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Byline: C. Kabaca, B. Sariibrahim, I. Keleli, A. Karateke, S. Cesur, H. Cetiner Background: A serious proportion of the patients with invasive cervical cancer can be women who have had [...]

The purpose of this study was to investigate the frequency of microcystic, elongated and fragmented (MELF) pattern of invasion in endometrioid endometrial adenocarcinomas (EA) and its association with prognostic factors. Stained tissue sections from 121 cases of EA (total hysterectomy and pelvic, with or without para-aortic, lymphadenectomy specimens) were reviewed to identify cases showing MELF-type invasion. The prognostic factors of low tumour grade, deep myometrial invasion (MI), cervical stromal involvement, lymphovascular space invasion (LVSI), lymph node (LN) metastasis and advanced clinical stage were more frequently observed in MELF-positive cases (p < 0.05). Thus, MELF-positive cases had an increased frequency (28/121) of these prognostic factors, which has implications in routine clinical practice, as it signals the importance of recognising MELF pattern invasion. In univariate analysis, MELF positivity, deep MI, cervical stroma involvement and LVSI were significantly related to LN metastasis (p < 0.05). However, in multivariate analysis, only MELF pattern invasion and cervical stroma involvement were independent factors for LN metastasis. Nevertheless, further studies are needed to evaluate the clinical significance of MELF pattern of invasion in endometrial adenocarcinoma. [ABSTRACT FROM AUTHOR]

Background. There is no immunohistochemical study to show luteinizing hormone receptor (LHR), estrogen receptor (ER) and progesterone receptor (PR) in the pregnant Fallopian tubes (FT). Objective. To study LHR, ER, PR expression in FT containing an ectopic pregnancy (EP) and during the menstrual phase. Design. Thirty FT were obtained from women diagnosed with EP and twenty FT collected by hysterectomy performed for benign diseases not affecting the tubes were included in this study. Assessment of immunohistochemical expression staining LHR, ER, PR in epithelium, smooth muscle cell and blood vessel endothelium in FT containing an EP and during the different phases of menstrual cycle. Results. In ectopic pregnancy group we found LHR expression in epithelium in 30 cases, muscle cell in 28 cases, and endothelium in 9 cases in FT. In menstrual cycle group we noted LHR expression in FT in epithelium in all cases, muscle cell in 4 cases. Conclusion. There is a significant difference in the proportions of the existence of LH receptor immunostaining in the muscle cells for ectopic pregnancy group as compared to the menstrual cycle groups (p < 0.001). Our findings may suggest that the women who have increased LH receptors on muscle cells in Fallopian tubes are at increased risk for having external pregnancy. [ABSTRACT FROM AUTHOR]

Objective: This study aimed to define the relationship between chronic tonsillitis and levels of malondialdehyde and superoxide dismutase in free radical and antioxidant forms. It is suggested that free oxygen radicals may play a role in chronic tonsillitis. Materials and methods One hundred twenty-four patients were enrolled in the study. Tonsillectomy was performed via the usual dissection-snare method. Venous blood was taken preoperatively and at 2 weeks postoperatively. Blood samples and tonsil specimens were evaluated for malondialdehyde and superoxide dismutase analysis.Results: The levels of malondialdehyde and superoxide dismutase in plasma were compared preoperatively and postoperatively, and there were statistically significant differences between these levels (P < 0.05). In contrast, the levels of malondialdehyde and superoxide dismutase in tonsil tissue were not correlated with the plasma levels of malondialdehyde and superoxide dismutase in pretonsillectomy and posttonsillectomy terms (P > 0.05).Conclusion: The presence of malondialdehyde and superoxide dismutase in plasma and tonsil tissue reinforces the involvement of oxidative stress in the pathophysiology of chronic tonsillitis. [ABSTRACT FROM AUTHOR]

Introduction. This study aimed to determine whether endocervical glandular involvement by squamous intraepithelial lesion would differ with respect to the depth of the excised specimen and analyze the related factors that may define endocervical glandular involvement among cases treated with cone biopsy. Methods. Between April 2016 and December 2018, women who underwent colposcopy and excisional procedures in the department of gynecologic oncology were retrospectively investigated. Patients with multiple specimens, or whose specimen depths were not measured, and a negative/unknown HPV status were excluded from the study. Also, patients with no dysplasia or microinvasive/invasive cancer in the final pathology report and those who had not undergone endocervical curettage during colposcopy were excluded. HPV genotypes, degree of dysplasia, surgical margin status, and specimen depth were documented from medical records. Further, the association of these factors with endocervical glandular involvement was evaluated. Results: A total of 321 patients who fulfilled the criteria were included in the study, with a mean age of 41.9 years. In total, 101 patients (31.5%) had endocervical glandular involvement. The mean excised specimen depth was 17.04 mm; 17.9 and 16.7 mm for the positive and negative glandular involvement groups, respectively ( p  = .13). The mean ages were 42.7 and 41.6 years for these groups, respectively ( p  = .32). There was no association between the HPV genotypes and glandular involvement. Conclusions: Endocervical glandular involvement is not associated with the depth of the excised specimen. A deeper cone biopsy may not necessarily enable a more effective treatment of the disease.

Objective: The goal of this study was to compare conventional osteotomes and Magic Saws in terms of edema and ecchymosis, in rhinoplasty patients., Study Design: A retrospective, case-control study., Methods: In this prospective, randomized study, we evaluated the results of 258 rhinoplasty patients who underwent osteotomy by either conventional osteotomes or new designed saws called; "Magic Saws." On postoperative days 2 and 7, the patients were photographed by the surgeon; photographs were evaluated by another otolaryngologist, blinded from the osteotomy procedure., Results: There were no statistically differences between the groups, in terms of age, sex, weight, or average arterial blood pressure (P > 0.05). The postoperative periorbital edema (days 2 and 7) and ecchymosis (day 2) scores were significantly higher in the conventional osteotomy group, as compared to Magic Saw group (P < 0.05). However, on postoperative day 7, the differences in the periorbital ecchymosis scores between the groups, were not statistically significant (P > 0.05)., Conclusions: As compared to conventional osteotomes, Magic Saws were reported to be associated with minimal soft tissue injury, as well as decreased edema and ecchymosis, in the early postoperative period after rhinoplasty., Competing Interests: The authors report no conflicts of interest., (Copyright © 2021 by Mutaz B. Habal, MD.)

Background: Glandular cell abnormalities may indicate the presence of pre-malignant or malignant lesions., Aim: This study aimed to investigate the relationship between atypical glandular cells (AGC) and patients' demographics, histopathological outcomes, Human Papillomavirus (HPV) test results., Material and Methods: Between January 2015 and December 2019, women with AGC on Pap tests were retrieved from the hospital electronic database. The patients with AGC on cervicovaginal smears who underwent further pathological, laboratory, and imaging diagnostic testing and who were followed up at least 1-year were included in the study, while those who had a history of cervical dysplasia or cancer, lost during follow-up, or had missing data were excluded., Results: Of 85,692 Pap smears, 114 (0.13%) were diagnosed with AGC, of those 88 cases were eligible for final analysis. Gynecological malignancies were detected in 13 (14.8%) patients; including 6 (6.8%) endometrioid endometrial cancers, 3 (3.4%) non-endometrioid endometrial cancers, 2 (2.3%) cervical adenocarcinomas, 1 (1.1%) cervical squamous cell carcinoma, and 1 (1.1%) high-grade tubal serous cancer. Multivariate analysis revealed that presence of concomitant abnormal squamous lesion ( P = 0.002), being 50 years and older ( P = 0.028), HPV positivity ( P < 0.001), and menopause ( P = 0.023) were risk factors for significant pathology., Conclusion: The diagnosis of AGC may be related to the preneoplastic/neoplastic processes. A further comprehensive histopathological examination is required in women with AGC, aged 50 years and older, postmenopausal, HPV-positivity and concomitant squamous cell abnormality Clinicians should consider ovarian pathologies when there is no pathological finding on endometrial or cervical histopathological examination., Competing Interests: There are no conflicts of interest., (Copyright: © 2021 Journal of Cytology.)

Background: Human papillomavirus (HPV) is a primary risk factor for cervical cancer. HPV 16 and 18 are the two most carcinogenic genotypes and have been reported in the majority of cervical cancer. High-risk HPVs (hrHPVs) other than HPV 16/18 cause approximately a quarter of cervical cancers. We aimed to present the colposcopy-guided biopsy results of non-16/18 hrHPV-infected women with negative cytology., Methods: This is a retrospective cohort study conducted on 752 patients between the ages of 30-65 years with non-16/18 hrHPV and negative cytology undergoing colposcopy-guided biopsy at a tertiary gynecological cancer center between January-2016 and January-2019., Results: The mean age of the women was 42.35±9.41 years. Cervical intraepithelial neoplasia (CIN) 2+ lesion was detected in 49 (6.5%) women with negative cytology. The rate of CIN 2+ lesions in women with abnormal cytology was 12.8%. Patients with abnormal cytology had about 2.1 and 2.4 times increased the odds of CIN 2+ lesion in cervical biopsy and endocervical curettage specimens, respectively. CIN 3+ lesion was detected in 20 (2.7%) women with negative cytology. One (0.1%) of the patients with HPV 39 and negative cytology had invasive cervical cancer. The two most common HPV subtypes were HPV 31 and HPV 51., Conclusions: The risk of cervical preinvasive lesions still can be detected and cannot be completely eliminated among hrHPV other than 16/18-infected women with negative cytology. Based on the results of this study, referral of non-16/18 hrHPV-infected women with negative cytology to colposcopy is supported as a credible and feasible strategy., (© 2021 Wiley Periodicals LLC.)

Background: We aimed to present the biopsy results of women with HPV 16/18 infection and investigate whether cytology is necessary as a part of routine cervical cancer screening in women with HPV 16/18., Methods: This is a retrospective cohort study conducted on 1647 patients between the ages of 30 and 65 years with HPV 16/18 undergoing colposcopy-guided biopsy at a tertiary gynecological cancer center between January-2016 and January-2019. We compared the preinvasive lesion rates and the invasive cervical cancer rates of women with HPV 16/18 between the negative and the abnormal cytology group., Results: Of the 1647 women, 1105 (67.1%) had negative cytology and 542 (32.9%) had abnormal cytology. Among women with initial negative cytology, cervical intraepithelial neoplasia (CIN) 2+ lesion was detected in 205 (18.6%) women. The rate of CIN 2+ lesion in women with abnormal cytology was 28%. There was a significant difference between negative and abnormal cytology group in terms of CIN 2+ lesion rates (P < .001). Among women with initial negative cytology, invasive cervical cancer was detected in 6 (0.5%) women. The rate of invasive cervical cancer in women with abnormal cytology was 8 (1.5%). There was no significant difference between negative and abnormal cytology group in terms of invasive cervical cancer rates (P = .082)., Conclusions: The rate of cervical cancer among HPV 16/18-infected women with negative cytology is similar to women with abnormal cytology. Based on the results of this study, Pap testing could be unnecessary in HPV 16/18-infected women to diagnose invasive cervical cancer who will undergo colposcopy biopsy., (© 2020 Wiley Periodicals LLC.)

Introduction: According to international reports, 30-40% of all head and neck cancers are larynx cancers, comprising 1-2.5% of all cancer types. Cervical nodal involvement has been reported to be 40% and 65% in T3 and T4 cases, respectively. Five-year survival in patients with cervical lymph node metastasis has been demonstrated to be 50% lower compared to patients with no metastasis. Chromosome segregation like 1 protein; is a DNA fragment isolated by Brinkmann et al. in 1995 that corresponds to yeast chromosome segregation protein. Studies on the effect of chromosome segregation like 1 protein expression in head and neck tumors are rare and it has been shown that nuclear chromosome segregation like 1 protein is over-expressed in these studies where gastrointestinal and breast tumors over-expressed cytoplasmic chromosome segregation like 1 protein., Objective: Chromosome segregation like 1 protein may regulate the proliferation and metastasis of T3-T4 glottic larynx cancer. The aim of this study is to show the relationship between chromosome segregation like 1 protein expression and cervical lymph node metastasis of T3-T4 glottic larynx cancer., Methods: A total of 57 male patients who were operated for T3-T4 glottic cancer in a tertiary referral hospital was included in this study. There were 28 patients with cervical lymph node metastasis and 29 patients without lymph node metastasis. Immunohistochemistry was carried out on formalin-fixed, paraffin-embedded archival glottic larynx tumour tissue. According to the percentage of immunoreactive cells, chromosome segregation like 1 protein status was analyzed., Results: Among the patients, who had no cervical lymph node metastasis, 15 patients showed weak nuclear staining, 12 patients showed moderate nuclear staining and only 2 patients showed high nuclear staining for chromosome segregation like 1 protein. Among the patients who had cervical lymph node metastasis, 18 patients showed high nuclear staining, 9 patients showed moderate staining and only one patient showed weak staining for chromosome segregation like 1 protein. None of the metastatic patients showed cytoplasmic staining and only one patient in the non-metastatic group showed cytoplasmic staining for chromosome segregation like 1 protein. There was a positive correlation between nuclear chromosome segregation like 1 protein expression and cervical lymph node metastasis (r = 0,668) and it was statistically significant (p < 0,001)., Conclusion: Chromosome segregation like 1 protein expression is correlated with lymph node metastasis in T3-T4 glottic cancers. This may change the approach to cervical node treatment in patients with glottic cancers in future., (Copyright © 2019 Associação Brasileira de Otorrinolaringologia e Cirurgia Cérvico-Facial. Published by Elsevier Editora Ltda. All rights reserved.)

Introduction: Submandibular glands are exposed to many effects due to diseases and therapeutic interventions. A study evaluating the effect of submandibular gland dysfunction on the parotid gland has not been presented in the literature., Objective: The aim of this study was to evaluate the histopathological changes in the parotid gland following submandibular gland failure., Methods: Three groups of seven randomly selected female New Zealand rabbits weighing 2500-3000g were studied. Unilateral and bilateral submandibular glands were removed in Groups 1 and 2, respectively. No procedure was performed in Group III, the control group. The parotid glands were removed 30 days later. Histological parameters were evaluated and graded between 0 (none) and 3 (severe). Differences between groups were compared using the Mann-Whitney U test., Results: Mean mucus accumulation in acinar cells was 2.57±0.53 and 1.71±0.75 in Groups 1 and 2, respectively (p<0.05). This value was 0.57±0.53 in Group 3, which was significantly lower than in Groups 1 and 2 (p<0.05). Mean dilatation of the intercalated ducts' lumen was 1.28±0.48 and 1.57±0.53 in Groups 1 and 2, respectively (p>0.05). This value was 0.28±0.48 in Group 3, which was significantly lower than in Groups 1 and 2 (p<0.05). Mean mucus accumulation in the intercalated ducts' lumen was 2.00±0.81 and 1.00±0.57 in Groups 2 and 3, respectively (p<0.05)., Conclusion: The findings of this study indicate that only 1 month after submandibular gland failure, the parotid glands exhibit significant changes., (Copyright © 2018 Associação Brasileira de Otorrinolaringologia e Cirurgia Cérvico-Facial. Published by Elsevier Editora Ltda. All rights reserved.)

Objective: The achievement of consistently superior results in rhinoplasty is difficult. This study aimed to evaluate the effect of anchoring the columellar strut graft to the thread of the lateral crural steal for nasal tip projection and rotation., Study Design: A retrospective, case-control study., Methods: Two groups were created which consisted of patients who had a history of low nasal tip deformity according to the type of nasal tip surgery in rhinoplasty. In group 1, the lateral crural steal technique with the strut graft was used, whereas in group 2, a new technique, in which the strut graft was anchored to the thread of the lateral crural steal, was used. Patients with low nasal tip deformity due to intrinsic factors such as long lateral crura were included. The effects of the 2 different surgical approaches on facial parameters (the nasolabial angle, nasofacial angle, and Goode ratio) were statistically compared using the Mann-Whitney U test and Student t test, as applicable., Results: Sixty patients were enrolled: half of them were included in group 1 and the other half in group 2. Average postoperative increases of the nasolabial angle score were 10.9 ± 4.72° and 18.76 ± 6.30° in groups 1 and 2, respectively (P < 0.001). Average improvements of the nasofacial angle were 2.33 ± 2.12° and 3.50 ± 2.44° in groups 1 and 2, respectively (P = 0.053). Average postoperative increases of the Goode ratio were 0.02 ± 0.02 in group 1 and 0.04 ± 0.03 in group 2 (P = 0.028)., Conclusion: The new technique provided a prominent nasal cephalic rotation with a strong effect on the nasolabial angle and a partial effect on nasal projection.

Objective: Androgen (AR), Estrogen (ER) and Progesterone (PR) hormones play an important role in the prenatal and postnatal development of urogenital tract and especially the penis. The expressions of AR, ER and PR receptors in penile tissues in children with hypospadiases had also been shown previously. In this leading study, to demonstrate of the sex hormone receptor expression in cases with different types of hypospadias were aimed., Methods: This study was designed in children operated due to hypospadiases without DSD. Biopsy samples of 3 mm's were obtained from three different sytes as the lateral parameatal tissue and the anterior corner of the prepuce, and inner layer of posterior prepuce. The presence of AR, ER and PR receptors was investigated immunehistochemically., Results: Mean age was 5.4 years in 18 children with hypospadiases; in totally 33 specimens were taken in 5 subcoronal as 5 specimens, and 7 penile as 15 specimens, and 6 penoscrotal as 13 specimens. According to sytes of samples; 13 samples were from lateral para-meatal tissues, and 13 were from anterior corners of prepuces, and 7 were from inner layers of posterior prepuces. In regard to receptor expression; ER and AR receptors were positive in 29 (87.8%) and 12 (36.4%) respectively; PR receptors were negative., Conclusion: This study emphasized the dominant expression of estrogen receptors in penile tissues of children with hypospadias. Although there was not a manifest correlation of androgen receptors absence in regard to the severity of hypospadias patients, there was a marked estrogen receptors presence in penile tissues. These findings suggest that the disrupted androgen and estrogen receptor interaction and/or balance could play a role during the development of external genitalia in hypospadias patients. Progesterone receptor was not present and therefore the active role in the postnatal development of hypospadias is still debatable., Competing Interests: Conflict of Interest: The authors declare no conflict of interest.

Objective: The aim of this study was to evaluate the effect of suturation (tonsillary fossa closure) plus Surgicel application on postoperative bleeding and pain after tonsillectomies performed using a classical dissection method., Study Design: A prospective, randomized, double-blind, clinical trial was performed on 760 patients undergoing tonsillectomy or adenotonsillectomy during a 5-year period., Methods: After excluding patients with hemorrhagic disorder, chronic disease, and peritonsillar abscess, both tonsils were removed via classic dissection technique (cold knife or blunt dissection) and then electrocauterized for hemostasis. The tonsillar fossa randomly assigned to the treatment protocol (Group 1) was closed by sutures, following Surgicel application. The other side was unaltered and acted as the control (Group 2). Pain was evaluated every day for 10 days postoperatively, and bleeding was reported at any time., Results: A total of 760 patients (393 males, 367 females) between the ages of 4 and 35 years (mean age 13.46 ± 7.98) were included in the study. Bleeding was observed in 31 patients: 8 from Group 1; and 23 from Group 2 (95% confidence interval [CI], P < 0.05). The average pain score was greater in Group 1 than in Group 2 on each postoperative day (95% CI, P < 0.05)., Conclusion: Suturation plus Surgicel application increased pain levels while decreasing bleeding incidence during the postoperative period.

Introduction: The aim of this study was to establish how reliable a given tympanogram is in predicting the presence or absence of a middle ear effusion, and to provide new views for the diagnostic information of tympanometry. The use of tympanometric gradient in addition to static admittance is the focus of this study., Materials and Methods: The authors enrolled 146 female and 129 male patients. The participants were allocated into groups as follow: Group A1 consisted of 50 healthy children. Group A2 consisted of 86 children with otitis media with effusion. Group B1 consisted of 85 healthy adults. Group B2 consisted of 54 adults with otitis media with effusion. All diagnostic otoscopic examination and tympanometry were performed in both ears. The authors analyzed the distribution of tympanograms in patients with otitis media with effusion and healthy controls., Results: When the right and left ear canal volume of either children or adults with otitis media with effusion compared with healthy controls, no statistically significant different was observed (P > 0.05). On the other hand, the statistically significant difference was detected for the values of compliance, pressure and gradient of either children or adults with otitis media with effusion compared with healthy controls (P < 0.05)., Conclusion: The authors found the values range from 0.01 to 1.52 mL gradients (mean least value 0.15 mL) in adults and the values range from 0.01 to 0.93 mL gradients (mean least value 0.10 mL) in children in the presence of otitis media with effusion. The authors think that tympanometric gradient may be useful to detect the otitis media with effusion.

Background: The relationship between septal perforation and smoking (of cigarettes) was not previously studied in patients who underwent septoplasty., Objective: To evaluate the effect of smoking on nasal septal perforation development and the postoperative healing process in patients who underwent septoplasty., Methods: Medical records of patients who underwent septoplasty procedures between January 2010 and December 2014 were retrospectively reviewed. Any candidates with chronic systemic disease, were >40 years of age, were prone to complications (i.e., excessive septal deviation), or had previous nasal surgery were excluded from study. The subjects were grouped by smoking habits, and septal effects of smoking were evaluated clinically., Results: Of 281 patients, 88 qualified as smokers (group 1) and 193 were considered nonsmokers (group 2). Septal perforation was observed in eight patients in group 1 and in one patient in group 2 (p < 0.05). In groups 1 and 2, the average healing times were 8.8 ± 2.04 days and 7.51 ± 1.75 days, respectively (p < 0.05)., Conclusions: Both nasal recovery time and development of septal perforation proved significantly greater in patients who smoked after septoplasty.

Objective: To discuss the pathological features of sirenomelia in the light of our 10 cases and review the current theories., Methods: We identified 10 patients with sirenomelia from our hospital database. All clinical details and the autopsy features of 10 cases were noted., Results: Of the 10 children with sirenomelia seven had bilateral renal agenesis, three had bladder agenesis and one had a renal hypoplasia. Single umbilical artery was found in 60% of children with sirenomelia. External genitalia was ambiguous in seven of 10 patients., Conclusions: Even though the etiology of caudal regression syndrome (CRS) and sirenomelia remains unknown we tend to believe that sirenomelia and CRS might be different entities.

Objective: This study aimed to analyze the correlation between the histopathologic results of excisional procedure and cervical punch biopsy and to investigate the accuracy rates of colposcopic punch biopsy and cervical cytology to detect cervical intraepithelial neoplasia (CIN) grade 2 and/or more severe lesions (CIN 2+)., Materials and Methods: Two hundred six patients who underwent excisional procedure in the gynecologic oncology clinic of the Zeynep Kamil Women and Children Diseases Education and Research Hospital between 2004 and 2011 were enrolled in a retrospective study., Results: The correlation between the pathologic findings gained by excisional procedure and punch biopsy was weak ( p = .0001, κ = 0.03). The overall concordance rate between the pathologic findings of cervical biopsy and excisional procedure was 57.29%. The rates of detecting more severe lesions by excisional procedure when compared to biopsies (biopsy underestimation) were 71.42%, 22.91%, 37.03%, and 12.72% for biopsy results with negative, CIN 1, CIN 2, and CIN 3/adenocarcinoma in situ lesions, respectively. Similarly, the rates of less severe lesions diagnosed by excisional procedure when compared to biopsies (biopsy overestimation) were 29.16%, 40.74%, and 15.45% for biopsy results with CIN 1, CIN 2, and CIN 3/adenocarcinoma in situ lesions, respectively. The rate of CIN 2+ lesions after excisional procedure in cases with previous biopsy results with either negative or CIN 1 was 27.27%., Conclusions: Our results suggested that colposcopy-directed biopsy was neither a good diagnostic nor a reliable management method. We think that the indications of conization should be enlarged to avoid overlooking high-grade lesions.

Objective: To investigate the significance of extra-nodal spread in special histological sub-types of breast cancer and the relationship of such spread with prognostic parameters., Methods: A total of 303 breast cancer cases were classified according to tumor type, and each tumor group was subdivided according to age, tumor diameter, lymph node metastasis, extra-nodal spread, vein invasion in the adjacent soft tissue, distant metastasis, and immunohistochemical characteristics [estrogen receptor (ER), progesterone receptor (PR) existence, p53, c-erbB-2, and proliferative rate (Ki-67)]. The 122 cases with extra-nodal spread were clinically followed up., Results: An extra-nodal spread was observed in 40% (122 cases) of the 303 breast cancer cases. The spread most frequently presented in micro papillary carcinoma histological sub-type (40 cases, 75%), but least frequently presents in mucinous carcinoma (2 cases, 8%). Patients with extra-nodal spread had a high average number of metastatic lymph nodes (8.3) and a high distant metastasis rate (38 cases, 31%) compared with patients without extra-nodal spread., Conclusion: The existence of extra-nodal spread in the examined breast cancer sub-types has predictive value in forecasting the number of metastatic lymph nodes and the disease prognosis.

Angiomatoid Fibrous Histiocytoma (AFH) is a distinctive tumor in children, adolescent and young adults which is slow growing with metastatic potential. The histogenesis of AFH is uncertain. Here, we present a case of AFH of 6-year-old on the trunk. In addition, the differential diagnosis for this lesion is also discussed.

Aim: Sclerosing stromal tumor is a benign tumor of ovary. We aimed to review the clinical findings and immunohistochemical results of SSTs through the 7 diagnosed cases in our hospital., Material and Methods: As immunohistochemical, blocks were applied with estrogen receptor , progesterone receptor, inhibin, calretinin, melan-A, CD10, smooth muscle actin, desmine, vimentin, CD34, S-100, C-kit, cytokeratin , cytokeratin7., Results: Macroscopically, while 5 tumors had solid appearance, 2 tumors were composed of solid and cystic areas. All the tumors were in shape of ovarian masses with good limits. Microscopically, two types of cells were observed as fusiform fibroblast-like cells and theca-like cells with vacuolised cytoplasm. Immunohistochemical results: vimentin, smooth muscle actin, desmine, progesterone receptor, calretinin, inhibin were positive in all the cases; S-100, cytokeratin, cytokeratin7, estrogen receptor were negative in all the cases; CD-10 was positive in 2 cases; C-kit was positive in 5 cases; melan-A was positive in 4 cases., Conclusions: The significance of these tumors is that it is necessary to distinguish the histopathology in the frozen section in order to protect the other adnexa because of the characteristics to be observed at early ages (2(nd) and 3(rd) decades). Our findings support the conclusion that sclerosing stromal tumors are benign-character tumors that stem from over stroma and are hormonally active tumors because of the detected clinical and immunohistochemical results, although no hormonal effect that could be supported with laboratory tests was observed.

Background: Spontaneously exfoliated benign-appearing endometrial cells (BEC) on a Papanicolaou smear might indicate endometrial pathology in postmenopausal women, necessitating further investigation. A cut-off age of 40 years was included in the Bethesda System 2001 based on studies of clinical significance of endometrial cells in Pap smears in Western countries., Aims: The purpose of this study was to determine the significance of age subgroup for women with a cytological diagnosis of BEC, regardless of menopausal status, in a retrospective cohort of Turkish women., Materials and Methods: Between October 2006 and November 2011, 41 patients with a BEC diagnosis and 64 patients with a cytological diagnosis of normal smear (NS) were enrolled; regardless of menopausal status, these women were 40 years and older and for whom follow-up endometrial biopsies had been performed., Results: On subsequent histopathologic evaluation, no malignant lesion was detected in women aged 40-50 years compared to three endometrioid-type adenocarcinomas in women older than 50 years with cytological diagnosis of BEC. There was a significant difference between women older than 50 years with cytologic diagnosis of BEC and NS in relation to premalignant lesions on histopathologic evaluation; however, this was not the case for women aged 40-50 years., Conclusions: According to our study, reporting BEC for women aged between 40 and 50 years has minor clinical significance but is significant for women older than 50 years, regardless of menopausal status. Larger sample size would be appropriate to confirm the results of the current study.

Objective: A number of cervical smears may exhibit unequivocal low-grade squamous intraepithelial lesions (LSIL) in association with atypical cells cytomorphologically suspicious, but not sufficient to be interpreted as high-grade squamous intraepithelial lesions (HSIL). These lesions are presently called LSIL, atypical squamous cells cannot exclude HSIL (LSIL/ASC-H). Previous studies have shown that LSIL/ASC-H and ASC-H are both equivocal for HSIL and have a high risk of underlying HSIL. However, in researching the literature only two studies were found which rendered the results as cervical intraepithelial neoplasia (CIN) 2 and CIN3 separately. The purpose of this study was to compare the distribution of biopsy results for CIN2 and CIN3 in patients with ASC-H, HSIL, and LSIL/ASC-H., Study Design: Between January 2005 and December 2011, cervicovaginal smears (98,594) with a diagnosis of ASC-H, LSIL, LSIL/ASC-H, or HSIL were re-evaluated to determine the prevalence of future lesion development., Results: A total of 252 patients who had histologic follow-up within a year were selected. Among these, LSIL/ASC-H (31.7%) had the highest prevalence of CIN2 between LSIL (9.3%), ASC-H (10%), and HSIL (16%). All differences were statistically significant., Conclusion: Because of the high predictive value of CIN2, LSIL/ASC-H may have further importance, especially in women of different age groups.

Background: The demonstration that adipose tissue produces numerous cytokines increases interest of investigators in their role in the pathogenesis of obesity. Resistin is one of those cytokines. There are conflicing reports as cigarette smoking impairs insulin secretion, augments insulin resistance, or has no effect on glucose metabolism. In our study, we intended to examine the relationship of obesity with resistin levels in smokers and nonsmokers., Patients and Methods: The study included 52 male smokers and 34 age matched nonsmoker male control subjects. We classified smoker and nonsmoker groups according to their body mass index as BMI < 27 and ≥27. As well as making physical and anthropometric examinations, fasting plasma glucose and insulin, postprandial plasma glucose, lipid profile, and resistin levels were measured in all male subjects. We compared all parameters in smoker and nonsmokers either having BMI < 27 or ≥27., Results: In both BMI levels, resistin levels were higher in smoker groups than nonsmoker ones (P<0.01 all), we did not find any difference in other parameters., Conclusion: in conclusion we may speculate that if someone smokes resistin levels increase.

Background: The association between C-reactive protein, homocysteine, uric acid levels and cardiovascular risk have been debated for decades. Resistin is a newly discovered adipocyte derived cytokine. Smoking besides its effect on atherosclerosis, is shown to alter adipocytokine levels. Bearing in mind, these complex relationship of resistin with smoking, C-reactive protein, homocysteine and uric acid, we planned to investigate the association of resistin and these cardiovascular risk factors in smoker and non-smoker subjects., Methods: We conducted a cross-sectional randomized study including 52 smoking and 33 non-smoking men. After making comparisons of C-reactive protein, homocysteine, uric acid and resistin between the two groups, we classified the subjects according to their insulin resistance and body mass and made again the comparisons.., Results: Resistin levels were higher in smokers than in non-smokers (p<0.001) and also in insulin resistant than in non-insulin resistant smokers (p<0.05). Resistin levels were indifferent in non-smokers as insulin resistance was concerned and in smoker or non-smokers as body mass index was concerned. As all subjects were grouped based on homeostasis model assesment index and body mass index, neither C-reactive protein nor homocysteine and uric acid levels differred., Conclusions: We found that smoking may have influence on resistin levels and in smokers, insulin resistance is related to resistin levels, but in smoker and non-smokers body mass may not have any association with resistin. Resistin also may not have a role in C-reactive protein, homocysteine and uric acid levels both in smokers and non-smokers.

Objective: Conventional Pap smears exhibiting unequivocal features of 'low grade squamous intraepithelial lesion' (LSIL) are occasionally mixed with some cells suspicious for, but not diagnostic of 'high grade squamous intraepithelial lesion' (HSIL) on daily routine. The 2001 Bethesda System does not address the significance of such cytological entities. We have referred to these changes in our laboratory as'LSIL, atypical squamous cells cannot exclude HSIL' (LSIL/ASC-H). In this study, we aimed to compare the cytology and biopsy results of LSIL/ ASC-H to LSIL, ASC-H and HSIL., Material and Method: Out of 37884 cases which were evaluated between 2005-2009 in our laboratory, cases interpreted as LSIL, LSIL/ ASC-H, HSIL and ASC-H were reevaluated and 153 cases for which biopsy materials were available were selected., Results: The rate of histological CIN2 or worse associated with LSIL/ ASC-H (45%) was between the rates of LSIL (10%) and HSIL (65%), but not significantly different from ASC-H (50%). However, LSIL/ ASC-H was more frequently associated with a definitive histological diagnosis of any CIN2 than ASC-H (30% vs. 8%)., Conclusion: Based on our results, we recommend LSIL/ASC-H to be added to Bethesda System, and Pap test cases of LSIL/ASC-H may need to be clinically followed-up in a manner similar to ASC-H, i.e., with colposcopy for all patients.

In the literature, there is no reported pediatric leiomyosarcoma case that has metastasized from the small intestine to the adrenal gland. A 10-year-old boy who had anemia and weight loss over 2 years presented with abdominal pain that began 1 week previously. Radiologic examination revealed bilateral adrenal tumors. At the time of surgery, the terminal ileum was resected and a tru-cut biopsy was done from the right adrenal mass. The pathology report was leiomyosarcoma for both of the resection and tru-cut specimens. We present an intestinal leiomyosarcoma that metastasized from the small intestine to both adrenal glands with clinical, morphologic, and immunohistochemical studies with a literature review.

Ewing sarcoma/primitive neuroectodermal tumor (ES/PNET) family of tumor is a very aggressive malignant round cell tumor characterized by translocations involving EWS-FLI1 genes. They are increasingly recognized in extraosseous sites as a result of improvements in diagnostic tools. In this paper, we report 2 additional cases arising in vulva of young adults who have been treated aggressively and have survived fore more than 7 and 4 years successively. Histologic examination showed small round (blue) cell morphology in both cases. The tumor cells contained glycogen and were positive for CD99 and vimentin and negative for keratins, lymphoid markers, S-100, synaptophysin, chromogranin, and desmin. Reverse transcriptase polymerase chain reaction analysis from paraffin-embedded tissue revealed EWS-FLI1 fusion product in 1 case. Collectively, 13 cases of vulvar ES/PNET have been reported in the literature. Only 8 cases have detailed follow-up information with an average follow-up data of 28 months. Ewing sarcoma/PNET should be considered in the differential diagnosis of any undifferentiated tumors involving the lower gynecologic tract and all axillary tests including molecular tests should be performed for correct diagnosis because prolonged survival is possible for this dreadful disease after complete surgical resection, followed by adjuvant therapy.

Placental site trophoblastic tumor is a rare form of gestational trophoblastic disease, derived from invasive implantation site (intermediate) trophoblastic cells. It is frequently resistant to chemotherapy. Patients with metastases, however, frequently have progressive disease and die despite surgery and multiagent chemotherapy. In this case, a 24-year-old woman was referred because of intermittent vaginal bleeding episodes for 5 months following delivery. Multiple metastases in lungs, liver, kidneys, breast, pancreas, and adrenal and thyroid glands were detected. Combination therapy including surgery and multiagent chemotherapy was planned. Hysterectomy and pelvic lymph node dissection were performed. All metastatic lesions disappeared with EMA-CO treatment. However four courses of BEP regimen, salvage therapy, was performed for plateauing hCG level. Surgery and multiagent chemotherapy seem mainstay of treatment of cases having multiple metastases of PSTTs.

Objective: We aimed to investigate the utility and efficacy of the Keyes skin biopsy instrument for cervical biopsy procedures., Material and Methods: A prospective clinical trial was conducted on 50 women with cervical lesions. Colposcopy-guided cervical biopsies were collected using a Keyes biopsy punch and a Kevorkian biopsy forceps and the two methods were compared with definitive histopathological examination of the specimens obtained by the loop electrosurgical excision procedure (LEEP), conization or hysterectomy., Results: There were no differences in speed of collection, diagnostic value of specimens, complication rates, or sample quality. The sensitivity, specificity, positive and negative predictivity of specimens were all 100% for both methods., Conclusions: The Keyes biopsy punch was found to be a safe, rapid and accurate diagnostic tool in cervical biopsy procedures. Based on the results of this study, the use of a Keyes punch instrument can be recommended as an alternative to other cervical biopsy methods.

The aim of this study was to evaluate the value of epithelial membrane antigen overexpression (EMA OE) in benign, hyperplastic and neoplastic endometrium and to analyze its association with estrogen and progesterone receptors (ER, PR) immunohistochemistry, tumor grade and myometrial invasion in patients with endometrial carcinoma (EC). The OE of EMA was analysed immunohistochemically in nine patients with benign endometrium (BE), in 18 patients with atypical complex endometrial hyperplasia (ACH) and in 29 patients with EC. EMA OE was present in 13 of 29 patients (44.8%) with EC, in two of 18 patients (11.1 %) with ACH, and in none of nine patients with BE (p < 0.05). EMA OE of endometrial carcinoma was statistically correlated with the International Federation of Gynecology and Obstetrics (FIGO) grade (G1 vs G2 and G3, p < 0.05) and depth of myometrial invasion (< 1/2 vs > 1/2, p < 0.05). EMA OE was significantly associated with PR negativity (p < 0.001). However it did not show any association with ER immunohistochemistry (p = 0.14). PR immunohistochemistry had significant correlations with FIGO grade (p < 0.001) and depth of myometrial invasion (p < 0.05) but ER loss showed a nearly significant association only with advanced FIGO grade (p = 0.054). In conclusion, EMA shows increased expression as the lesion progresses to malignancy and can also aid discrimination between hyperplastic and neoplastic states. The correlation of imunohistochemical findings with tumor grade and myometrial invasion could help in predicting behavior of the tumor and planning treatment in patients with endometrial carcinoma.

To determine the immunohistochemical staining profile of intravenous leiomyomatosis (IVL), we analysed six IVLs and 12 ordinary leiomyomas (LM) for immunoreactivity with a panel of 11 antibodies. All IVLs and LMs reacted with antibodies to alpha-smooth muscle actin (alphasm), h caldesmon, vimentin and progesterone receptor (PR). Five of six IVLs and all LMs reacted with desmin. All IVLs were negative for CD-10. Only one LM exhibited focal CD-10 positivity. Three of six IVLs and nine of 12 LMs showed estrogen receptor expression. All IVLs and LMs showed immunnegativity with MIB-1 and inhibin. There were not any significant differences between immunoreactivity patterns of IVL and LM for asm, desmin, h caldesmon, CD-10, MIB-1 and PR. We conclude that, although they appear to be useful markers in differentiating IVL from ESS and LMS, a larger study also including ESS and LMS would be necessary to confirm their validity.

Frozen-section and paraffin section diagnoses were compared in 55 patients with Stage I endometrial adenocarcinoma. In 44 patients (80%), a corresponding depth of myometrial invasion and in 54 (98%) patients the same tumor grade were found. Regarding the depth of myometrial invasion and histologic grade, sensitivity, specificity, positive and negative predictive values were 70%, 86%, 73%, 83% and 92%, 100%, 100%, 94%, respectively. Concerning myometrial invasion 9% false-positivity and 10% false-negativity rates were noted. The histopathologic characteristics of false-positive and false-negative patients are emphasized because carcinomatous involvement of deeply situated adenomyosis and advanced grade tumors are the main diagnostic pitfalls. It is important for pathologists to be able to identify carcinomatous involvement of adenomyosis and adjacent foci of minimal myometrial invasion during frozen-section examination which can prevent aggressive surgery.

Recently it has been shown that there is a 15-30% risk of associated cervical intraepithelial neoplasia (CIN 2-3 or greater) for a low-grade squamous intraepithelial lesion (LSIL) diagnosis. We tried to define a subgroup of "LSIL with atypical squamous cells of undetermined significance. High-grade squamous intraepithelial lesion (LASC-H)" in cervicovaginal screening which may aid in predicting the cases associated with high risk cannot be ruled out. In the years between 2001 and 2003 a total of 21,342 cervicovaginal smears were evaluated. The smears with pure LSIL and LASC-H diagnosis which had histologic follow-up were selected. The cases with diagnosis of LASC-H contained numerous typical cells of LSIL and only a few cells with features suggesting high-grade squamous intraepithelial lesion (HSIL). Eight (61%) of 13 cases with a diagnosis of LASC-H but three (11%) of 27 cases with a diagnosis of pure LSIL resulted in CIN 2-3 histology (p < 0.05). Diagnosis of LASC-H may be a valid diagnostic category in distinguishing patients with LSIL that would have HSIL in follow-up.