuçlarımızın literatür ile uyumluluk halinde olduğu görüldü

WOS: 000363982500014, PubMed ID: 25786895, Background Dermatology literature lacks a study investigating both histopathological and dermatoscopic features of dermatofibroma. Objective To analyse histopathological, dermatoscopic and digital microscopic features of dermatofibromas. Methods Two hundred dermatofibromas and 190 patients were included and retrospectively evaluated. Nine histopathological and ten dermatoscopic patterns were used to classify the lesions. We identified four different types of dermatofibroma in digital microscopy. Results The mean age of the patients was 42.18 +/- 13.72 years. Dermatofibroma was more common in females (67%) and the male to female ratio was 1 : 1.97. The most common location was leg (41%). The most frequent histopathological variant was fibrocollagenous type (49%). Grenz zone was the most common histopathological finding (89%). The most frequent digital microscopic type was type 1 (63%). Conclusions We found that palisading variant displayed only pattern 6 in dermatoscopy and cellular variant showed type 3 significantly in digital microscopy.

Desmoplastic neurotropic melanoma (DNM) is known as a rare variant of cutaneous melanoma. The authors defined the term `neurotropic' which is used to refer to the associated nerve infiltration or neural differentiation. A 74-year-old female applied to the plastic surgery clinic with a one-year history of a nodule in the left infraorbital skin. The lesion was excised by the surgeons and was sent to the pathology department. The tumor with spindle cells in a scar-like stroma was detected microscopically and diagnosed as a `dermatofibroma'. Eight months after surgery, a deep-seated nodule recurred at the same place. This nodule was re-excised. In this sample, we observed hypercellularity, atypical mitoses and nerve infiltration of the spindle tumor cells having strong positive staining with S-100 protein and negative staining with HMB-45, thus, the ultimate diagnosis was DNM. The differential diagnosis of this lesion includes many benign and malignant entities. This is crucial because of the potential for recurrence and metastasis of the lesion.

WOS: 000340257800020 PubMed: 25006940 Oropharyngeal and tonsillar masses are a very rare cause of dysphagia in children. In this article, we describe a rare cause of dysphagia in children, a lymphangiomatous lesion of the palatine tonsil, and discuss the clinical and histopathologic features of these lesions.

Background/Aims: The aim of this study is, therefore, to classify appendiceal serrated polyps in a large case series with respect to the recent World Health Organization classification using diagnostic criteria provided for colorectal serrated polyps. Materials and Methods: A total of 960 appendix specimens diagnosed between 2005 and 2010 were reviewed retrospectively, and cases presenting with a polyp with serrated morphology were classified with reference to the recent World Health Organization criteria. Histologic criteria comprised architectural features of the crypts, including serration, branching, basal dilatation, inverted T- or L-shaped crypts together with cytologic features comprising a mucin pattern, dysplasia, in terms of pseudostratification and nuclear atypia, mitoses in the upper crypts, and cytoplasmic eosinophilia. Results: A total of 71 cases (7.39%) were diagnosed as serrated polyps, including 36 (50.7%) hyperplastic polyps, 33 (46.48%) sessile serrated adenoma/polyps, and 2 (2.81%) traditional serrated adenomas. There were 32 males and 39 females with an age range of 2 to 82 years. Histology revealed that the majority of both hyperplastic polyps (63.9%) and sessile serrated adenomas/polyps (74.3%) involved the entire appendiceal circumference. Basal dilatation (94.3%), basal serration (94.3%), T-/L-shaped crypts (94.3%), and ectopic crypts (68.6%) were significantly more commonly observed in sessile serrated adenomas/polyps compared to hyperplastic polyps. Dysplasia was observed in 31.4% of sessile serrated adenomas/polyps, while hyperplastic polyps did not show dysplasia. Conclusion: The results of the present study suggest that appendiceal serrated polyps, despite bearing many similarities with their colorectal counterparts, may have some special features due to the anatomic uniqueness of the organ itself and also the polyps arising from its mucosal lining.

A 60-year-old woman presented with a 2-year history of two large nodules on her head. She also reported a 1-year history of intermittent mild headache. On physical examination, two nodules were seen, located on the occipital region of the patient’s head. The larger nodule was 51 9 45 mm in size, of a greyish-white colour, and was ulcerated, lobulated and sharply demarcated from neighbouring structures (Fig. 1). The smaller nodule was smooth and rounded, with a diameter of 39 mm (Fig. 1). Both nodules were totally excised and sent for histological examination.

A 54-year-old woman with immune thrombocytopenic purpura (ITP) referred to our dermatology department with a three-week-history of a purple-colored lesion on her right arm. The patient was on treatment with oral prednisone at 20 mg/day for ITP and levothyroxine at 25 mg/day for hypothyroidism. No topical treatment was prescribed or used before our consultation. Dermatological examination revealed a 12.5 x 7.5 mm solitary purple papule located on the right upper extremity (Figure 1). Dermatoscopic examination disclosed bluish-red coloration (Figure 2). Surgical excision of the lesion was performed. Histopathological examination of the lesion revealed nodular vascular proliferation in dermis, pronounced congestion and extravagated erythrocytes (Figure 3). What is your diagnosis? What is your diagnosis? A solitary purple papule on the arm

Pyogenic granuloma (PG) is a rare side effect of isotretinoin therapy. Oral pyogenic granuloma developing during isotretinoin treatment has not been reported so far. A 22-old-male patient, who had been given oral isotretinoin treatment for severe nodular acne, was admitted with the complaint of a painless and red nodule in his lower gum at the end of the second month of the treatment. The patient did not report any history of trauma or dental treatment. Dermatologic examination revealed a hemorrhagic nodule measuring 1.5x1 cm in size in the lower gums of the cutting and canine teeth. The lesion was excised completely. Histopathological examination disclosed acanthosis and hyperkeratosis in epidermis, subepidermal vascular proliferation, edema, and sparsely scattered inflammatory cell groups. The mechanism by which isotretinoin causes pyogenic granulomas is not exactly known. It should be considered that this rare side effect can be gingival in patients taking isotretinoin and the regular oral examination should not be neglected. WOS:000351336800012

Below is the answer to the quiz by Dr. Senel et al presented in the previous issue of Dermatology Practical & Conceptual [2014;4(4):13]. Diagnosis: Kaposi sarcoma. Kaposi sarcoma (KS) was first described by Kaposi in 1872. There are four clinical types of the disease: classic, endemic, epidemic and iatrogenic [1]. Iatrogenic KS develops in patients taking immunosuppressive treatment. Bluish-reddish coloration is seen in 84% of KS lesions in dermatoscopy. Rainbow pattern and scaly surface are other dermatoscopic features of KS (36% and 15%, respectively) [2]. Multicolored rainbow pattern is the most diagnostic appearance of KS in dermatoscopic evaluation and is associated with vascular lumen-rich histological sub-type [3]. This pattern can be rarely seen in the dermatoscopy of melanoma [4]. Congratulations to Dr. Arina Vashkevich (ur.liam@khsavaa), who was the first to send us the correct answer!

Intraosseous ganglia of the proximal humerus are rare and their etiology is unknown. This report describes a case of an intraosseous ganglion of the proximal humerus. The patient was a 47-year-old woman with a painful left shoulder with a limited range of motion. On magnetic resonance imaging a cystic lesion of the proximal humerus was detected. There was no communication between the cyst and the joint space. On macroscopic examination, a multiloculated cystic lesion was seen. Microscopically it was clear that it was a cyst of intraosseous ganglia. At 2 weeks after the surgery, the patient was almost free of pain. Though there were few reports earlier, the pathological feaures were not highlighted. We describe here more about the pathologic features of the lesion.