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Abstract COVID-19-related acute respiratory distress syndrome (CARDS) is associated with high mortality rates. We still have limited knowledge of the complex alterations developing in the lung microenvironment. The goal of the present study was to comprehensively analyze the cellular components, inflammatory signature, and respiratory pathogens in bronchoalveolar lavage (BAL) of CARDS patients (16) in comparison to those of other invasively mechanically ventilated patients (24). In CARDS patients, BAL analysis revealed: SARS-CoV-2 infection frequently associated with other respiratory pathogens, significantly higher neutrophil granulocyte percentage, remarkably low interferon-gamma expression, and high levels of interleukins (IL)-1β and IL-9. The most important predictive variables for worse outcomes were age, IL-18 expression, and BAL neutrophilia. To the best of our knowledge, this is the first study that was able to identify, through a comprehensive analysis of BAL, several aspects relevant to the complex pathophysiology of CARDS.

Aim:One of the underlying causes of cisplatin-induced hepatotoxicity is oxidative stress. We assessed the effect of an antioxidant, resveratrol, on cisplatin-induced damage in the rat liver.Methods:The project-starting date was designed as 01.10.2020 and the project-ending date was planned as 01.04.2021. Three groups were created with 30 female Wistar-Albino rats: In group 1 (control group), 1 mL of 0.9% NaCl (saline) was administered intraperitoneally for 3 days. In group 2 (cisplatin group), 7.5 mg/kg intraperitoneal cisplatin was given for 3 days. In group 3 (cisplatin + resveratrol group), 7.5 mg/kg cisplatin and 10 mg/kg resveratrol were given via the intraperitoneal route. The livers were surgically extirpated in all the groups. In both blood and tissues, malondialdehyde (MDA) levels and activities of catalase (CAT) and superoxide dismutase (SOD) were measured. Also, toxicity markers such as hepatocyte damage (cellular changes), inflammation, hemorrhage, congestion, fibrosis, disorganization of the hepatic cords, and necrosis were assessed by examining the preparations prepared from hepatic tissue with light microscopy and immunohistochemistry.Results:Histopathological tissue damage was significantly higher in group 2 than in other groups (p 0.03). MDA levels were significantly higher and the activities of SOD and CAT were lower in group 2 than in the other groups (p=0.04 and p=0.01, respectively).Conclusion:According to our short-term findings, resveratrol might be an effective molecule for preventing the harmful effects of cisplatin in the rat liver.

Amaç: Bu çalışmanın amacı Kırşehir popülasyonunda örneklenen periferik sinir kılıfı tümörleri (PSKT)’nin epidemiyolojik verilerini tanımlamaktır. Gereç ve yöntemler: Hastanemizde Ocak 2010-Mayıs 2018 tarihleri arasında histopatolojik olarak periferik sinir kılıfı tümörü tanısı alan 76 olgunun verileri geriye dönük analiz edildi. Klinik ve histopatolojik özellikleri incelendi. Bulgular: Serimizde yer alan 76 olgunun %52.6 (n:40)’sı nörofibrom (NF), %35.6 (n:27)’sı Schwannom, %9.2 (n:7)’si Nörom, %2.6 (n:2)’sı Granüler hücreli tümördü. Malign tanılı olgu saptanmadı. Ortalama yaş NFda 49.1, Schwannomda 42.3, Nöromda 36.1, Granüler hücreli tümörde 50.5’di. Hastaların yaşları 16-78 yılları arasında değişmekte olup ortalaması 45.5 idi. Olguların 47’si erkek, 29’u kadındı. Tümörlerin hepsi tam olarak çıkarılmaya çalışılmıştı. NFların yaklaşık yarısı baş-boyun dışı yerleşimli olup, 16 olgu baş-boyun yerleşimli, 5’inde lokalizasyon belirtilmemişti. Schwannomların yaklaşık %78’i baş-boyun dışı, geri kalan 4 olgu; skalp, boyun, dil, antrakoanal bölgedeydi, 2’sinde lokalizasyon belirtilmemişti. Nöromların 2’si el, 2’si ayak (2 Morton nöromu), 1’i dudak, 1’i çene, 1’i frontal yerleşimliydi. Granüler hücreli tümörler özefagus ve kol yerleşimliydi. Eksize edilen kitlelerde nüks izlenmedi. En sık histolojik tip NFdu. Tüm tümör gruplarında erkek olguların oranı-nörofibromda daha fazla olmak üzere-daha fazlaydı. Tümörler en sık orta yaş grubunda, 40-50 yaş arasında dağılım gösteriyordu. Lokalizasyon olarak tümörlerin tamamında baş-boyun dışı yerleşim daha sıktı (total:%60.6); Schwannom tanılı olguların büyük kısmı; NF olgularının ise yaklaşık yarısı baş-boyun dışı yerleşimliydi. Sonuç: PSKT'leri, genellikle benign, yavaş büyüyen kitleler halinde bulunurlar, ancak nadir yerleşimli bölgelerde yanlış teşhise ve suboptimal cerrahi tedaviye yol açabilir. Preoperatif planlama, dikkatli bir cerrahi eksizyon ve histopatolojik değerlendirme tümör nüksünü önlemek ve postoperatif fonksiyonel sonuçları iyileştirmek için gereklidir.

Angiomatoid Spitz nevus is an uncommon histopathological variant of Spitz nevus that is most frequently seen on the extremities of children and young adults. Dermatoscopic features of this unusual variant have rarely been reported. We presented a 19-year-old female diagnosed with angiomatoid Spitz nevus based on the clinical, dermatoscopic, and histopathological findings. Polarized-light dermatoscopic examination showed a red structureless background, white lines reticular, numerous coiled vessels without specific arrangement and surface scale. Although the dermatoscopic findings we described in this case can be observed in SN in general, we believe that the predominancy of coiled vessels may be an important clue to the angiomatoid variant of SN.

Aim: Ashy dermatosis (AD) is a cutaneous pigmentation disorder with unknown etiology characterized by ash-colored hyperpigmented macules. The diagnosis of Ashy dermatosis is primarily based on the clinical and histopathological findings. In this study, we aimed to identify the dermoscopic features of AD, which may facilitate the diagnosis by reducing the need for invasive procedures. Material and Methods: The study included the patients diagnosed with Ashy dermatosis. Demographic, clinical, dermoscopic and histopathological features of the lesions were reviewed and the findings observed were recorded. Results: A total of 60 lesions from 15 patients were included. The most common dermoscopic finding were irregular linear dots and globules, pinkish brown color was the predominant color of the background, and found to be associated with early lesions. Among the vascular structures observed, irregular linear vessels were the most prevalent. There were no significant differences in terms of dermoscopic structures according to age and localization of the lesions. Conclusion: Dermoscopy can serve as a noninvasive helpful tool for the diagnosis of Ashy dermatosis.

Aim: Dermoscopic features of cutaneous squamous cell carcinoma (SCC) have been well described; however, there are a few studies focused on the dermoscopic aspect of lip SCC. In this study, we aimed to identify dermoscopic findings of lower lip SCC. Materials and Methods: The clinical and histopathologic features, dermoscopic images, and demographic data of the patients with histologically approved lip SCC were retrospectively evaluated. Results: A total of 10 lesions were enrolled in the study. Milky red structureless background (100%) and keratin scale (100%) were present in all the lesions. Blood spots on thick keratin scale were observed in eight lesions. Seven lesions showed white structureless areas. Two lesions exhibited ulceration and one of the lesions had structureless brown pigmentation. The most common vascular pattern observed was polymorphous vascular pattern (60%). Conclusion: White and milky red structureless areas, blood spots on thick keratin scale, and polymorphous vascular pattern are the main dermoscopic clues to lip SCC. The presence of these findings should direct the clinician to the possibility of SCC. The dermoscopic findings observed may also reflect histological grade of the lesion.

Foregut cyst (FC) is an uncommon, benign, solitary cyst comprising four layers: ciliated pseudostratified columnar epithelium, subepithelial connective tissue, smooth muscle layer, and outer fibrous capsule. FCs are classified as bronchogenic, enterogastric, or undifferentiated. Friedreich first described the lesion in 1857 and predicted its congenital origin. We present an FC that developed in the retroperitoneum and was difficult to separate from other retroperitoneal cystic mass lesions. A 27-year-old female presented with flank pain. Abdominal computed tomography revealed a cystic lesion, measuring approximately 7.8 cm in diameter, located near the posterior stomach, superior pole of the left kidney, and pancreas. Total cystectomy was performed. Macroscopic examination revealed a 7.8×6 cm unilocular cyst enclosed by a thin capsule, which contained a viscous, yellowish fluid. No solid component was observed in the lesion. The surgeon confirmed no continuity of the cyst into the surrounding organs. Microscopy revealed the cyst to comprise four layers. In focal areas, seromucous glands were observed in the wall. There was no evidence of malignancy. With these findings, this case was diagnosed as retroperitoneal ciliated FC. FC located in the abdomen or retroperitoneum is extremely rare, and few cases have been described in literature. Intraabdominal and retroperitoneal locations have been explained by the presence of pleuroperitoneal canals in the early embryonic stage. FC should be considered in the differential diagnosis of retroperitoneal cystic masses including lymphangiomas, cystic pancreatic tumors, pseudocysts, and hematomas.

Idiopathic Granulomatous Mastitis (IGM) is a rare, chronic, non-malignant and non-life-threatening breast disease. IGM may mimic carcinoma of the breast. This case report is about concurrence of chronic granulomatous mastitis with breast cancer. The important aspect of this case is that it is the 4th case where IGM and breast cancer are present concurrently.

Purpose: The aim of this study was to evaluate the protective effect of resveratrol on cisplatin induced damage in rat kidney. Materials and Methods: 30 female Wistar-Albino rats were allocated to form three groups: In group 1 (control group), 1 mL of 0.9% NaCl (saline) was administered intraperitoneally for 3 days. In group 2 (cisplatin group), 7.5 mg / kg intraperitoneal cisplatin was given for 3 days. In group 3 (cisplatin + resveratrol group) 7.5 mg / kg cisplatin and 10 mg / kg resveratrol were given via intraperitoneal route. Right kidneys were surgically extirpated in all groups. Malondialdehyde (MDA) levels and activities of catalase (CAT) and superoxide dismutase (SOD) were measured in both blood and tissues. Also, toxicity markers such as vascular congestion, hemorrhage, tubule degeneration and glomerular damage were assessed by examining the slides prepared from kidney tissue with microscopy. Results: Tissue damage was significantly higher in group 2 than other groups. The MDA levels were significantly higher and the activities of SOD, and CAT were lower in group 2 than other groups. Conclusion: According to our short term findings, resveratrol might be an effective molecule to prevent the harmful effect of cisplatin in rat kidney.

BACKGROUND: Lumbar disc herniation (LDH) occurs owing to the inability of the posterior longitudinal ligament (PLL) to preserve the disc material within the intervertebral space. There is apparently no study that has investigated the histopathological changes occurring in both PLL and disc material in patients with LDH. OBJECTIVE: Investigate and compare the histopathological changes occurring in PLL and disc material of the patients who underwent a surgical operation for LDH. DESIGN: Descriptive, cross-sectional. SETTING: Pathology and neurosurgery departments of a tertiary health care institution PATIENTS AND METHODS: The study included patients who underwent surgical operation for LDH from January 2018 to May 2019 and whose PLL and disc material were removed together, and had disc degeneration findings that were radiologically and histologically concordant. MAIN OUTCOME MEASURES: PLL degeneration scores according to the histopathological findings, changes in disc materials according to the MRI findings, disc degeneration scores according to the histo-pathological findings. SAMPLE SIZE: 50. RESULTS: MRI and histological examinations showed fully degenerated black discs (Grade 2) in 12 patients, partially degenerated discs (Grade 1) in 29 patients and fresh/acute discs (Grade 0) in 9 patients. The PLL showed grade 0 degeneration in 2 patients, grade 1 degeneration in 23 patients, and grade 2 degeneration in 25 patients. PLL degeneration grades were higher than the disc degeneration grades (P=.002). CONCLUSION: Longitudinal ligament degeneration can play a significant role in the pathogenesis of LDH. To the best of our knowledge, this study represents the first to focus on the histopathological changes occurring in both the PLL and disc material in patients with LDH. LIMITATIONS: Small sample, retrospective CONFLICT OF INTEREST: None.

OBJECTIVE: Rainbow pattern is a dermoscopic finding composed of multiple colors simulating a rainbow. It is known as a characteristic feature of Kaposi's sarcoma. Here, we reported different non-Kaposi's sarcoma conditions with a rainbow pattern aiming to discuss the diagnostic significance of the finding. METHODS: In this multicenter study, dermoscopic images of the non-Kaposi's sarcoma lesions having a histopathological diagnosis were reviewed for the presence of a rainbow pattern. Dermoscopic examination was performed by a polarized handheld dermoscope with x10 magnification. RESULTS: A total of 840 lesions were reviewed and 21 (2%) non-Kaposi sarcoma lesions having dermoscopic rainbow pattern were detected. These lesions were as follows; pyogenic granuloma (n=4, 19%), hypertrophic scar (n=4, 19%), basal cell carcinoma (n=2, 10%), dermatofibroma (n=2, 10%), angiokeratoma (n=2, 10%), blue nevus (n=1, 5%), granuloma annulare (n=1, 5%), strawberry angioma (n=1, 5%), epidermal cyst (n=1, 5%), malignant melanoma (n=1, 5%), dissecting cellulitis (n=1, 5%) and subungual hematoma (n=1, 5%). The most common localization was limb (n=14, 67%) followed by face (n=3, 14%). CONCLUSION: We suggest that the rainbow pattern is a complex and quite unspecific optic phenomenon which can be seen both in vascular and non-vascular lesions. Its diagnostic significance should be considered in the context of the other structural dermoscopic finding. To the best of our knowledge, to our knowledge, this is the most comprehensive study focusing on rainbow pattern in non-Kaposi's sarcoma lesions. Here, we also reported rainbow pattern in dissecting cellulitis, granuloma annulare and subungual hematoma which has not been shown to have rainbow pattern previously.

Amaç: Şiddetli akut pankreatit (SAP) yüksek morbidite ve mortalite riski taşır. SAP'nin proenflamatuar yanıt fazı kontrol edilemezse, çoklu organ yetmezliği (ÇOY) ile sonuçlanabilir. Nükleer faktör-kappa B (NF-κB) aktivasyonu ÇOY'un gelişiminde önemli bir rol oynar. Bu çalışmada, bir anti-enflamatuar ve immünsüpresif ajan olan triptolidin SAP'lı sıçanlarda iyileştirici etkilerinin araştırılması amaçlanmıştır.Gereç ve Yöntemler: Toplam 20 Wistar-Albino sıçanı SAP ve triptolide tedavi (TT) grubu olmak üzere iki gruba ayrıldı. SAP her iki grupta da intraperitoneal cerulein (50 mg/kg) enjeksiyonu ile indüklendi. TT grubuna, SAP indüksiyonundan 24 saat sonra tek bir doz (0.2 mg/kg) triptolid uygulandı. Serum ALT, AST, GGT, Lipaz, Glikoz, ALP ve amilaz düzeyleri ve pankreatik doku örnekleri incelendi.Bulgular: Serum glukoz ve amilaz düzeyleri TT grubunda anlamlı olarak daha düşük bulundu (sırasıyla p=0.011 ve p=0.035). Diğer biyokimyasal parametreler açısından gruplar arasında anlamlı bir fark yoktu. Pankreas ödemi, asiner hücre dejenerasyonu, yağ nekrozu, intrapankreatik&perivasküler inflamasyon ve peripankreatik yağ dokusunda inflamasyon her iki grupta da sık görülen histopatolojik bulgulardı. Gruplar arasında histopatolojik değişiklikler açısından anlamlı bir fark yoktu.Sonuç: Cerulein kaynaklı pankreatit, deneysel SAP için başarılı bir yöntemdir. Tek doz triptolid tedavisinin iyileştirici etkileri SAP'nin erken evresinde belirgin değildir. Pankreatik doku histopatolojik ve biyokimyasal parametreler açısından incelendiğinde, triptolidin enflamatuar ve oksidatif stres üzerindeki terapötik etkileri yeterli düzeyde değildi.

Objective: Cutaneous smooth muscle tumors represent a rare group of cutaneous lesions including piloleiomyoma, angioleiomyoma, genital leiomyoma, smooth muscle hamartoma, and leiomyosarcoma. In this study, we aimed to evaluate the clinical and pathological characteristics of CSMTs, focusing on the rare and unspecified histological features. Material and Method: The clinical, demographic and histological findings of the patients with CSMTs were reviewed and evaluated retrospectively. The histopathological sections were re-evaluated for all cases. Results: A total of 32 patients with CSMTs were enrolled. The majority were female (n=20). The most common tumor diagnosed was angioleiomyoma (n=19, 59.4%) followed by piloleiomyoma (n=8, 25%), smooth muscle hamartoma (n=2, 6.3%), leiomyosarcoma (n=2, 6.3%), and genital leiomyoma (n=1, 3%). Five lesions were painful and only 3 specimens were submitted with the preliminary diagnosis of a cutaneous smooth muscle tumor. Conclusion: There are very few studies investigating both clinical and histological characteristics of CSMTs in detail. Along with the classical histological clues, evaluation of the clinical findings and less-defined histological features may enhance the diagnostic accuracy. To the best of our knowledge, this study represents the first original study focusing on the clinical and pathological aspects of CSMTs in our country.

Phyllodes tumor (PT) of the vulva is very rarely seen and has been reported in only 17 cases in English literature. It is still uncertain that proliferative mammary gland lesions including PT in the anogenital region originate from ectopic breast tissue or from local adnexal structures. We report a case of primary benign PT of the vulva in a 41-year-old female patient. Microscopic examination revealed biphasic tumoral formation with typically extensive leaf-like papillary structures growing toward slit-like spaces under the skin. In immunohistochemical examination, more than 50% of epithelial cells showed a positive reaction with ER, PR, and panCK and a focal positive reaction with GCDFP-15. Myoepithelial cells showed a positive reaction with SMA, CD10, and WT-1. In this report, we underline the clinicopathologic features of PT localized to an unusual site, and also discuss its etiology, differential diagnosis in the light of the current literature.

Basal cell carcinoma (BCC) is the most common skin cancer with several clinical and histopathological subtypes. Trauma and scar tissue have been implicated as possible etiological causes of BCC. Here, we report a case of a 37-year-old man with BCC arising on a longstanding cicatricial plaque with nearly 30 years' duration. Intractable pruritus, which had started two months ago and gradually intensified, was the patient's main complaint upon admission. The lesion presented as a linear, erythematous, excoriated cicatricial plaque in the left supraclavicular region. Pearly borders and the mildly atrophic center of the plaque, that were recognized upon close examination, were notable features and may indicate BCC. We believe that a detailed patient history and meticulous clinical examination are essential for diagnosing BCC arising in longstanding scars. Keywords: Scar, Basal cell carcinoma, Pruritus, Malignancy, BCC

Extraskeletal osteosarcomas are rarely observed tumors. Besides this, primary osteosarcomas of uterus are rarer, and only 21 cases have been reported in the literature. It is generally seen at the postmenopausal period, and it progresses quite aggressively. Particularly, malignant mixed mullerian tumors (MMMTs) are important for differential diagnosis. Histopathological and immunohistochemical examination of a mass that was detected in the uterus of a 61-year-old postmenopausal patient revealed the diagnosis of primary chondroblastic osteosarcoma, and this very rare case is presented here.