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Introduction: Paragangliomas are tumors of neuroendocrine origin, may appear in different localizations, and are related to the autonomic nervous system. Paragangliomas are generally asymptomatic and may rarely appear with adrenergic symptoms, and clinical findings depend on the catecholamines they secrete. Extra-adrenal paragangliomas are mostly benign, like all paragangliomas. Malignancy criteria consist of local recurrence, metastasis after total resection, and presence of distant metastasis during primary diagnosis. Case Presentation: This report presents the case of a 31-year-old man with jugular paraganglioma, multiple skeletal metastases, and a long-segment tumor thrombus. Imaging procedures showed a continuous tumor thrombus extending from the posterior fossa to the right atrium and metastases in C2, T1, T6, T8, L5, and right humerus. Histopathological assessment of the metastasis in C2 identified malignant paraganglioma. Curative surgery was not an option for this patient, hence combined chemotherapy was given. Conclusion: In cases of malignant paraganglioma with multiple distant metastases, chemotherapy and radiotherapy are feasible treatment methods.

Introduction: Extraneural metastases of glioblastoma are very rare clinical entities, especially in pediatric patients. Because of their rarity, they can be confused with other pathological processes. Case Presentation: We report a case of 16-year-old boy with extensive extraneural metastases of glioblastoma. Lung, liver, cervical lymph nodes, skin, and bone metastases were detected in the patient. Conclusion: We describe the presentation, evaluation, and diagnosis of this rare condition with regard to pertinent literature.

Purpose: The aim of the study was to review our clinical 7 years experiences with silent corticotroph adenoma (SCA) and Cushing disease (CD) with regard to clinical, radiological features, immunohistochemical and surgical outcomes and compare the results between two groups. Material and Methods: We retrospectively reviewed a series of patients (n=17; SCA 10, CD 7) with corticotroph adenomas and collected biochemical, neuroradiological and pathological data of those during follow-up time. Results: Mean pre-operative ACTH values of the patients with CD and SCA were 60.4±29.5, 45.5±34.6 pg/mL, respectively. Mean preoperative cortisol of the patient with CD (21.2±4.4 vs 11.5±4.0 mcg/dL) was increased than the patients with SCA measurements’. Patients with SCA had larger pituitary mass (20.4±4.5 vs 8.8±4.0 mm) than the patients with CD. And cavernous sinus invasion also was determined in all patients with SCA. Sparsely granulation staining was more common in all patients with SCA (7/10) or CD (4/7). Conclusion: SCAs are totally different from functional CD adenomas related with clinical characteristics and postoperative outcomes. SCA can be thought of as a diverse group of pituitary adenomas.

Neuroendocrine carcinomas (NECs) of the urinary bladder are rare and aggressive, without an effective treatment approach. Immune checkpoint inhibitor agents targeting the interaction of programmed cell death protein 1 (PD-1) and programmed death ligand 1 (PD-L1) have been approved for urothelial carcinoma, but their use for small-cell carcinoma (SmCC) of the urinary bladder is unclear. Thus, we analyzed PD-1 and PD-L1 expression in NECs, particularly in SmCC of the urinary bladder. We used PD-1 antibody and two different biomarkers for PD-L1 antibodies, Ventana SP263 (Ventana Medical Systems, Inc.) and AM26531AF-N (Acris Antibodies GmbH). Among the 12 SmCC cases, 16.7% stained positive on immune cells for PD-1 and 33.0% for PD-L1. PD-L1 positivity on tumor cells was 25.0% of SmCC cases. The overall survival was shorter in PD-L1-positive patients compared with PD-L1-negative patients (15.4 months vs. 27.6 months). Large cell carcinoma (n = 1) was strongly and diffusely stained with PD-L1, and this case had the longest survival (68 months) in the group. Immune checkpoint inhibitors may be an alternative treatment option in SmCC of the urinary bladder. Furthermore, the absence of PD-L1 may be a good prognostic parameter.

Merkel cell carcinoma (MCC) is a rare and lethal type of skin cancer characterized by frequent recurrences and metastases. In view of the lack of a proven treatment option for MCC, we immunochemically evaluated the presence of Merkel cell polyomavirus (MCPyV), PD-1, PD-L1, CD8, and EZH2 on slides prepared from tumor tissues of 13 patients with MCC, and examined their association with disease progression and overall survival. PD-1 was expressed on tumor infiltrating lymphocytes (TILs) in 92.3% of the patients. None of the tumor cells expressed PD-L1. CD8 levels were higher in MCPyV-positive tumors. Interestingly, higher CD8 levels correlated with better overall survival (p = 0.025), while higher EZH2 expression correlated with metastasis/recurrence (z = -1.396, p = 0.089). However, low EZH2 expression was associated with poor overall survival (χ2 = 3.745, Cramer V = 0.537, p = 0.086). These findings suggest that EZH2 plays a significant role in MCC and may be a promising therapeutic target.

Central nervous system xanthogranulomas are uncommon clinical entities, and symptomatic bilateral choroid plexus xanthogranulomas are rare. We present the case of a 15-year-old male patient with bilateral choroid plexus xanthogranulomas with symptoms of increased intracranial pressure. Gross total resection of the tumor in the left lateral ventricle was performed. The patient improved, and asymptomatic right-sided tumor was monitored at follow-up. The main treatment objective in these tumors is gross total resection. Asymptomatic tumors can be followed without intervention. However, surgery should be performed for symptomatic tumors that cause hydrocephalus or symptoms of increased intracranial pressure.

Purpose: Multiple myeloma is a heterogeneous disease, for which an understanding of the prognostic and predictive value of chromosomal aberrations is necessary to prescribe the most appropriate therapy. We aimed to document the frequencies of chromosomal aberrations in our institute and searched the relationships between therapy regimens and chromosomal aberrations. Materials and methods: We analyzed the frequency of del(17p13), del(13q14), t(11;14), and t(4;14) in patients with MM by interphase-fluorescent in situ hybridization who were diagnosed between January 2010 and December 2015 in our institute. We researched the relationship between response to conventional chemotherapy and Bortezomib based chemotherapy.Results: Eighty patients (72.7%) had at least one chromosomal aberration. The most frequently observed aberration was del(17p13) (48.2%), followed by del(13q14) (40.9%), t(11;14) (16.4%), and t(4;14) (11.8%). In clinically analyzed subgroup (n=67), 36 patients who received Bortezomib based chemotherapy showed a higher response rate (55.6%) than conventional chemotherapy group (48.4%). With respect to chromosomal aberrations, response rates were higher in Bortezomib based therapy group (63.2%) than conventional chemotherapy group (50%) in del (17p13) positive patients as well as in del (13q14) positive patients (61.5% in Bortezomib based, 50% in conventional chemotherapy group). Conclusion: Bortezomib-containing regimens may have beneficial effects on the clinical outcome of patients with del (17p13) and del (13q14).

The purpose of this study is to compare the predisposing factors, clinical findings, treatment results, and prognosis for polymicrobial keratitis. In this retrospective comparative case study, we identified the cases of polymicrobial keratitis from the microbiological records (n = 649) at Balcali Hospital, Cukurova University (Adana, Turkey; October 2010–2018). We included all the cases of infectious keratitis with two different types of microbial agents and grouped them as follows: group 1 (n = 25), bacterium–fungus coexistence; group 2 (n = 12), herpes simplex virus (HSV) or Acanthamoeba with bacterial infection; and group 3 (n = 7), HSV or Acanthamoeba with fungal infection. We compared the clinical and microbiological characteristics, and treatment outcomes among the groups. In our study, we found that 44 infectious keratitis cases (6.7%) were of polymicrobial nature. The mean follow-up period was 11.4 ± 17.8 months. In total, 17 different bacteria along with 3 different fungi, HSV, and Acanthamoeba were isolated. The most common bacterium was Staphylococcus epidermidis (25%). Most of the fungal pathogens were filamentous. Patients with initial treatment failure and requiring surgical intervention had larger infiltrates (p = 0.023, p = 0.003, respectively) than other patients. Older age was associated with delayed recovery and poor visual prognosis. Bacterial–fungus coexistence is the most common combination among patients, but other combinations should also be considered for suspected polymicrobial etiology. The corneal infiltrate size may be an important indicator of the course of disease and response to treatment. A closer and longer follow-up period should be planned for older patients.

Background:Silent pituitary adenomas are clinically non-functional (i.e., without clinically evident pituitary hormone production).Introduction:The aim of this study was to investigate subjects with silent pituitary adenomas for possible variations in their clinical status.Methods:A total of 102 patients who had undergone surgery for pituitary adenoma and had been diagnosed with silent pituitary adenoma was included in the study. The patients’ preoperative and postoperative hormonal parameters and magnetic resonance imaging (MRI) features were collected, and pathological specimens were re-evaluated.Results:Immunohistochemistry results of the 102 patients were as follows: hormone-negative adenomas (n=35) 35.5%; FSH+LH-positivity (n=32) 31.3%; ACTH-positivity (n=11) 10.7%; α-subunit- positivity (n= 9) 8.8%; prolactin-positivity (n=8) 7.8%; GH-positivity (n=6) 5.4%; and plurihormonal adenoma (n=1). The mean sizes of SGA, SGHA, and SCA were 28.0±12.7, 30.0±16.0, and 27.7±8.9mm (p>0.05), respectively. With the exception of silent gonadotroph adenomas (SGAs), female gender dominance was shown in patients with silent growth hormone adenoma (SGHA) and silent corticotroph adenoma (SCA). Although no clinical relevance was observed in relation to hormonal excess, preoperative GH (4.21±4.6, vs. 0.27±0.36 p=0.00) was slightly more elevated in SGHA than in GH-negative adenomas. Additionally, preoperative basal ACTH values (47.3±28.7 vs. 23.9±14.4, p=0.003) were also higher in SCA compared to the other types. Our findings revealed SCAs to be of more aggressive behaviour than SGHAs and SGAs due to invasiveness in radiological imaging, their elevated re-operation, and postoperative ACTH values.Conclusion:Silent pituitary adenomas represent a challenging diagnostic tumour group. Careful initial evaluation of patients with pituitary adenomas should consider any mild signs and symptoms of functionality, particularly in cases of GH- and ACTH-secreting adenomas.

A 45-year-old man presented with a 3-month history of a mass located in the caruncle of his right eye. An incisional biopsy had been performed one month prior by another specialist, and the histopathology report showed basal cell carcinoma. The mass was completely excised with a 2 mm safety margin, and the large conjunctival defect was reconstructed with one sheet of amniotic membrane allograft. A histological diagnosis of pilomatrix carcinoma was established. To prevent recurrence after surgery, we added bevacizumab (25 mg/mL, 1.25 mg/mL per drop) eye drops four times per day for three months. At the one-year follow-up, the patient showed no evidence of local recurrence or distant metastasis after initial excision and remains under close follow-up. Pilomatrix carcinoma should be considered in the differential diagnosis of a caruncular mass. RESUMO Um homem de 45 anos apresentou história de massa na carúncula no olho direito durante 3 meses. Uma biópsia incisional foi realizada 1 mês antes por outro especialista e o laudo histopatológico mostrava carcinoma basocelular. A massa foi completamente excisada, com uma margem de segurança de 2 mm, e a grande lesão conjuntival foi reconstruída com uma folha de aloenxerto de membrana amniótica. Foi estabelecido um diagnóstico histológico de carcinoma pilomatricial. Para evitar a recorrência após a cirurgia, adicionamos colírio de bevacizumabe (25 mg/mL, 1,25 mg/mL por gota) quatro vezes ao dia durante três meses. No seguimento de 1 ano, o paciente não apresentou evidência de recidiva local ou metástase distante após a excisão inicial e continua sob acompanhamento próximo. O carcinoma pilomatricial deve ser considerado no diagnóstico diferencial de uma massa caruncular.

PubMedID: 31430070 Background. The reconstruction of defects is a major area of interest in plastic surgery. Tissues are expanded to extend the tissue surface area and to prepare more reliable perforator flaps. Objectives. Because expanded perforator flaps have become more popular, the aim of this study is to determine the response of the perforator artery to tissue expansion. Material and methods. We used a rabbit S1 perforator (first perforator branch of the thoracodorsal arteries) flap model. In 12 New Zealand White rabbits, left flaps were used as the experimental group (n = 12) and right flaps were used as the control group (n = 12). Both flaps were constructed in the dorsal skin. The experimental group was further divided into 3 subgroups according to expansion volume: 150 mL (n = 4), 200 mL (n = 4) and 250 mL (n = 4). We evaluated the responses of the perforator arteries to tissue expansion using the resistivity index (RI), the pulsatility index (PI), vessel diameter (D), histopathological examinations, and angiography. Results. After 3 weeks of expansion, the perforator artery diameter had increased (p = 0.002) and the RI had decreased (p = 0.031) in the experimental group. The perforator artery diameter (p = 0.006) and RI had increased (p = 0.003) in the control group. No significant changes were observed in the PI in either group (p > 0.05) and no significant differences in post-expansion measurements were observed between experimental subgroups (p > 0.05). Conclusions. Suprafascial expansion of a perforator flap leads to an increase in diameter and a decrease in the RI of the perforator artery. The decrease in RI may indicate increased flap perfusion. © 2019 by Wroclaw Medical University. Firat University Scientific Research Projects Management Unit The study was supported by a grant from Çukurova University Scientific Research Projects Fund (project No. TF2013LTP39).

Objective: The aim of this study was to investigate the importance of immunohistochemical findings and tumor size and laterality in addition to the histopathological features in the diagnosis of primary and metastatic mucinous tumors of the ovary.Material and Methods: Two hundred and twenty two mucinous ovarian tumors diagnosed between 2001 and 2012 were retrospectively reviewed in our hospital pathology archive. The cases were evaluated for age, lateralization, tumor size and immunohistochemistry.Results: Of the 222 cases included in the study, 195 were diagnosed as primary mucinous tumor and 27 as metastatic mucinous tumor. The distribution of the primary cases was cystadenomas in 135/195, mucinous carcinomas in 31/195 and borderline tumors in 29/195 cases. The mean age of the patients was 48.7 years range 14y-72y . When laterality was evaluated, borderline tumors 29/29 and mucinous carcinomas 27/31 had a higher incidence in a single ovary but this rate was lower in metastatic tumors 13/27 . When tumor size was evaluated, it was found that tumor size was lower in metastatic lesions while the size of the primary tumors was larger.Conclusion: Mucinous tumors are an important group where the differentiation of metastasis and primary lesion should be performed. Most of the metastatic tumors mimic the primary ovarian tumor, but we think that tumor size and laterality are important for the differentiation between metastasis and primary while immunohistochemistry may be useful in increasing the diagnostic accuracy, Amaç: Bu çalışmanın amacı overin primer ve metastatik müsinöz tümörlerinde ayırıcı tanıda histopatolojik özelliklere ek olarak immünohistokimyasal bulgular, tümör boyutu ve lateralitenin primer – metastaz ayırımındaki tanısal değerini araştırmaktır. Gereç ve Yöntemler: Hastanemizde 2001-2012 yılları arasında tanı alan 222 müsinöz over tümörü olguları patoloji arşivinden retrospektif olarak tarandı. Olgular yaş, lateralizasyon, tümör boyutu ve immünohistokimyasal olarak değerlendirildi. Bulgular: Çalışmaya dahil edilen 222 olgunun 195’i primer müsinöz over tümörü, 27’si metastatik müsinöz tümör tanısı almış idi. Primer olguların kendi içinde dağılımları sırası ile kistadenomlar 135/195, müsinöz karsinomlar 31/195 ve borderline tümörler 29/195 idi. Olguların yaş ortalaması 48,7 14y-72y idi. Lateraliteye bakıldığında borderline tümörlerin 29/29 ve müsinöz karsinomların 27/31 tek overde görülme oranları daha yüksek iken metastatik tümörlerde bu oran daha düşük idi 11/27 . Tümör boyutları değerlendirildiğinde primer tümörlerde boyutun daha yüksek olduğu metastatik lezyonlarda tümör boyutunun daha düşük olduğu tespit edildi. Sonuç: Müsinöz tümörler, over tümörleri içerisinde metastaz ve primer ayırımının yapılması gereken önemli bir gruptur. Metastatik tümörlerin büyük bir kısmı primer over tümörünü taklit ederler ancak metastaz-primer ayırımında tümör boyutu ve lateralitenin önemli bir veri olduğunu bunun yanında immünohistokimyanın da tanısal doğruluğu artırmada yararlı olacağını düşünmekteyiz

Aims: To determine herpes simplex virus (HSV) DNA positivity in corneal scraping samples obtained from patients with microbial keratitis whose findings were not specific for HSV keratitis and to evaluate these particular cases with respect to clinical features and antiviral treatment results. Methods: Records of patients with microbial keratitis treated in a tertiary eye care hospital within the 3-year period were evaluated retrospectively. Real-time polymerase chain reaction (PCR) was used to identify HSV DNA. Smear slides were evaluated by light microscopy. Patients with typical presentations and histories of HSV keratitis were excluded. Results: Two hundred and seventy-six eyes of 276 patients were included in the study. HSV-1 DNA was detected in 25 eyes (9%). In these 25 eyes, the initial diagnosis was fungal or bacterial keratitis. The mean symptom duration was 20 ± 14 days (2–60 days). The risk factors were ocular surgery (20%), blepharitis (16%), trauma (8%) and contact lens wear (4%); however, the majority of patients did not have any specific cause for keratitis (52%). Clinical features were variable and not typical for any particular etiology. Culture and microscopic examinations revealed bacteria and/or fungi in 6 patients in addition to herpes infection. Antiviral treatment was successful in 72% of patients. Conclusion: Herpetic corneal infections can present without typical dendritic or geographic ulcers and may be masked by other infections. Real-time PCR is a useful method for rapid and definitive diagnosis. HSV infection should be considered for microbial keratitis without specific risk factors, with negative culture results and poor response to antimicrobial agents. © 2019, Springer Nature B.V.

Amaç: Prostat karsinomu (PK) önemli oranda ölümcül ve morbiditesi olan, sık görülen kanser türlerinden biridir. PK'nin etiyolojisi net değildir. Enflamatuvar yolaktaki sitokin ve mediatörler; kronik enflamasyon ve kanser arasındaki ilişkide, çeşitli basamaklarda rol oynamaktadır. Bu çalışmanın amacı, PK'li hastalarda siklooksijenaz-2 (COX), apopitozis ve anjiyogenezis arasında ilişki olup olmadığını belirlemektir.Gereç ve Yöntem: 2005-2010 yılları arasında, patolojik evresi pT2 olup radikal prostetektomi uygulanan 49 olgu, Çukurova Üniversitesi Tıp Fakültesi Patoloji arşivinden retrospektif olarak seçilmiştir. Histolojik slaytlar tanısal açıdan tekrar gözden geçirilmiş ve Gleason skorlama sistemine göre derecelendirilmiştir. Olgulara immünohistokimyasal olarak COX-2, vasküler endotelyal büyüme faktörü (VEBF), monoklonal antikor (M30), bcl-2 uygulanarak değerlendirilmiştir. Bulgular: Hastaların ortalama yaşı 63,8 idi. Yirmi bir hasta Gleason skor =7 olarak derecelendirildi. COX-2 ekspresyonu %81,6 hastada tespit edildi. COX-2 ekspresyonu bcl-2 ekspresyonu ile korele olarak bulunurken, VEBF ile COX-2 arasında korelasyon saptanmadı. Gleason skor ile M30 arasında negatif korelasyon saptandı. Ortalama yaşam ve COX-2 arasında negatif korelasyon saptandı. COX-2 ekspresyonu arttıkça sağkalım süresinin anlamlı olarak azaldığı saptandı.Sonuç: Çalışmamız PK karsinogenezisinde COX-2'nin anjiyogenezisi arttırmaktan çok apopitozisi inhibe ederek etki ettiğini düşündürmektedir. Bu sonuçların, tedavi stratejilerine yeni bakış açıları sunabileceği gibi, hastaların klinik takiplerinin sonuçlarını öngörmede faydalı olabileceğini düşünmekteyiz. Objective: Prostate carcinoma (PC) is one of the most commonly diagnosed cancer types with significant rates of mortality and morbidity. The etiology of PC is not clear. Cytokine and mediators at the inflammatory pathway plays role at the various steps of the relation between chronic inflammation and cancer. The objective of this study is to determine if there is relationship between cyclooxygenase-2 (COX) apoptosis and angiogenesis in patients with PC.Materials and Methods: Sample of 49 cases who were at pathologic stage pT2 and underwent radical prostatectomy, were selected retrospectively between 2005-2010, from the archives of Pathology Department of Çukurova University Faculty of Medicine. Histologic slides of each case were reviewed for the diagnostic reassessment and graded by the Gleason scoring system. COX-2, vascular endothelial growth factor (VEGF), monoclonal antibody (M30) and bcl-2 were immunohistochemically applied to the cases and they were evaluated.Results: The mean age of the patients were 63.8. Twenty-one cases had their Gleason score =7. COX-2 expression was detected in 81.6% of cases. While COX-2 expression was significantly correlated with bcl-2 expression, there was no correlation between VEGF and COX-2 expression. Gleason score was negatively correlated with M30. It was detected that as COX-2 expression increased mean survival time significantly decreased.Conclusion: This study makes us think that in the PC carcinogenesis COX2 inhibits apoptosis rather than promoting angiogenesis. These results may offer new insights for the treatment strategies, also they may be useful for the prediction of clinical outcomes.

To determine the effects of N-acetylcysteine (NAC) and melatonin, alone and in combination, on McFarlane flap viability in a rat model.Forty Wistar rats were divided into four groups and received daily intraperitoneal injections for one week before surgery: control (sham [n=10]); melatonin (n=10); NAC (n=10); and NAC+melatonin (n=10). One week after surgery, the experiment was terminated and photographs were taken for topographic studies. A transillumination study was performed to observe vascularization in the flaps and biopsies were obtained for histopathological studies.Flap viability was significantly greater in the antioxidant- (ie, NAC and melatonin) treated groups compared with the control group; however, there were no significant differences among the groups that received antioxidants.Melatonin and NAC are important antioxidants that can be used alone or in combination to increase flap viability and prevent distal necrosis in rats.Déterminer les effets de la N-acétylcystéine (NAC) et de la mélatonine, seules ou ensemble, sur la viabilité d’un lambeau de type McFarlane dans un modèle de rat.Les chercheurs ont réparti 40 rats Wistar en quatre groupes à qui ils ont administré des injections intrapéritonéales quotidiennes pendant une semaine avant l’opération: sujets témoins (n=10), mélatonine (n=10), NAC (n=10) et NAC+mélatonine (n=10). Une semaine après l’opération, ils ont mis fin à l’expérience et pris des photos en vue d’études topographiques. Ils ont réalisé une étude de transillumination pour observer la vascularisation des lambeaux et effectué des biopsies pour mener des études histologiques.La viabilité des lambeaux était beaucoup plus importante dans les groupes traités aux antioxydants (NAC et mélatonine) que dans le groupe témoin. Cependant, les différences n’étaient pas significatives entre les divers groupes qui avaient reçu des antioxydants.La mélatonine et la NAC sont d’importants antioxydants qu’on peut utiliser seuls ou ensemble pour accroître la viabilité des lambeaux et prévenir la nécrose distale chez les rats.

Primary melanoma of the urinary tract is a very rare and aggressive cancer. It accounts for less than 1% of all the melanoma cases, making it difficult to histopathologically diagnose and manage. We present a retrospective case series of eight primary urinary tract melanoma with clinical, pathological, and molecular findings to add more insight to this challenging disease. These cases were evaluated for histopathological, immunohistochemical, and molecular features of melanoma that were most commonly found in the urethra, followed by those in the bladder and ureter. Identification of nested growth patterns and in situ melanocytic components at cell edges are helpful in the histopathological diagnosis of amelanotic or hypomelanotic tumors. Our results indicate that urinary tract melanoma has several molecular traits, such as gene expression patterns. Genetic mutations may be related to metastasis, as well as provide targets for the management programs.

The cytokine profile and the ultrastructural changes of refluxing ureterovesical junctions(UVJs) of children treated with failed dextranomer/hyaluronic-acid (Dx/HA) injections were investigated using immunohis-tochemical methods and transmission electron microscopy(TEM).Eighteen children who had undergone injection for reflux were included the study. The smooth muscle arrangement of the ureteral wall, transforming growth factor-? (TGF-?1),vascular-endotheli-al-growth factor (VEGF) and CD34 were evaluated immunohistochemically, and the results were compared with 10 age-matched autopsy specimens as controls. The ultrastructural evaluation and morphological description was made semi-quantitatively and compared with published data.Four of the patients (22%) were male, and 14 (78%) were female. The mean age of the patients was 105.4 ± 44.5(48-184) months. There was no correlation between the vesicoureteral reflux (VUR) grade and age (P = 0.85). The mean VEGF and CD34 scores were 16.2 ± 9.6 (0-90) cells per HPF and 10.2 ± 3.5 (4-16) vessels per HPF in ureters with reflux; these values were 60.6±16.4 (32-84) cells per HPF and 17.8 ± 4.1 (12-24) vessels per HPF in the control group. The amount of VEGF and CD34 were significantly decreased in patients compared with the control group (P0.001, P0.001).The TGF-?1 levels were significantly higher in patients with VUR compared with the control group (34.2 ± 19.9 vs 5.0±1.9; P=0.001).The amount of VEGF, CD34, and TGF-?1 were not correlated with the grade of reflux (P = 0.26, P = 0.94, and P = 0.42, respectively). Ultrastructural changes in the muscle cells were observed in all the VUR specimens (Grade II-IV).Refluxing ureters exhibited immune-histopathological abnormalities and ultrastructural changes of the muscle cells in all VUR specimens in the ureterovesical junctions of children treated with failed Dx/HA injec-tions for reflux.

PubMedID: 30246397 Background: In the absence of a real gold standard, comparative studies are still done on diagnostic methods for onychomycosis. There are only a few attempts using latent class analysis to determine the value of polymerase chain reaction in comparison to conventional methods. We aimed to determine the value of histological examination in such a way for the diagnosis of onychomycosis. Methods: Potassium hydroxide mount (KOH), culture and histological examination with periodic acid-Schiff (PAS), and Gomori's methenamine silver (GMS) stains were done in 106 patients having clinically suspected toenail onychomycosis. Results: KOH was positive in 74% of the patients; culture in 14%; PAS in 30%; and GMS in 66%. According to the results of the latent class analysis, culture and PAS were highly specific but poorly sensitive; KOH, highly sensitive but poorly specific; and GMS, both highly sensitive and specific. Conclusions: Based on these results, we have proposed KOH as a screening test and GMS as a confirmatory test for the diagnosis of onychomycosis in our own practice. However, since positivity rates of different diagnostic methods vary widely in different centers, it is more suitable that every center should determine their own diagnostic strategy by evaluating their own results with latent class analysis. © 2018 The International Society of Dermatology TSA-2015-5032 Bilge Fettahlıog^lu Karaman, MD Department of Dermatology, Faculty of Medicine C©ukurova University 01330, Adana Turkey E-mail: bilgef@hotmail.com.tr Funding: This study was supported by Research Fund of Cukurova University Project (TSA-2015-5032). Figure 2 On histological examination with GMS, hyphae are seen as blackish dots or thread-like structures on a pale and mostly green background consisting of corneocyte layers of the nail plate (9400) Written informed consent was obtained from all patients. This study was approved by the Ethics Committee of the Medical Faculty of C©ukurova University and supported by Research Fund of Cukurova University, Adana, Turkey. Project Number: TSA-2015-5032.

Purpose: The aim of this study was toexplore the histopathologic subtypes of pediatric lymphomas and their relation with Ebstein-Barr virus infection in our region. Materials and Methods: In this retrospective study, 87 children including 36 cases with Hodgkin lymphoma and 51 cases with non-Hodgkin lymphoma were included in the study. The pathologic slides were used to investigate immunohistochemical staining with ebstein-barr virüs latent membrane protein-1 and in-situ hybridization. Results: The most common histopathological subtype in hodgkin lymphoma cases was mixed cellular classical hodgkin lymphoma (55.6%). The most common histopathological subtype in Non-Hodgkin lymphoma cases was Burkitt lymphoma (51.0%). Ebstein-Barr virüs latent membrane protein-1 was positive in 29 Hodgkin lymphoma. All non-Hodgkin lymphoma cases were stained negative with ımmunohistochemical. The positive staining rate of Hodgkin lymphoma cases with in-situ hybridization was 83.3% and this rate was 27.5% in non-Hodgkin lymphoma cases. The differences between groups for both staining methods were significant. Conclusion: The results of this study show that the distribution of histopatholojik subtypes of pediatric lymphomas similar to in developing countries. And we have observed that in-situ hybridization is more specific than immunohistochemistry because Ebstein-Barr virus positivity is more detected in in-situ hybridization. Amaç: Bu çalışmanın amacı bölgemizdeki pediatrik lenfomaların histopatolojik alt tiplerinin oranını ve bunların Ebstein-Barr virüs enfeksiyonu ile olan ilişkisini incelemektir. Gereç ve Yöntem: Hodgkin lenfoma tanısı alan 36 olgu ve non-hodgkin lenfoma tanısı alan 51 olgu retrospektif arşiv taraması yapılarak çalışmaya dahil edildi. Olgulara immünohistokimyasal olarak Ebstein-Barr virüs latent membran proteini-1 ve in-situ hibridizasyon uygulandı. Bulgular: Hodgkin lenfoma olgularında; en sık rastlanan histopatolojik alt tipler sırası ile mikst sellüler klasik hodgkin lenfoma (%55,6) idi. Non-Hodgkin lenfoma olgularında en sık rastlanan histopatolojik alt tip Burkitt lenfoma (%51) idi. Ebstein-Barr virüs latent membran proteini-1 ile 29 hodgkin lenfoma olgusunda pozitif iken non-hodgkin lenfoma olgularında immünohistokimya ile pozitif boyanma saptanmadı. Hodgkin lenfoma olgularında in situ hibridizasyon ile boyanma oranı % 83.,3 iken non-Hodgkin lenfoma olgularında bu oran % 27.5 idi.. Her iki boyama yöntemi için gruplar arasındaki fark istatistiksel olarak anlamlıydı. Sonuç: Bu çalışmada, olgularımızın histopatolojik dağılımlarının gelişmekte olan ülkelerdeki pediatrik lenfoma olguları ile benzer olduğunu göstermektedir. Aynı zamanda in situ hibridizasyon’da Ebstein-Barr virüs pozitifliği daha fazla olması nedeniyle in situ hibridizasyonun ebstein barr virüs tespitinde immünohistokimyadan daha spesifik olduğunu düşünmekteyiz.

PubMedID: 29773452 Introduction: The aim of the study is to investigate the effect of Rolipram, a selective phosphodiesterase 4 inhibitor, on testicular torsion – detorsion injury. Methods: Sixty young male rats were divided into five groups. In each group, the right testes of six rats were removed four hours after detorsion for biochemical analysis, and the right testes of the remaining six rats were removed 24 h after detorsion for pathological analysis. In group 1 (sham-operated) right orchiectomy was performed without torsion, and right testes were sent to the laboratory for biochemical and pathologic analyses. In group 2 (control) torsion was applied to the right testes for 60 min, and detorsion was performed without the administration of Rolipram. In group 3 torsion was applied to the right testes for 60 min. 1 mg/kg Rolipram was administered 30 min before detorsion. In group 4 torsion was applied to the right testes for 60 min, and 1 mg/kg Rolipram was administered during detorsion. In group 5 torsion was applied to the right testes for 60 min. 1 mg/kg Rolipram was administered 30 min after detorsion. The malondialdehyde and nitric oxide levels were determined. The rates of necrosis and apoptosis were evaluated by histopathological examination. Results: The level of malondialdehyde was higher in the torsioned groups (Group 2, 3, 4, 5) than that in group 1 (p = 0.004). There was no statistically significant difference between the groups regarding the level of nitric oxide (p = 0.182). Apoptosis was higher in groups 2, 3 and 4 than in group 1; however, apoptosis was similar in group 1 and group 5 (p = 0.122). The level of necrosis in group 1 was similar to that in groups 4 and 5 (p = 0.194 and p = 0.847, respectively). Conclusion: We suggest that the administration of Rolipram can decrease the rate of necrosis and apoptosis in testicular ischaemia-reperfusion injury. © 2018 Elsevier Inc.

PubMedID: 25362536 Here, we describe a case of keratitis caused by Aspergillusterreus in an 80-year-old immunocompetent woman 1 month after uneventful cataract surgery. The patient presented with decreased visual acuity (20/50) and severe pain in her right eye. Examination revealed a 3.5 × 4.5 mm white-colored deep stromal infiltration located on the temporal corneal tunnel incision. Corneal scraping samples were obtained for cytological and culture examinations. The cinnamon-brown colonies consisting of a dense felt of conidiophores were identified as A. terreus using molecular data. Using CLSI M38-A2 microdilution method, minimum inhibitory concentration values of amphotericin B, itraconazole, voriconazole, and posaconazole were determined to be 2, 1, 0.25, and 1 µg/ml, respectively, and minimum effective concentration values of caspofungin and anidulafungin were ?0.03 and ?0.03, respectively, at 48 h for the A. terreus strain. Antifungal therapy was started as topical 1 % voriconazole drops hourly and 5 % natamycin ointment five times a day; however, corneal infection and melting progressed despite the ongoing intensive treatment and visual acuity dropped to the 20/200 level at the end of the first week. Amniotic membrane transplantation was performed to promote corneal healing. Topical medication was tapered and discontinued within 2 months based on the clinical features. The ulcer healed with scarring and vascularization, and visual acuity improved to 20/50. In conclusion, A. terreus is a very uncommon cause of mycotic keratitis and is especially rare after cataract surgery. We suggest that early and accurate diagnosis and appropriate treatment of A. terreus keratitis may have a major impact on preventing severe disease complications. © 2014, Springer Science+Business Media Dordrecht.

Objective:Kidney transplantation is an important treatment option in end stage renal failure. Tissue death may be an important problem when a kidney is removed from a cadaver and transported to a donor a long distance away. The purpose of this study is to determine the critical time point for apoptotic cell death in a renal ischemia/reperfusion model and determine the effects of N-acetylcystein on apoptosis induced by ischemia injury.Methods:Apoptotic cell death after induced renal ischemia followed by reperfusion, was estimated in a group of Wistar albino rats by immunoflourescence and ELISA techniques. N-acetylcystein, an antioxidant agent, was given to the rats to study the effect on apoptosis. Tissues were examined immunohistochemically at 0, 1 h, 24 h, 5 days and 10 days for detection of apoptotic cells.Results:Our results showed that an ischemia for 60 min followed by reperfusion for 60 min triggered apoptosis. Moreover, N-acetylcystein significantly diminished both the ischemia/reperfusion damage and apoptosis.Conclusion:We anticipate our results would be important for kidney transplantation in estimating the critical time point for apoptosis and administration of N-acetylcystein prior to removal of the organ may be important in delaying the onset of apoptosis.

Extramedullary myeloid tumors (EMMTs) are the tumors of myeloid cells. These tumors may occur in all of the organs of the body, but some localizations are rare. Pancreatic involvement of EMMTs is a rare entity. Here we report a case of EMMT of the pancreas 4 years after allogeneic stem cell transplantation and we review the existing data about EMMTs involving the pancreas.Extramedüller miyeloid tümörler (EMMT) miyeloid hücrelerin neoplazileridir. Bu tümörler bütün organlarda oluşabilir fakat bazı lokalizasyonlarda EMMT saptanması nadirdir ve pankreasın EMMT ile tutulumu da nadirdir. Burada allogeneik kök hücre naklinden 4 yıl sonra gelişen pankreas EMMT’ü sunulmuş ve mevcut bilgi gözden geçirilmiştir.

Granülositik sarkom genellikle akut myeloid lösemi veya myeloproliferatif neoplazilere eşlik eden ekstramedüller yerleşimli tümördür. Bu tümörler nadiren bilinen bir hematolenfoid hastalık olmaksızın herhangi bir anatomik bölgede ortaya çıkabilirler. Jinekolojik trakt, granülositik sarkomun görülebileceği bölgelerden biri olup izole servikal kitle şeklinde az sayıda olgu bildirilmiştir. Otuz yedi yaşında, primer tanısını serviks biyopsisi ile almış, rekürrens ve metastazlarla seyreden, ancak kemik iliği tutulumu göstermeyen olguyu literatür bilgileri eşliğinde tartışmayı amaçladık. Granulocytic sarcoma is an extramedullary tumor, frequently associated with acute myeloid leukemia or myeloproliferative neoplasm. This tumor occasionally occurs in any anatomical part of the body without a known hematolymphoid disorder. Gynecologic tract is one of the rare localization of this tumor. Isolated cervical granulocytic sarcoma is extremely rare. In this case report, we present clinical and pathological findings of a 37 years old women with isolated cervical granulocytic sarcoma without any hematolymphoid disorder evidence.

Well-differentiated papillary mesothelioma is an uncommon tumor of the testes that usually presents as a hydrocele. Here, we present the case of one patient who did not have a history of asbestos exposure. The tumor was localized in the tunica vaginalis and was composed of three pedunculated masses macroscopically. Microscopically, branching papillary structures with focal coagulative necrosis were present. In addition to immunohistochemistry, simian virus 40 DNA was also tested by polymerase chain reaction. This report presents one case of this rare entity, its clinical and macroscopic features, and follow-up results. © 2014 The Korean Society of Pathologists/The Korean Society for Cytopathology.

PubMedID: 24841913 The objective of this study was to evaluate the reliability of an intraoperative frozen section during the endometrial carcinoma staging surgery procedure. The paraffin section reports of 291 cases with endometrial carcinoma were compared with intraoperative frozen section reports, which were diagnosed in the Pathology Department of Cukurova University, Medical Faculty between June 2006 and December 2012. The reports were reviewed for diagnostic accuracy of the frozen section in terms of histological subtype, grade, and myometrial invasion. Concordance values between frozen and paraffin section reports were 86, 84.3, and 91.6 % for histological subtype, grade, and myometrial invasion, respectively. When collectively evaluated, two (0.7 %) of 291 patients were inappropriately operated on due to frozen section reports. Intraoperative frozen section is a reliable guide for surgeons to evaluate the risk group of patients with endometrial cancer and prevent an unnecessary staging surgery operation. © 2014, Arányi Lajos Foundation.

Context: Distant metastases of primary malignancies to the skeletal muscle tissue are a very rare event. Distant metastases that affect the rotator cuff are even rarer, and only a few of cases have been reported so far. Case Report: The present article reports two cases that presented to our hospital with the complaint of shoulder pain and had a soft tissue mass affecting the muscles of the rotator cuff and invading the neighboring bone compartments. One of the patients developed mucoepidermoid cancer metastasis of the submandibular gland, and the other was found to have a malignant epithelial tumor metastasized from the lower lobe of the right lung, whose primary origin could not be diagnosed until the imaging examinations were employed. Ultrasound and magnetic resonance imaging fi ndings are presented in this paper. Conclusion: Metastases to the muscle tissues could be misdiagnosed as primary sarcomas. Because the therapy regiments and prognoses are fairly different for these two entities, the possibility of a metastasis to the muscle tissue must be considered as a differential diagnosis for case of painful soft tissue mass. Ultrasound is very useful in detection of the lesion and acts as a very important tool during guidance for biopsy. Magnetic resonance imaging, however, is a very valuable asset in the evaluation of the borders of the soft tissue mass and its invasive effect on the bony tissues. Particularly when the features such as lobulated contours, peripheral edema, and intratumoral necrosis exist, the possibility of metastases must be considered. © 2014, North American Journal of Medical Sciences. All right reserved.

A 43-year-old woman presented to our hospital with the complaint of a reddish-purple rash on the extensor sides of her forearms. She had been diagnosed with ankylosing spondylitis 7 years ago. On physical examination, reddish-purple nodules were detected on the pretibial areas of both legs and extensor sides of both hands and forearms. Neutrophil, eosinophil, lymphocyte, and mixed-type leukocyte infiltration and erythrocyte extravasation were observed in skin biopsy. Erythema elevatum diutinum (EED) was diagnosed. For treatment, sulphasalazine, colchicine, and diclofenac were started. After 3 months of treatment, the lesions were healed. To the best of our knowledge, this is the first report of EED coexisting with ankylosing spondylitis A 43-year-old woman presented to our hospital with the complaint of a reddish-purple rash on the extensor sides of her forearms. She had been diagnosed with ankylosing spondylitis 7 years ago. On physical examination, reddish-purple nodules were detected on the pretibial areas of both legs and extensor sides of both hands and forearms. Neutrophil, eosinophil, lymphocyte, and mixed-type leukocyte infiltration and erythrocyte extravasation were observed in skin biopsy. Erythema elevatum diutinum (EED) was diagnosed. For treatment, sulphasalazine, colchicine, and diclofenac were started. After 3 months of treatment, the lesions were healed. To the best of our knowledge, this is the first report of EED coexisting with ankylosing spondylitis

PubMedID: 23974278 Purpose: Stage, tumor grade and histological subtype determine the clinical behavior in ovarian tumors. Some additional factors are related to tumor cell biology and are the useful predictors for identifying the patients with poor prognosis. The aim of this study is to evaluate the prognostic significance of survivin, Ki-67 and Topoisomerase II? (TOPO II?) in epithelial ovarian cancer (EOC). Materials and methods: Seventy-three patients with EOC were included in this study. Survivin, Ki-67 and TOPO II? expressions were studied by immunohistochemistry on formalin-fixed, paraffin-embedded tissue sections. Nuclear staining for all antibodies was scored on a three-tiered system and more than 10 % staining was accepted as expression. The relationship between the expressions of survivin, Ki-67, TOPO II? and clinicopathological parameters including age, stage, grade, platinum resistance and survival was evaluated. Results: Survivin, Ki-67 and TOPO II? expressions were found in 20, 82 and 86 % of the tumors, respectively. Ki-67 and TOPO II? expressions were found to be related to poor overall survival (p = 0.005, 0.004, respectively), while survivin expression was not associated with overall survival. There was no association between TOPO II? and Ki-67 expressions and histological subtype, stage or grade. However, we found an important relationship between TOPO II? expression and platinum resistance (p = 0.044). Platinum resistance was found to be an independent prognostic factor in EOC. Conclusion: Ki-67 and TOPO II? expressions were found to be related to poor overall survival, and TOPO II? expression was found to be associated with platinum resistance. © 2013 Springer-Verlag Berlin Heidelberg.

Primary hepatic Burkitt’s lymphoma (PHBL) is rarely seen in adults. Here we reported a case presenting with hepatomegaly and diagnosed as PHBL and also reviewed the literature.

PubMedID: 26951445 miRNAs are small RNAs and control the expression of protein-encoding genes. The aim of this study was to determine the association between miRNA profile and clinical variables including age, stage, B symptom, histopathologic subtype, response to treatment, disease-free survival (DFS) and overall survival (OS) in classical Hodgkin lymphoma (cHL). A total of 377 miRNAs were studied by qPCR in 32 cases with cHL, and results were compared with 60 samples taken from cases with reactive lymphadenopathy. Biogazelle qbasePLUS 2.0 software was used to analyze the results. miR-582-3p, miR-525-3p, miR-448, miR-512-3p, miR-642a-5p, miR-876-5p, miR-532-3p, miR-654-5p, miR-128, miR-145-5p, miR-15b-5p, miR-328 and miR-660-5p were found to be decreased in cHL compared with controls. In contrast, miR-34a-5p (2.626-fold), miR-146a-5p (4.32-fold), miR-93-5p (2.347-fold), miR-20a-5p (4.930-fold), miR-339-3p (4.948-fold), miR-324-3p (4.98-fold), miR-372 (7.038-fold), miR-127-3p (8.234-fold), miR-155-5p (4.947-fold), miR-320a (17.502-fold) and miR-370 (21.479-fold) (p

Acikalin, Arbil/0000-0003-1592-2887; DURUKSU, GOKHAN/0000-0002-3830-2384; Kuyucu, Yurdun/0000-0001-6289-0860; Duruksu, Gokhan/0000-0002-3830-2384; yildizdas, dincer/0000-0003-0739-5108 WOS: 000314536200007 PubMed: 22810359 We hypothesized that bone marrow-derived mesenchymal stem cells (BM-MSCs) would have a possible role in the treatment of acute respiratory distress syndrome (ARDS). ARDS disease model was developed in Wistar albino male rats by intratracheal instillation of physiological saline solution. Anesthezied and tracheotomized rats (n = 8) with ARDS were pressure-controlled ventilated. Isolated and characterized rat (r-) BM-MSCs were labeled with GFP gene, and introduced in the lungs of the ARDS rat-model. After applying of MSCs, the life span of each rat was recorded. When rats died, their lung tissues were removed for histopathological examination. Also the tissue sections were analyzed for GFP labeled rBM-MSCs and stained for vimentin, CK19, proinflammatory (MPO, IL-1 beta, IL-6 and MIP-2) and anti-inflammatory [IL-1ra and prostaglandin E2 receptor (EP3)] cytokines. The histopathological signs of rat-model ARDS were similar to the acute phase of ARDS in humans. rBM-MSCs were observed to home in lung paranchyma. Although the infiltration of neutrophils slightly decreased in the interalveolar, peribronchial and perivascular area, a notable improvement was determined in the degree of hemorrhage, edema and hyaline membrane formation in rats treated with rBM-MSCs. Also decreased proinflammatory cytokines levels and increased the intensity of anti-inflammatory cytokines were established. Therefore MSCs could promote alveoar epithelial repair by mediating of cytokines from a proinflammatory to an anti-inflammatory response. As a novel therapeutic approach, mesenchymal stem cell treatment with intratracheal injection could be helpful in the management of critically ill patients with ARDS. Cukurova University Research FundCukurova University [TF2011BAP20] This work was supported by the Cukurova University Research (TF2011BAP20) Fund. The authors thank Kezban Bostaner, Recep Mutlu and Gizem Turac for their technical assistance. We also express our gratitude to Dr. Gokhan Duruksu for editing of this manuscript.

PubMedID: 22647456 The purpose of this study was to investigate the effects of silymarin, a phytotherapeutic agent, on bladder overactivity in a cyclophosphamide (CYP)-induced cystitis rat model. Female Wistar Albino rats received a single intraperitoneal injection of CYP (150 mg/kg) or saline and after 72 h, bladder function was evaluated by in vitro preparations of whole bladders and cystometry with continuous saline infusion under urethane anesthesia. Silymarin or a vehicle was orally given for 7 days in rats. CYP was injected on the 5th day of silymarin or vehicle treatment and then the animals were killed on the 8th day. CYP-treatment dramatically potentiated the basal spontaneous contractions of isolated whole bladders compared to control rats. In anesthetized rats, during continuous infusion cystometry, intercontraction interval (ICI) was significantly shorter, but bladder voiding pressure was not significantly changed in CYP-injected rats compared to control rats. In the CYP-injected group, silymarin treatment significantly decreased the amplitude, frequency (contractions/min) and area under the curve of spontaneous contractions, but failed to change carbachol-induced contraction in isolated whole bladder. Also, silymarin treatment significantly increased the ICI in comparison to the vehicle treatment. In the saline-injected group, no significant changes in the bladder function were observed between the silymarin and vehicle-treated groups. Histopathological examination showed that CYP-induced bladder inflammation tended to be lower in the silymarin + CYP-treated group. In conclusion, the oral administration of silymarin suppressed CYP-induced bladder overactivity. Silymarin may be considered as an attractive treatment for CYP-induced bladder overactivity. © 2012 Elsevier GmbH. All rights reserved.