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Ayşegül Küçük,1,* Yücel Polat,2 Aydan Kılıçarslan,3 Nuran Süngü,3 Hakan Kartal,4 Ali Doğan Dursun,5,* Mustafa Arslan6 1Kutahya Health Sciences University, Medical Faculty, Department of Physiology, Kutahya, Turkey; 2Mehmet Akif Ersoy Thoracic and Cardiovascular Surgery Training and Research Hospital, Department of Cardiovascular Surgery, Istanbul, Turkey; 3Yildirim Beyazit University, Medical Faculty, Department of Pathology, Ankara, Turkey; 4Gulhane Medical Faculty, Gulhane Education and Research Hospital, Department of Cardiovascular Surgery, Ankara, Turkey; 5Atilim University, Medical Faculty, Department of Physiology, Ankara, Turkey; 6Gazi University, Medical Faculty, Department of Anesthesiology and Reanimation, Ankara, Turkey*These authors contributed equally to this workCorrespondence: Mustafa ArslanGazi University, Medical Faculty, Department of Anesthesiology and Reanimation, Ankara, 06510, TurkeyTel +90 312 202 67 39Email mustarslan@gmail.comAim: The aim of this study was to evaluate the effects of irisin in a murine model of hind limb ischemia reperfusion (I/R).Methods: The mice were divided into four groups (n = 6 in each group): control, irisin, ischemia reperfusion (I/R), and irisin-ischemia reperfusion (I–I/R). Irisin (0.5 μg.g− 1, intraperitoneally [i.p.]) was administered 30 min before the I/R procedure. After 2 h of ischemia and 2.5 h of reperfusion, blood and tissue samples were taken for biochemical and histopathological analysis. The results were analyzed by Kruskal–Wallis and Mann–Whitney U-tests.Results: There was a statistically significant difference in the total antioxidant status (TAS) and total oxidant status (TOS) levels in all the groups. The TAS level in the I/R group was significantly lower than that in the control, irisin, and I–I/R groups, whereas the TOS level was significantly higher in the I/R group as compared with that in the other groups. Caspase-3 activity and caspase-8 activity, indicators of inflammation, were significantly higher in the I/R and I–I/R groups as compared with those in the control and irisin groups.Conclusion: Irisin may have protective effects in skeletal muscle ischemia reperfusion injury.Keywords: irisin, ischemia reperfusion, caspase-3, caspase-8, mice

DTC is a group of malignant neoplasms composed of papillary thyroid carcinoma, follicular carcinoma and poorly differentiated thyroid carcinoma. Postsurgical histopathology enables the clinician to make the definitive staging and risk classification to determine the need for further treatments. Our primary outcome was to evaluate the adequacy of our center’s histopathology reports in large cohort of DTC patients. Our center is a high-volume tertiary center in our country specialized for DTCs with great experience. Data of 2114 patients were analyzed, 1407 patients who were operated in our center were included in the study. Maximum dimension of the tumor was absent in 2 (0.14%) patients, histological subtype was not reported in 688 (48.61%), the surgical margin was absent in 249 (17.69%). Of 153 patients with lymph node metastases, the size of the metastatic lymph node was not reported in 61 (39.86%) patients. Information on the number of involved lymph nodes, extranodal extension in the lymph node, and the size of the metastatic foci in the lymph nodes were missing in 4 patients (2.63%), 64 patients (42.10%), and 91 patients (59.47%), respectively. In conclusion the histopathology report is the backbone of the DTC management on what all risk determinations and treatment plans are built on. The pathology reports in our center are comprehensive but still the percentage of the patients whose histopathology report includes all criteria suggested by ATA guidelines was found to be %13.

Background The programmed death receptor (PD-1) and ligand (PD-L1) pathway act by suppressing the antitumor response in chronic Hodgkin lymphoma (cHL). In this study, we aimed to investigate the effect of PD-1, PD-L1, and Epstein-Barr virus (EBV) positivity on prognosis at the initial diagnosis of cHL. Material and Methods Thirty-six patients with cHL were retrospectively analyzed. PD-L1 staining was performed for RS cells and tumor microenvironment in the biopsy materials of cases. The presence of EBV was investigated by EBER (EBV-encoded RNA) method in tumor cell. P Results The presence of advanced-stage disease, B symptoms, intermediate or high-risk international prognostic index (IPS), and extranodal involvement were found to be related to both PD-L1 positivity and EBV positivity in RS cells. PD-L1 positivity in RS cells was also associated with EBV positivity. There were 6 (16.7%) triple-positive (EBV+, RS-PD-L1+, mic-PD-1+) patients. All of these patients had advanced-stage disease, B symptoms at the time of diagnosis, and intermediate-high IPS score, and 4 of 6 patients had extranodal involvement. This group also had significantly shortened overall survival compared with others (38.4 months vs. 67.9 months P = .024). Conclusion Our data suggest that there is correlation between PD-L1 positivity and EBV positivity in tumor RS cells that are also associated with extranodal involvement, intermediate and high IPS score, presence of B symptoms, and advanced-stage disease. In addition, we identified a group of triple-positive (EBV+, RS-PD-L1+, mic-PD-1+) cHL patients who have a very high-risk disease.

This study was made to determine the clinical and pathological features and incidences of tumors according to the results obtained from the samples taken during an appendectomy, to evaluate the post-diagnosis treatments and the survival time of patients. The data of this retrospective study had from the files of 4813 patients who were operated with pre-diagnosis of acute appendicitis at Ankara Atatürk Training and Research Hospital between 2007,-2017. Fifteen (0.31%) of the patients who underwent appendectomy were detected to have appendix tumors. According to the histopathological classification of tumors of these patients, it was determined that 8 of them had a carcinoid tumor, 6 of them had mucinous adenocarcinoma and 1 of them had adenocarcinoma. The mean age of the patients with carcinoid tumor was 30.29 ± 7.95 and the mean age of the patients with mucinous adenocarcinoma was 65 ± 18.81. It has been determined that women develop two times more appendix tumors than men. Nine patients with a tumor diameter less than 1 cm had only appendectomy operation and it was determined that tumors did not recurrence after the follow-up. Three patients with postoperative mesoappendix involvement underwent right hemicolectomy in the second operation. Preoperative computed tomography revealed periappendicular mass in 3 patients. In addition to right hemicolectomy, omentectomy, peritonectomy and lymph node dissection were performed in these three patients with suspected malignancy. The five-year survival of patients was found to be 100.0% in patients with carcinoid tumors and 67.0% in patients with mucinous adenocarcinomas. In conclusion, the majority of appendiceal tumors in our study that were found to be more widespread in women than in men were detected incidentally. The prognosis and survival rates of patients with carcinoid tumors were better than mucinous adenocarcinomas. Therefore, to made follow-up and treatment of the patients according to the report obtained after histopathologic examination of the appendix tumor is important.

Primary or secondary lymphoma of the prostate is a rare condition. Mantle cell lymphoma (MCL) represent 4-9% of all lymphomas. Prostate involvement with MCL is very rare, with only 11 reported cases up to now. Here we present a case with lower urinary tract symptoms and prostate-specific antigen (PSA) elevation diagnosed with MCL of the prostate. Prostate biopsy was performed in a 70-year-old patient due to increased PSA. After the pathology result was reported as prostatic MCL, imaging studies and sampling of additional pathological specimens were performed for staging. An improvement was observed in the urinary system complaints of the patient who started chemotherapy regimen. While prostatectomy was performed in some of the prostatic MCL cases reported previously, in some, no additional treatment was required after chemotherapy. Our case is the only prostatic MCL case with elevated PSA levels, but did not receive the diagnosis of prostate cancer. Physicians should keep in mind that, prostatic MCL can present with nonspecific symptoms. Staging should be performed in patients whose histopathologic diagnosis is lymphoma of the prostate so as to determine appropriate treatment options.

Aim: Fullerenol, a water-soluble C60-fullerene, has been demonstrated to scavenge free radicals in vitro and in vivo. The aim of the study was to investigate the effects of fullerenol C60 on lower skeletal muscles in a rat model of ischemia/reperfusion (I/R).Methods: After approval of the ethics committee, 30 Wistar Albino rat were divided into 5 groups with six animals per each as follows: Control (C), diabetes (D), diabetes+fullerenol C60 (DF), diabetes+I/R (group DIR) and diabetes I/R+fullerenol C60 (DIR-F) groups. Streptozotocin was administered to the rats to induce diabetes at a dose of 55 mg/kg. Four weeks after the onset of diabetes, rats were subjected to 2 hours of ischemia and 2 hours of reperfusion. At the end of the reperfusion period, skeletal muscle samples were taken from the lower extremity in all groups for histopathological and immunohistopathological examinations. Results: Myositis and endothelial caspase 3 enzyme activities were high in all groups, particularly DIR. Compared to C, DF and DIR-F groups, inflammation and myositis were significantly higher in the DIR group (P=0.001, P=0.006, P=0.001, respectively, and P=0.001, P=0.022, P=0.001, respectively). Vascular dilatation and congestion were significantly more prominent in all groups compared to the control group (P=0.001 for all).Conclusion: Our results confirm that fullerenol C60 has protective effects against skeletal muscle damage resulting from I/R in diabetic rats. Future studies conducted to evaluate these effects may help illuminate the action mechanism of fullerenol C60 and pathophysiology underlying the tissue damage related to I/R injury., Amaç: Suda çözünür bir fulleren olan Fullerenol C60'ın, serbest radikalleri in vitro ve in vivo temizleyebildiği gösterilmiştir. Çalışmanın amacı, fullerenol C60'ın iskemi reperfüzyon (I/R) sıçan modelinde alt iskelet kasları üzerindeki etkilerini araştırmaktı. Yöntemler: Etik kurul onayı alındıktan sonra 30 Wistar Albino sıçan; 5 gruba ayrıldı (n: 6); Kontrol (C), diyabet (grup D), diyabet + fullerenol C60 grubu (DF), diyabet + I/R (grup DIR) ve diyabet I/R + fullerenol C60 (DIR-F). Diyabet için sıçanlara 55 mg / kg streptozotosin uygulandı. Diyabet oluşumundan dört hafta sonra sıçanlara 2 saatlik iskemi ve 2 saatlik reperfüzyon uygulandı. Reperfüzyon döneminin sonunda histopatolojik ve immünohistopatolojik incelemeler için tüm gruplardan alt ekstremite iskelet kası örnekleri alındı.Bulgular: Miyozit ve endotelyal kaspaz 3 enzim aktiviteleri, özellikle DIR ve C, D, DF ve DIR-F grubunda yüksektir. Enflamasyon DIR grubunda C, DF ve DIR-F grubuna göre anlamlı olarak yüksektir (sırasıyla P

Purpose To investigate the long-term effects that CXL has on the tear function and ocular surface in keratoconus. Methods Twenty-one consecutive patients (24 eyes) with progressive keratoconus scheduled for CXL were included. All patients underwent the following procedures: conjunctival impression cytology analysis, ocular surface disease index (OSDI) score, tear osmolarity test, Schirmer test, tear film breakup time (TBUT), ophthalmic surface fluorescein (Fl) staining, and topographical corneal evaluation before as well as 3 and 18 months after accelerated CXL. Results There was no change in the median OSDI score, tear osmolarity test, Schirmer test, and the Fl staining score after CXL. The median TBUT increased from 9.00 s at baseline to 12.00 s at 18 months postoperative (P < 0.001). The cytological features of the temporal and superior bulbar conjunctiva deteriorated at 3 months post-CXL (P < 0.001). An improvement in impression cytology analysis of the temporal conjunctiva was noted at 18-month follow-up (P < 0.001). Significant improvements in the median maximum keratometry and mean keratometry (K-mean) readings were also noted 18 months after CXL (P < 0.001). The changes in the K-mean correlated significantly with the changes in TBUT levels at 18-month follow-up as compared to baseline (r = - 0.688, P < 0.001). Conclusions The improvement in TBUT, conjunctival squamous metaplasia, and the goblet cell density indicates a favorable effect of CXL on the ocular surface and tear film in keratoconus, presumably due to the reduced corneal irregularity after CXL.

Objective Although classical Hodgkin lymphoma (cHL) has a relatively good prognosis, it also entails different treatment responses and involves patients who have different clinical courses. Our aim was to investigate c-Myc, Bcl-2 and EBV biomarkers in cHL and their relationship with the IPS score. Material and method c-Myc and Bcl-2 immunohistochemical staining with EBER in situ hybridization (EBER-ISH) was applied to the paraffin sections of 94 cases diagnosed as cHL. These cases were classified into two groups as low and high clinical symptoms according to the International Prognostic Scores (IPS). Results Positive results were obtained in 83 (88.3%) cases with c-Myc and 39 (43.5%) cases with Bcl-2 while EBER-ISH was found positive in 42 (44.7%) cases. No difference was found between the groups of low/high IP scores with respect to the positive or negative results of EBER-ISH, Bcl-2 and c-Myc. When Bcl-2 and c-Myc positive cases were grouped together and compared to the IP scores of the remaining cHL cases, again no difference was seen. Extranodal involvement and bone marrow involvement was observed in 25 (26.5%) and 9 (9.5%) cases, respectively. Similarly, no statistically significant differences was found between these groups according to their positivity with EBER-ISH, Bcl-2 and c-Myc. Conclusion We could not find any relationship between Bcl-2, c-Myc and EBER-ISH positivity and the low/high IPS groups in cHL. New studies with larger series are needed in which more precise cut-off values are used and clinically and biologically heterogeneous groups of cHL patients are determined more clearly.

PubMed ID: 30144808 Background: Clear cell renal cell carcinoma (ccRCC) is the most common renal malignancy. Hypoxia-inducible factors, HIF-1? and HIF-2?, are expressed in the majority of ccRCC. Targeting immune checkpoints with the blockade of PD-1 and its ligand PD-L1 reorganizes T-cell activity in tumor microenvironment and provides important antitumor responses. PD-L1 upregulation has been found to be hypoxia-inducible factor (HIF) dependent. Our aim is to demonstrate the association between PD-L1 and HIF expression and to reveal the role of PD-L1 in prognosis and its association with tumor microenvironment. Methods: Surgical specimens from 145 patients diagnosed with ccRCC, who had undergone radical or partial nephrectomy, were retrospectively analyzed. Immunohistochemistry on tissue microarrays (TMA) was performed to demonstrate expressions of PD-L1, HIF-1?, and HIF-2? in tumor cells and PD-1, CD4, and CD8 in lymphocytes to assess lymphocyte density in tumor microenvironment. Results: PD-L1 tumor cell expression was detected in 20/125 (13.8%) cases, which correlated with higher levels of PD-1, CD4, CD8 and HIF-2? expression. Low or high expression of HIF-1? was similar in PD-L1-positive cases. When PD-L1-positive cases were compared with negative ones, there was no significant difference in terms of prognostic factors. However, the number of WHO/ISUP grade 3-4 tumors was significantly higher in PD-L1-positive cases than in negative ones. Conclusion: PD-L1 tumor cell expression is strongly associated with increased HIF-2? expression and presence of dense lymphocytic infiltration in ccRCCs. Our findings confirm that PD-L1 positivity is associated with high ISUP nucleolar grade. The association between PD-L1, HIF, and lymphocyte density in tumor microenvironment must be clarified and especially taken into account in combination treatment. © 2018 The Author(s).

Objective: Owing to their importance in cell proliferation in cutaneous malignancies, we aimed to immunohistochemically compare the expression profiles of p53 and Ki67 in basal cell carcinoma (BCC) cases in both a usual and an unusual locations in this study. Material and Method: In this study we included 12 in an unusual location of BCC cases and 21 BCC cases in a usual location. Immunohistochemical expression of p53 and Ki67 antibodies were studied in 33 paraffin-embedded tissue specimens of basal cell carcinoma. We compared the p53 and Ki67 staining scores with clinicopathologic features. Results: The tumor size was found to be greater in BCC cases in an unusual location than those in a usual location. The relationship between age and tumor size was also evaluated in both groups and it was found that tumor size increased with age. A comparative study between the two groups showed no difference p53 and Ki67 expression percentages. There was a linear correlation between the Ki67 and p53 marker staining rates (ρ=0.420; p=0.015). In the samples taken from cases in a usual region, there was a linear and moderate relationship between the markers (ρ=0.513; p=0.017). Median tumor diameter results were similar to the marker staining score (p>0.05). Conclusion: This is the first study comparing the expression profiles of p53 and Ki67 of BCC cases in an unusual and a usual location. No significant difference was found concerning Ki67 and p53 expression levels between the two groups.

The human epidermal growth factor receptor 2 (Her2/neu) signal pathway plays a significant role in the occurance of various solid tumor types. The rate of Her2/neu in colorectal carcinoma (CRC) is not clearly elucidated. In this study, we discuss the association between Her2/neu overexpression and clinicopathological parameters in CRC. Her2/neu immunohistochemical (IHC) staining was performed on whole sections of formalin fixed paraffin embedded tumor tissues of 100 CRC resections. Cases with score 3+ and score 2+ expressions were further evaluated by silver in-situ hybridization (ISH) for the existence of Her2/neu gene amplification. Her2/neu membranous overexpression was observed in 12 of the 100 cases (6 cases with a score 3+ and 6 cases with a score 2+) and 6 of these were heterogenous. There were 10 cases with Her2/neu amplification (6/6 score 3+, 4/6 score 2+). Strong cytoplasmic staining was observed in 5 cases. Membranous scores were either 3+ or 2+ in 3 of these 5 cases. Moreover, there was Her2/neu amplification in 2 of these 3 cases. Her2/neu amplification status and overexpression was not related to clinicopathological parameters and overall survival. More clear results can be obtained from studies with Her2/neu IHC and ISH test on whole sections.

Blastic plasmacytoid dendritic cell neoplasm (BPDCN) is a rare and aggressive hematological malignancy characterized by proliferation of plasmacytoid dendritic cell precursors. Herein, we describe a 65-year-old male presented with a 6 month history of a progressively enlarging purple mass over his forehead. The histopathological examination revealed non-epidermotropic, dermal, and subepidermal homogeneous infiltration with moderate-sized cells resembling lymphoblasts or myeloblasts. The neoplastic clone diffusely stained positive with CD4 and CD56. They were negative for CD3, CD20, pax-5, CD30, myeloperoxidase, and TdT. Rearrangement studies for T and B cell receptor were negative. Ki-67 proliferation index was 80%. Involvement of multiple lymph nodes was detected. Bone marrow biopsy was normal. The patient was put on six cycles of R-CHOP chemotherapy which was successfully cleared all lesions. A rapid recurrence was observed after 1.5 months. While being prepared for autologous stem cell transplantation, the patient died due to rapidly onset myelosuppression and systemic infections. In conclusion, BPDCN should be in the clinical and histopathological differential diagnosis of rapidly developing tumoral cutaneous lesions. Early diagnosis is important to initiate aggressive treatments in BPDCN, in which skin involvement is very frequent.

To investigate the alterations in the ocular surface and tear film parameters 3 months after accelerated corneal collagen cross-linking (A-CXL) in progressive keratoconus (KC) patients. Twenty-six patients (33 eyes total) with progressive KC were enrolled in this study. All patients were subjected to ophthalmic surface examination, such as OSDI (ocular surface disease index) scoring, the osmolarity tear test, Schirmer test, tear film breakup time (TBUT) analysis, rose bengal (RB) and fluorescein (Fl) ocular surface staining, and conjunctival impression cytology (IC) analysis, respectively. These tests were performed at baseline and 3 months after A-CXL. Nelson's grading system was used to evaluate the cell morphology and goblet cell density. No statistically significant differences in the levels of tear osmolarity, TBUT, Schirmer test, OSDI scoring, and Fl and RB staining between pretreatment and 3 months postoperatively were observed (all P values >0.05). A statistically significant increase in superior (P=0.005) and temporal (P=0.006) IC grading was seen at the postoperative third month compared to pretreatment. Only metaplastic changes and a reduction in the density of the goblet cells were seen in conjunctival IC, which is probably because of the toxicity of ultraviolet-A 3 months after A-CXL. However, these results do not lead to deterioration in TBUT. In this study, A-CXL has no adverse effect on ocular surface and tear function, which are important for visual quality.

Objective:Basal cell carcinomas (BCC) are the most common cutaneous malignancy and most often seen in the head and neck region, only 1.2% occur in unusual localizations. We aimed to analyze the incidence and clinicopathologic features of our unusual localizations between 2006-2016 in our study. Methods:BCC findings in excisional biopsies from 2006 to 2016 were rewieved retrospectively. Results:Of 1140 patients with BCC diagnosis, only 11 (2 vulva, 2 inguinal region, 2 umbilicus, 1 acral-periungual region, 1 anal region, 1 areola, 1 sacral region and 1 axilla) were unusual localized. Lesions at a unusual localization accounted for 0.96% (11 cases) of all cases. Nodular, superficial and cystic variants were observed in these cases. Conclusion:BCC should be considered in unusual localizations due to its local aggression and tissue destruction however the risk of metastasis is very low.

Objective The Bethesda classification was introduced in 2008 to provide standardisation in the evaluation of thyroid fine needle aspiration cytology (FNAC). We compared the diagnostic value of pre-Bethesda and Bethesda classification systems in the differentiation of benign and malignant thyroid nodules. Methods Medical records of patients who underwent a thyroidectomy between June 2007 and June 2014 were reviewed retrospectively. Nodules evaluated with FNAC before March 2010 were classified as pre-Bethesda (non-diagnostic, benign, indeterminate, suspicious for malignancy and malignant), and those evaluated after March 2010 were considered Bethesda (non-diagnostic, benign, atypia of undetermined significance/follicular lesion of undetermined significance, follicular neoplasia/suspicious for follicular neoplasia, suspicious for malignancy and malignant). Sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV) and accuracy of the two classification systems were calculated. Results There were 1810 nodules in the pre-Bethesda and 5115 nodules in the Bethesda group. The non-diagnostic rate was significantly higher, and benign and suspicious for malignancy rates were lower in Bethesda compared with the pre-Bethesda group (P

Background We aimed to compare the cytology and histopathology results of hot, cold, and warm nodules in patients who had thyroidectomy due to toxic multinodular goiter (TMNG). Methods Five hundred and nine thyroid nodules from 413 patients who had operation with TMNG were included in this retrospective study. The nodules were categorized as hot, cold, and warm groups. The cytology and histopathology results were compared. Results The 509 thyroid nodules were grouped as hot (n = 364 [71.5%]), cold (n = 122 [24.0%]), and warm (n = 23 [4.5%]) according to scintigraphy. Cytological evaluations of 364 hot nodules were as follows: 80 (22%) nondiagnostic (ND), 259 (71.2%) benign, 17 (3.6%) atypia of undetermined significance/follicular lesion of undetermined significance (AUS/ FLUS), 2 (0.5%) follicular neoplasm/suspicious for follicular neoplasm (FN/SFN), 2 (0.5%) suspicious for malignancy (SM), and 4 (1.1%) malignant. The cytology of 122 cold nodules were ND in 25 (20.5%), benign in 86 (70.5%), AUS/FLUS in 8 (6.6%), FN/SFN in 1 (0.8%), and finally SM in 2 (1.6%). The 23 warm nodules were determined as ND, benign, and FN/SFN in 7 (30.4%), 15 (65.2%) and 1 (4.3%), respectively. There were no differences according to cytological results between groups (P = .616). However, malignancy rate was 3.8% in hot nodules, it was found as 6.6% in cold nodules. The malignancy was detected in 4.3% of warm nodules. There were no differences in malignancy rates between groups (P = .459). Conclusion We demonstrated similar malignancy rates in hot nodules when compared with cold and warm nodules.

Acute promyelocytic leukemia is characterized by the presence of atypical promyelocytes in bone marrow and peripheral blood. Neoplastic promyelocytes, which often have Auer rods, are most commonly seen in early myeloid precursors in certain subtypes of myeloid leukemia. A 63-year-old male patient,was admitted to our clinic with the complaints of malaise and weight loss for several months, presented with leucopenia and mild anemia. There were no findings of organomegaly, lymphadenopathy and bleeding diathesis and no evidence of infection. Bone marrow aspiration and biopsy which was performed with the preliminary diagnosis of myelodysplastic syndrome revealed a slightly increased Myeloid/Erythroid ratio, distinct maturation arrest in the cells of myeloid lineage 15-20% of which have nucleocytoplasmic asynchrony, course cytoplasmic granules and Auer rods. Auer rods were also present in the cytoplasm of mature neutrophils. Additionally, megakaryocytes were also dysplastic. The immunohistochemical staining was positive for CD117 in 10% of the cells and there was no staining for CD34. The diagnosis was obscure until the fluorescein in situ hybridization results which was positive for PML-RARa fusion t(15;17) (q24.1;q21.2) was received. The patient was eventually diagnosed with acute promyelocytic leukemia. This unusual case of APL was characterized with rarity of atypical promyelocytes in the bone marrow, distinct dysplasia in the myeloid and megakaryocytic lineages and silent clinical course without coagulopathy which caused delay in diagnosis, and well response to treatment.

Background We intended to study whether there is a meaningful difference in microscopic examination between dividing a biopsy section into two equal parts before tissue processing (first method) or after (second method). Methods A total of 400 cases were included in the study. Punch biopsies (PB) were cut into two pieces using the first method in 200 cases and just before paraffin embedding in another 200 cases using the second method. We microscopically evaluated the epidermal mesh view, the presence of a cross-cut hair follicle and bow shape because of epidermal angling, the presence of two pieces on the slide and if there was a difference of >2 mm between the parts, and the number of new sections and new slides. Results Cross-cut hair follicle (p = 0.018), epidermal mesh view (p = 0.036), difference of >2 mm between the parts (p = 0.008), the number of new sections (p < 0.001) and new slides (p < 0.001) were considerably higher when the first method was used compared with the second method. The presence of two pieces was less (p < 0.001) when using the first method. Conclusions We noted a meaningful difference in the quality of microscopic evaluation between the first and second methods. Better sections were obtained with the second method. In addition, the decrease in the number of new slides will reduce workload, archival work and cost.

BRAF(V600E) mutation was analyzed by real-time polymerase chain reaction in 96 consecutive cases with classical variant papillary thyroid cancer, and immunohistochemical staining of Na+/I- symporter (NIS) protein was evaluated. Localization (intracellular or membranous), density, and the intensity of cytoplasmic staining were characterized semiquantitatively. Extrathyroidal invasion, surgical margin positivity, and lymph node metastasis were compared with BRAF(V600E) mutation and NIS expression. Eighty-eight patients who had at least 24-month follow-up were also included in survival analysis. BRAF(V600E) mutation was determined in 78.1% (75/96) and functional NIS activity in 74% (71/96) of the cases. There were statistically significant differences in mean ages between BRAF(V600E) mutation-positive (48.6) and BRAF(V600E) mutation-negative cases (37.3; Levene test, P=.419; Student t test, P=.001). The surgical margin positivity (46.7%) and extrathyroidal extension percentage (54.7%) in the BRAF(V600E) mutation-positive group were higher than the negative (28.6% and 33.3%, respectively) group, without statistical significance (P=.138 and P=.084, respectively). Functional NIS activity was higher in BRAF(V600E) mutation-positive cases (78.1%) than mutation-negative ones (57.1%; P=.047). The possibility of moderate and intense cytoplasmic staining in BRAF(V600E) mutation-positive cases (72%) was 6.3 times higher than the possibility of weak staining (28%) in the mutation-positive cases (95% confidence interval, 2.2-18.8; P=.001). Functional NIS expression is higher in patients with classical variant papillary thyroid cancer with BRAF(V600E) mutation. However, the clinical features were not found to be associated with NIS expression. There may be different mechanisms determining the outcome of therapy.

Işın Güneş,1 Nuran Süngü,2 Aydan Kılıçarslan,2 Volkan Şıvgın,3 Metin Alkan,3 Ayşegül Küçük,4 Hakan Boyunağa,5 Yusuf Ünal,3 Mustafa Arslan3 1Department of Anaesthesiology and Reanimation, Erciyes University Medical Faculty, Kayseri, Turkey; 2Department of Pathology, Yıldırım Beyazıt University Medical Faculty, Ankara, Turkey; 3Department of Anaesthesiology and Reanimation, Gazi University Medical Faculty, Ankara, Turkey; 4Department of Physiology, Dumlupinar University Medical Faculty, Kütahya, Turkey; 5Department of Biochemistry, Kirikkale University Medical Faculty, Kirikkale, Turkey Objective: This study was conducted since the effects of colloid solutions on the renal system remain controversial and need to be adequately studied in animals. We aimed to evaluate the effects of hydroxyethyl starch (Voluven) on the kidney tissue of rats with late renal failure due to ureteral obstruction. Materials and methods: Rats were divided into four groups: Group C, control; Group HES, hydroxyethyl starch solution (HES) 130/0.4 (Voluven®); Group UUO, unilateral ureteral obstruction (UUO); and Group UUO-HES, UUO-HES 130/0.4 (Voluven®). In the groups with ureteral obstruction, the distal part of the right ureter was accessed and sutured through a lower abdominal incision under ketamine anesthesia. Any signs of late-stage renal failure were evaluated after three weeks. Rats in the HES group and the renal failure-HES group were administered with HES 130/0.4 as a single intravenous dose of 20 mL/kg. After a follow-up of 24 hours, intra-abdominal blood sample was collected, and the rats were sacrificed. Biochemical and histopathological parameters were then evaluated. Results: Ureteral obstruction significantly increased urea and creatinine levels. In addition, when the UUO-HES and HES groups were compared, the administration of HES increased urea and creatinine levels in the UUO-HES group. Nitric oxide enzyme activity and malondialdehyde levels have significantly increased in the UUO groups. In addition, HES significantly increased nitric oxide activity and malondialdehyde levels in the UUO-HES group, in comparison with the HES group. The activity of caspases 3 and 8 was significantly increased in the UUO groups. In addition, HES significantly increased the activity of caspases 3 and 8 in the UUO-HES group, in comparison with the HES group. Light microscopy revealed significant changes in the UUO groups, especially in the obstructed kidneys. Conclusion: If indicated, HES should be used with caution in cases of UUO, but not in the cases of bilateral ureteral obstruction. Other aspects of these findings, including the clinical significance and practical applications, merit further experimental and clinical investigation. Keywords: unilateral ureteral obstruction, hydroxyethyl starch solution 130/0.4, caspase 3, caspase 8, malondialdehyde, nitric oxide

Chemotherapeutic agents are not very effective in treating advanced endometrial cancers (ECs). Recent studies have demonstrated the immune evasion mechanism of tumors and possible remedies. Programmed cell death protein 1 (PD-1), programmed death ligand 1 (PD-L1), and programmed death ligand 2 (PD-L2) are immunomodulator molecules that have been the focus of research in lung cancer, melanoma, and renal cell cancer. However, there are few studies concerning EC. This retrospective study aimed to determine PD-1, PD-L1, and PD-L2 expression immunohistochemically in EC, and to study their correlation with clinicopathologic tumor characteristics. This study comprised 127 patients with EC. Anti PD-1, PD-L1, and PD-L2 antibodies were examined immunohistochemically on sections obtained from tissue microarray paraffin blocks. No staining with PD-1 in tumor cells was seen; however, we found positive staining in tumor cells at 36.2% with PD-L1 and 64.4% with PD-L2, and at 61.6% with PD-1, 36.2% with PD-L1, and 93.2% with PD-L2 in immune cells. When comparing staining and clinicopathologic findings, most of the PD-L1 negative tumors (both in tumor and immune cells) were FIGO Stage I, which was significantly higher than stage II-III-IV tumors (P

INTRODUCTION The incidence of thyroid cancer is increasing which can be attributed in part to improved ultrasonography (US) methods and increased detection of incidental thyroid carcinomas (ITC). We aimed to compare ITC with nonincidental thyroid carcinomas (NITC) in this study. METHODS Retrospective analyses of 906 individual patients who were operated for benign and malignant thyroid disease and had a final histopathological diagnosis of thyroid carcinoma were enrolled in this study. Preoperative US examination and fine needle aspiration (FNA) biopsy results were evaluated. The tumor foci in thyroidectomy specimens that were not represented in preoperative US or FNA reports were classified as ITC. The tumor foci that match with the lesions defined in US or FNA results were classified as NITC. RESULTS Final histology revealed ITC in 326 patients (36%) and NITC in 580 patients (64% Mean age was 51.7 ± 11.11 in ITC group and 48.15 ± 13.1 in NITC group (P

Gastrointestinal stromal tumors (GIST) are mesenchymal tumors of the gastrointestinal tract. Although bleeding is one of the most symptoms seen in GIST, significant acute bleeding is an unusual finding. Here in, three cases with gastrointestinal bleeding due to GIST are presented. Of these patients one had duodenal, one had jejunal and the other had ileal GIST. The duodenal GIST was detected by endoscopy while the jejunal GIST was found by capsule endoscopy and the ileal GIST was shown on magnetic resonance enterography. All patients underwent surgery and the diagnoses of GISTs were confirmed by histopathological evaluation.

Amac: Nedeni bilinmeyen ates (NBA) etiyolojisi cogu zaman klinisyenleri ugrastiran, tani icin invaziv islemler gerektiren klinik bir tablodur. Kemik iligi kulturu ve biyopsisi ile lenf nodu biyopsisi bu amacla tercih edilen invaziv girisimlerdir. Calismamizda NBA etiyolojisi arastirdigimiz hastalarimiza ait bu incelemelerin tanidaki rolu ve sonuclari tartisilmistir. Materyal ve Metot: Ankara Ataturk Egitim ve Arastirma Hastanesi Enfeksiyon Hastaliklari Klinigi’nde NBA etiyolojisine yonelik kemik iligi (KI) kulturu ve biyopsisi amaci ile Hematoloji ile konsulte edilen ve lenf nodu biyopsisi degerlendirilen hastalar incelenerek, tanida bu invaziv girisimlerin rolu degerlendirilmistir. Bulgular: Kemik iligi kulturu-biyopsisi yapilan 18 erkek, 14 kadin, toplam 32 hastadan alinan kemik iligi kulturlerinin altisinda ureme saptandi. Iki hastada es zamanli olarak hem kan, hem de kemik iligi kulturunde ureme vardi. Iki hastanin sadece kemik iligi kulturunde Brucella spp. uredi.Kemik iligi biyopsilerinden 24’u (%75,00) normoseluler, 6’si (%19,00) hiperseluler, biri (%3,00) lenfoma tutulumu gosteren kemik iligi ve bir digeri ise poliklonal plazma hucre artisi gosteren hiposeluler kemik iligi seklinde raporlandi. Fizik muayenede lenfadenopatisi saptanan dokuz hastaya lenf nodu biyopsisi yapildi. Lenf nodu biyopsileri ile bir hastada Leishmania spp., bir hastada EBV ve iki hastada diffuz buyuk B hucreli non-Hodgkin lenfoma (NHL) saptandi. Sonuc: NBA etiyolojisinde kemik iligi biyopsisi ve kulturu ve lenf nodu biyopsisi invaziv tanisal girisimler olup, kemik iligi tutulumu ile seyreden brusella gibi zoonotik enfeksiyonlar basta olmak uzere losemi, lenfoma, tuberkuloz gibi durumlari ortaya koymada altin standart testtir. NBA etyolojisi arastirilirken girisimsel hematolojik islemlerin degeri goz ardi edilmemelidir. Birinci basamak hekimleri, bu islemlerin gerekliligi ve zamanlamasi konusunda bilgi sahibi olmalidir.

WOS: 000452151700005, PubMed: 30546390, Glucagon-like peptide-1 (GLP-1) has been demonstrated to affect the oxidative stress status in several in vitro, in vivo and clinical studies. The aim of the present study was to evaluate the effect of a GLP-1 analogue, exenatide, on oxidative stress parameters and apoptotic markers in testicular cells in an iron overload rat model. To obtain this model, the animals were randomly divided into three groups (n=6/group). Rats in the control group received intraperitoneal injections of saline. Intraperitoneal iron dextran (60 mg/kg/day) was given to Group FE for 5 days a week for 4 weeks. The third group (Group Fe +E) was given subcutaneous injections of 10 mu g/kg exenatide in two divided doses for 4 weeks in addition to iron dextran. Testes of all rats were immediately removed for immunohistochemical staining and to measure the malondialdehyde level and superoxide dismutase enzyme activity. A significant reduction was observed in caspase-8 and -3 enzyme staining in testicular stromal and endothelial cells in exenatide injected iron overloaded rats when compared with controls. Oxidative stress markers malondialdehyde levels and superoxide dismutase enzyme activities were also significantly lower in exenatide-injected rats when compared with controls. These findings indicate that exenatide may be protective against the harmful effects of iron accumulation in testis. Further studies are required to evaluate how exenatide reduces oxidative stress and cell death in iron overloaded testis tissue.

The association between papillary thyroid carcinoma (PTC) and Hashimoto's thyroiditis (HT) is controversial. In this study, we aimed to compare preoperative thyroid functions, ultrasonography (US) features, fine-needle aspiration biopsy (FNAB) results, and histopathological characteristics of PTC in patients with and without HT. Data of 919 PTC patients were reviewed retrospectively. The diagnosis of HT was based on histopathological examination and patients were grouped as HT and non-HT. There were 1321 PTC lesions in 919 patients among which 317 (34.5 %) had coexistent HT. There were no significant differences in nodule volume, longitudinal diameter, texture, echogenicity, marginal regularity, presence of microcalcification and hypoechoic halo, and peripheral vascularization in patients with and without HT (p > 0.05, for all parameters). Macrocalcification was observed more frequently in the non-HT group (p = 0.021). FNAB results were similar in the two groups (p = 0.105). Distribution of variants, capsule invasion, vascular invasion, and extrathyroidal extension were observed with similar rates in the HT and non-HT groups. Lymph node metastasis was significantly higher in patients without HT (p = 0.012). Of the carcinomas, 66.1 % (n = 874) were papillary thyroid microcarcinoma (PTMC). Tumor size was lower in PTMC lesions coexistent with HT (p = 0.026). We observed lower rates of capsule invasion, extrathyroidal extension, and lymph node metastases in PTMC with HT compared to without HT (p = 0.007, p = 0.003, and p = 0.015, respectively). This study showed that US features, FNAB results, and histopathological findings of PTC lesions are not influenced by the presence of HT. However, PTMC seems to be related with less aggressive histopathological behavior in HT.

Background/aim: To evaluate the malignancy risk of thyroid nodules in different clinical thyroid diseases. Materials and methods: Patients who underwent thyroidectomy between 2007 and 2014 were grouped as euthyroid, hypothyroid, and hyperthyroid. Further classification was made depending on the presence of solitary/multiple thyroid nodules. Results: Among 2870 patients, 1719 (59.9%) were euthyroid, 962 (33.5%) were hyperthyroid, and 189 (6.6%) were hypothyroid. Overall malignancy was detected in 980 (34.1%) patients. Malignancy rates were 42.1%, 42.9%, and 18.3% in the euthyroid, hypothyroid, and hyperthyroid groups, respectively (P < 0.001). A total 41.4% of patients with euthyroid nodular goiter (ENG) and 46.3% of patients with euthyroid multinodular goiter (EMNG) had thyroid malignancy (P = 0.169). Mean tumor size and capsular and vascular invasion were significantly lower in EMNG than in ENG. Among hypothyroid patients, 45.7% with solitary and 42.2% with multiple nodules were malignant (P = 0.705). When toxic nodular goiter and toxic multinodular goiter were analyzed together, malignancy rate was 24.7% (104/421), and when Graves with nodule/nodules was considered, it was 19.7% (59/299). Conclusion: In hypothyroid or euthyroid patients who underwent thyroidectomy, malignancy rate was higher than 40%, and was lower in hyperthyroid patients. Patients with multiple nodules carry a similar risk of malignancy as patients with solitary nodules, independent of the functional status.

Background We aimed to compare nonaspiration (NAS) and aspiration (AS) techniques in the evaluation of fine-needle cytology of lymph node (FNC-LN) in terms of diagnostic adequacy of cytologic material. Methods One hundred and twenty-three superficial cervical LNs in 75 patients who underwent NAS and AS-FNC-LN in the same visit were evaluated. Cytological results were categorized as diagnostic and nondiagnostic. Results The rates of malignancy were 13.8% in AS versus 16.3% in NAS technique, whereas nondiagnostic cytology was detected in 43.1% and 25.2%, respectively (P = .549 and P

Introduction: Our goal was to evaluate benign and malignant lesions and testicular intraepithelial neoplasia (TIN) in the neighbouring normal- appearing testis tissue in men who underwent radical orchiectomy for testicular mass with a pathologic tumour size of ≤3cm.Methods: In this retrospective, multicentre study, data of 252 patients from 11 different institutions were included. Patients were divided into three groups based on tumour size: Group 1 (0‒1 cm; n=35), Group 2 (1.1‒2 cm; n=99), and Group 3 (2.1‒3 cm; n=118). Benign lesions and TIN were sought in the neighbouring testicular tissue and compared between groups.Results: Mean patient age was 32.3 years. Benign lesions were reported in 54.3%, 33.3%, and 14.4% of Groups 1, 2, and 3, respectively (p0.05 for Groups 2 vs. 3). Multifocality was detected in 8.6%, 4%, and 0% of Groups 1, 2, and 3, respectively (p0.05 for Group 1 vs. Group 2). A tumour cutoff size of 1.5 cm was found to be significant for detecting benign tumour. TIN and multifocality rates were similar in patients with a tumour size of ≤1.5 vs.>1.5 cm (p>0.05).Conclusions: Benign lesions and TIN in the neighbouring testis were significantly decreased and multifocality was increased in patients with a tumour mass size of ≤1 cm. Testis-sparing surgery should be performed with caution and a safety rim of normal tissue should also be excised.

Background: There are ultrasonography (US) features suggested to be associated with a higher risk of malignancy in thyroid nodules. However, exophytic appearence of thyroid nodules has not been studied previously. Objectives: To evaluate US features, and cytological and histopathological findings in exophytic thyroid nodules. Patients and Methods: Patients with an exophytic thyroid nodule who underwent fine needle aspiration biopsy (FNAB) between January and July 2015 were evaluated prospectively. Demographical data, US features, and cytology results were noted and histopathological findings were determined in operated patients. The results were compared with non-exophytic nodules of age and sex matched patients. Results: Data of 253 exophytic nodules in 247 patients and 529 non-exophytic nodules in 357 patients were analyzed. Hypoechogen-ity, mixed texture, and absence of peripheral halo were significantly higher in exophytic nodules (P < 0.001, P < 0.001, and P = 0.018, respectively). Nondiagnostic, atypia of undetermined significance/follicular lesion of undetermined significance and suspicious for malignancy cytology results were significantly higher in exophytic nodules (P = 0.002, P < 0.001 and P < 0.001 respectively). 6.7% of exophytic nodules and 1.9% of non-exophytic nodules had malignant cytology (P = 0.001). Histopathologically, 35 (47.9%) of 73 exophytic nodules and 18 (24.3%) of 74 non-exophytic nodules were malignant (P < 0.01). Capsular invasion was higher in the malignant exophytic group (53.5% vs 14.3%, P = 0.027). US features other than hypoechoic pattern which was higher in the malignant group were similar in benign and malignant exophytic nodules. Conclusions: Exophytic nodules seem to carry a higher rate of malignancy both cytologically and histopathologically. Suspicous US features except hypoechoic pattern were not higher in malignant compared to benign exophytic nodules. © 2016, Tehran University of Medical Sciences and Iranian Society of Radiology.

To evaluate the cytologic features of conjunctival epithelium in patients with unilateral primary acquired nasolacrimal duct obstruction (PANDO) using impression cytology. Twenty-four patients with unilateral PANDO for at least 1 year were enrolled in this study. The healthy eyes of the patients are assessed as control group. All patients were subjected to ophthalmic surface examination with conjunctival impression cytology analysis. Squamous metaplasia and goblet cell density were graded according to Nelson grading system. The mean age was 52.7 ± 16.3 (range 21–70) years. The mean period for complaints of epiphora was 3.2 ± 2.4 (range 1–8) years. The eye with PANDO had a mean squamous metaplasia grade of 2.38 ± 0.59 versus 1.91 ± 0.82 for control eyes (p = 0.011). The mean grade of goblet cell density was 2.0 ± 0.51 for eyes with PANDO and 2.38 ± 0.65 for control eyes (p = 0.013). There was no statistically significant correlation between conjunctival cytological features in terms of squamous metaplasia and goblet cell density grades and duration of epiphora complaint (r = −0.04, p = 0.82; r = 0.09, p = 0.66, respectively). PANDO may cause alterations in conjunctival impression cytology. Successful dacryocystorhinostomy surgeries will help to protect ocular surface health.

Background A fine needle aspiration biopsy (FNAB) is the most valuable diagnostic procedure for pre-operative discrimination of benign and malignant nodules. The Bethesda System for Reporting Thyroid Cytopathology provides standardised reporting and cytomorphological criteria in aspiration smears. The aim of the present study was to determine malignancy rates in nodules with different cytology results and evaluate the diagnostic value of Bethesda for variants of papillary thyroid carcinoma (PTC). Materials and methods A retrospective analysis of 2534 cases with 5784 thyroid nodules, who underwent FNAB followed by surgery, were included in this study. FNAB was performed with ultrasonography guidance. Cytological diagnoses were classified as: non-diagnostic (ND), benign, atypia of undetermined significance/follicular lesions of undetermined significance (AUS/FLUS), follicular neoplasm/suspicious for follicular neoplasm (FN/SFN), suspicious for malignancy (SUS) and malignant. Histopathological diagnoses were classified into four groups: benign, PTC, follicular thyroid cancer and other types of thyroid cancer (including medullary thyroid cancer, undifferentiated thyroid cancer and thyroid tumours of uncertain malignant potential). Cases with PTC were further divided into four categories: conventional variant, follicular variant, aggressive variants (tall cell, diffuse sclerosing and columnar variant) and other variants (oncocytic, solid/trabecular and warthin-like variants). FNAB results were compared with histopathological results. Results Malignancy rates were 6.3%, 3.2%, 20.7%, 33.3%, 74.2% and 95.6% in the nodules with ND, benign, AUS/FLUS, FN/SFN, SUS and malignant cytology results, respectively. Pre-operative cytology was malignant or SUS in 56.6% of conventional, 24.3% of follicular, 92% of aggressive and 41.7% of other variants of histopathologically confirmed PTC. The difference between the groups was significant (P < 0.001). Conclusion The Bethesda classification is a reliable indicator of malignancy in nodules with different cytology results and seems to be very effective in predicting the malignancy for the nodules diagnosed with aggressive variant PTC on the final histological examination.

Thyroid tumors of uncertain malignant potential (TT-UMP) comprise an accepted subgroup of follicular-patterned thyroid tumors for which benignancy or malignancy cannot be precisely assessed. We aimed to evaluate the demographic characteristics, ultrasound (US) findings, and cytological results of patients with TT-UMP and compare these findings to a classical variant of papillary thyroid carcinoma (CV-PTC) and non-encapsulated follicular variant of PTC (NEFV-PTC) patients; we also evaluated the immunohistochemical characteristics of patients with TT-UMP. Twenty-four patients with TT-UMP, 672 with CV-PTC, and 132 with NEFV-PTC were included in the study. Mean longitudinal nodule size and median nodule volume were higher in the TT-UMP group than in the CV-PTC and NEFV-PTC groups (p 0.001 and p 0.001 for CV-PTC; p 0.001 and p = 0.008 for NEFV-PTC). The presence of halo and peripheral vascularization was observed more frequently in the TT-UMP group than in the CV-PTC group (p = 0.002 and p = 0.024). Benign and follicular neoplasm/suspicious for follicular neoplasm cytological results were higher in the TT-UMP group than in the CV-PTC group (p = 0.030 and p = 0.001). US findings were similar between TT-UMP and NEFV-PTC groups (all, p 0.05). However, none of the patients with TT-UMP were called malignant; 105 patients (31.2 %) of CV-PTC and 11 patients (9.5 %) of NEFV-PTC (infiltrative FV) were classified as malignant cytologically. Tumor size was higher in the TT-UMP group than in the CV-PTC and NEFV-PTC groups (p 0.001 and p = 0.006). In the TT-UMP group, positive expression of HBME-1, CK-19, and Gal-3 was found in 50, 33.3, and 25 % of patients, respectively. This study demonstrated that none of the TT-UMP patients were evaluated as malignant in preoperative cytology. However, patients with TT-UMP had higher nodule and tumor sizes than CV-PTC and NEFV-PTC patients; US features were similar between NEFV-PTC and TT-UMP patients.

We aimed to evaluate malignancy rate and to determine false negativity of fine needle aspiration biopsy (FNAB) in thyroid nodules ≥4.0 cm.The medical records of patients who underwent thyroidectomy between January 2007 and December 2014 were reviewed. Demographic and clinical data as well as preoperative ultrasonography findings were analyzed. The nodules in these patients were grouped as ≥4.0 cm and4.0 cm according to ultrasonography measurements. Nodules4.0 cm were further divided into 1.0-3.9 cm and1.0 cm. Histopathologically malignant nodules with preoperative benign cytology were defined as having false-negative FNAB.There were 1,008 nodules that measured ≥4.0 cm, 4,013 nodules that measured 1.0-3.9 cm, and 540 that measured nodules1.0 cm. Based on histopathologic findings, 8.5%, 10.2%, and 25.6% of nodules ≥4.0 cm, 1.0-3.9 cm, and1.0 cm were malignant, respectively (P .001). There was no significant difference between 1.0-3.9-cm and ≥4.0-cm nodules with respect to malignancy (P = .108). False-negativity rates were 4.7% in nodules ≥4.0 cm, 2.2% in nodules measuring 1.0-3.9 cm, and 4.8% in1.0-cm nodules. Nodules measuring1.0 cm and ≥4.0 cm had similar false-negativity rates (P = .93), while 1.0-3.9-cm nodules had statistically lower false-negativity rates than those found in the other two groups (P = .03 and P .001, respectively).Of the nodules that were operatively excised, nodules ≥4.0 cm had a similar risk of malignancy as nodules 1.0-3.9 cm. The rate of false-negative FNAB in nodules ≥4.0 cm was twice as high as in nodules 1.0-3.9 cm; however, we do not think it is high enough to recommend a routine operation when cytology results are benign.

To present a case with recurrent dacryocystitis as an unusual complication of medial orbital wall fracture repair with cartilage tissue graft. A 20-year-old male had facial trauma and underwent surgery to reconstruct right medial orbital wall fracture. During follow–up, he presented with continuous epiphora, mucopurulent discharge from the right eye. A thorough history taking indicated that medial orbital fracture was reconstructed with postauricular cartilage. We planned a standard external dacryocystorhinostomy (DCR). During the creation of lacrimal sac flaps, hard tissue was noted in the lacrimal sac. This tissue was excised and sent for pathological examination. The pathological examination revealed cartilage tissue. There were no further ipsilateral symptoms or complications after DCR. In patients with lacrimal system injury related to orbital wall fracture, iatrogenic foreign bodies in the lacrimal sac should be considered in patients with recurrent dacryocystitis who had reconstructive surgery for facial and orbital trauma.

Background: As histopathological findings of parathyroid carcinoma are not certain, the diagnosis of tumors with degenerative changes may be difficult. In these cases, immunohistochemical markers are beneficial. We aimed to research the acceptability of calcium-sensing receptor (CaSR), Galactin-3, Cyclin D1, and Ki-67 as helpful markers in parathyroid tumors in cases which are difficult to diagnose. Materials and Methods: Those cases who had been diagnosed with atypical parathyroid adenoma and parathyroid carcinoma between 2010 and 2015 were reevaluated. İmmunohistochemical markers were applied to this cases. Results: About 21 cases were parathyroid adenoma, 14 were atypical adenoma, and 10 cases were parathyroid carcinoma. According to the immunohistochemical results, global loss of CaSR staining was seen in 50% (5/10) of the patients with carcinoma while there was no loss of staining in those with parathyroid adenoma (P = 0,001). Global loss of CaSR staining was found in only one out of 14 cases with atypical adenoma. The expression of Galactin-3 was found to be positive in 40% (4/10) of carcinoma cases, 71.4% (10/14) of those with atypical adenoma, and 14.3% (3/21) of those with adenoma (P = 0,002). Cyclin D1 expression was determined to be positive in 70% (7/10) of patients with carcinoma, 71.4% (10/14) of atypical adenoma cases, and 23.8% (5/21) of those with adenoma. The Ki-67 proliferation index was seen to be above 5% in 50% (5/10) of carcinoma cases and 35,7% (5/14) of those with atypical adenoma. Conclusion: In these studies, it has been emphasized that the global loss of CaSR staining was used as a negative marker in the diagnosis of carcinoma. In this study, we have also confirmed that the global loss of CaSR staining is a useful marker to determine potential increased malignancy.