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Malignant peripheral nerve sheath tumors (MPNSTs), glioblastomas (GBMs), and malignant melanomas (MMs) are neural crest-originating aggressive tumors with a poor prognosis. Signal transducer and transcription activator 3 (STAT3) plays a role in many biological processes, including cell life and proliferation, the acute phase response, chronic inflammation, autoimmunity, metabolism, and cancer progression, It is also known to be a prooncogenic transcription factor. Vascular endothelial growth factor (VEGF) is one of the most potent proangiogenic stimuli ever identified. It mediates tumor neovascularization, and is associated with angiogenesis and lymphangiogenesis. The prostate-specific membrane antigen (PSMA) folate hydrolase I, despite its name, has been found in tissues other than the prostate. It is overexpressed in prostate cancer cells and several other cancers, and has the potential to be a target for radioligand therapy. We investigated the value of STAT3, VEGF and PSMA immunohistochemical expression patterns and their effects on survival in MPNSTs, GBMs, and MMs. Their expression patterns were evaluated in 25 MPNSTs, 27 GBMs, and 25 MM cases. All GBM cases stained positively for STAT3 and VEGF. In the other groups, the staining patterns were heterogeneous. None of the cases showed positive staining with PSMA. There was no statistically significant difference in survival between cases with differing VEGF and STAT3 staining patterns in the MPSNT and MM groups, but there was an increase in mortality as the VEGF score increased in the GBM group. The suppression of VEGF and STAT3 may be a promising avenue for treatment of MPNSTs, GBMs, and MMs, although further research is needed.

Angiosarcomas of the breast are infrequent subtypes of sarcoma that are often diagnosed after radiation therapy for primary breast cancer. Primary angiosarcomas (PAS) are rare tumors that constitute 0.04% of all malignant breast tumors. We report a case of a 40-year-old woman with a lump in the right breast and diagnosed as angiosarcoma by pathological evaluation. She underwent simple mastectomy followed by adjuvant radiation. She is alive and disease-free for 66 months although tumor size was large and one surgical margin was tumor positive. Breast angiosarcoma is often in advanced stage at diagnosis and tends to recur locally. Although surgical methods constitute the primary treatment, we believe that a multidisciplinary treatment strategy should be used in high-risk patients with large primary tumors and tumor positive margins.

Klasik schwannomalar periferik sinir kılıfından köken alan iyi sınırlı benign tümörlerdir. Tüm schwannomaların yaklaşık %5 kadarını sellüler schwannomlar (SS) oluşturur. Fasiküler patern, yüksek sellülarite ve mitotik aktivite varlığı bazı vakalarda yanlış değerlendirme sonucu malign olarak tanı alabilir. Bursa Uludağ Üniversitesi ve Düzce Üniversitesi Tıp Fakültesi Patoloji Laboratuarı arşivlerindeki 16 SS olgusu yeniden değerlendirildi. En sık görülen yerleşim yeri paravertebral/paraspinöz bölge olup bunu mediasten, ekstremiteler, gövde, adrenal bez ve dil takip ediyordu. İmmünohistokimyasal boyama uygulanan 15 vakanın tamamında S100 ile kuvvetli pozitivite görüldü. Ki 67 ile boyanma düşük-orta seviyelerde olup sellüler alanlarda %25’e varan ki 67 proliferasyon indeksi mevcuttu. SS tanısı bazen zorlayıcı olabilir ve histopatolojik özelliklerinin bilinmesi olası yanlış tanı ve gereksiz tedavileri önlemek açısından önemlidir. Bu çalışmada iki merkezin arşivlerindeki SS olgularının klinikopatolojik özelliklerinin incelenmesi ve literatür ile karşılaştırılması amaçlanmıştır.

Objective Although lipomatous tumors are the most common type of mesenchymal tumors in adults, they account for less than 10% of all soft tissue lesions in pediatric patients. In this descriptive study, we aim to present our series of pediatric lipomatous tumors consisting of lipoma, neural fibrolipoma, lipoblastoma, atypical lipomatous tumor, myxoid liposarcoma and pleomorphic liposarcoma, and to evaluate the clinicopathological characteristics of these tumors in reference to the literature. Material and method In this study, pediatric lipomatous tumor cases diagnosed between 2002 and 2018 were screened from pathological archives and retrospectively evaluated. Results A total of 50 cases were diagnosed with lipomatous tumor within the mentioned period. Of the total cases, 24 were female (48%) and 26 were male (52%), with age distribution ranging from 1 to 204 months. Histopathological examination revealed lipoma in 26 cases (52%), lipoblastoma in 19 (38%), atypical lipomatous tumor in 2 (4%), myxoid liposarcoma in 2 (4%), and pleomorphic liposarcoma in 1 case (2%). Conclusion Although lipomatous tumors are the most common type of mesenchymal tumors; they rarely occur in children. Since there is a limited number of studies on pediatric lipomatous tumors in the literature, there is insufficient data on the prevalence and incidence of these tumors. These tumors may slowly enlarge to greater sizes, especially those localized in deep tissues, and may cause various clinical symptoms by compressing surrounding tissues. Local recurrences may occur, even after total excision, and require close monitoring.

Three patients (3 female patients; aged 7, 35, and 61 years) who had recalcitrant idiopathic sclerosing orbital inflammation were treated with rituximab. The disease was bilateral in 1 patient (4 orbits in total): diffuse in 2 and localized in 2 orbits. It caused optic neuropathy in 1 orbit of each patient. Conventional immunotherapy and tumor debulking surgery were unsuccessful in controlling the disease. After rituximab infusions (375 mg/m2/week for 4 weeks), all patients improved symptomatically. Radiologically, the local lesions resolved completely and diffuse lesions partially. Two patients with recurrent inflammation during follow up (78, 58, and 51 months) responded well to immediate, short-term steroid treatments. Short-term rituximab therapy can induce effective remissions in patients with refractory idiopathic sclerosing orbital inflammation. Early and local lesions may respond better to treatment than diffuse lesions. Nevertheless, inflammatory exacerbations can occur during late follow up.

Dermatofibrosarcoma protuberans (DFSP) is an uncommon soft tissue sarcoma that originates from the dermis or subcutaneous tissue in the skin. While its prognosis is generally favorable, disease recurrence is relatively frequent. Because morbidity after repeated surgery may be significant, an optimized prediction of recurrence-free survival (RFS) has the potential to improve current management strategies. The purpose of this study was to investigate the prognostic value of the Ki-67 proliferation index with respect to RFS in patients with DFSP. We retrospectively analyzed data from 45 patients with DFSP. We calculated the Ki-67 proliferation index as the percentage of immunostained nuclei among the total number of tumor cell nuclei regardless of the intensity of immunostaining. We constructed univariate and multivariate Cox proportional hazards regression models to identify predictors of RFS. Among the 45 patients included in the study, 8 developed local recurrences and 2 had lung metastases (median follow-up: 95.0 months; range: 5.2−412.4 months). The RFS rates at 60, 120, and 240 months of follow-up were 83.8%, 76.2%, and 65.3%, respectively. The median Ki-67 proliferation index was 14%. Notably, we identified the Ki-67 proliferation index as the only independent predictor for RFS in multivariate Cox proportional hazards regression analysis (hazard ratio = 1.106, 95% confidence interval = 1.019−1.200, p = 0.016). In summary, our results highlight the potential usefulness of the Ki-67 proliferation index for facilitating the identification of patients with DFSP at higher risk of developing disease recurrences.

Amiloidoma, amilodin değişik dokularda özellikle ekstrasellüler alanda lokalize bir kitle oluşturacak şekilde birikimi ile meydana gelen tümöral bir oluşumdur. En sık lokalizasyon mediasten ve retroperiton olup kemik tutulumu oldukça nadirdir. Amiloidoma tanısı histopatolo-jik, immünohistokimyasal ve histokimyasal değerlendirmeye dayanmaktadır. Olgu sunumumuzda patolojik femur kırığı ile başvuran ve kemikte yoğun amiloid birikimi saptanan 70 yaşındaki erkek hasta literatür bilgisi eşliğinde sunulmuştur.

Peripheral nerve sheath tumors may occur sporadically or related to neurofibromatosis (NF). Unless the mechanisms of tumorigenesis in NF related malignant peripheral nerve sheath tumors (MPNST) are better understood, it remained unclear in sporadic cases. We aimed to investigate the genetic route for malignancy in both individuals with NF-1 and sporadic ones to open a way for targeted therapies in the future. We investigated the role of HER2 with Dual ISH DNA Probe Cocktail test, BRAF mutation (exon 15) and TERT promoter mutation frequency with Sanger sequencing method in respectively 25 sporadic neurofibromas, 25 NF-1 related neurofibromas and 25 MPNST cases from two institutes. Categorical data were analyzed and summarized as frequency and percentage. Statistical analysis was done with SPSS v.22 statistical package, and the statistical significance level was considered as 0.05. We identified TERT promoter mutation only in one sporadic MPNST (4%) and no BRAF mutation in any case. HER2 amplification is found in 10/25 (40%) MPNST cases. No mutations or gene amplification detected in neurofibromas (p < 0.001). MPNSTs are sarcomas with poor prognosis and limited treatment options. TERT promoter mutations and HER2 amplification may play a putative role in therapeutic purposes. BAP unit (Scientific Research Projects) of Duzce UniversityDuzce University This study is supported financially by BAP unit (Scientific Research Projects) of Duzce University. WOS:000553220700001 2-s2.0-85088702178 PubMed: 32580246

Bronchial carcinoid tumors are primary lung neoplasms thought to originate from neuroendocrine cells, i.e. Kulchitsky cells, in the bronchial mucosa, although the type of cellular origin has not been clearly understood. A 61-year-old male patient underwent surgery and microscopic examination of the specimen revealed an anastomosing trabecular bony structure among the nests of tumor cells with round nucleus, granular chromatin, and large eosinophilic cytoplasm. Our case has been deemed worthy of being presented as bronchial carcinoid tumor with exaggerated osseous metaplasia.

Background This study aims to perform autologous blood pleurodesis in an animal model and investigate the effects of paracetamol and diclofenac on autologous blood pleurodesis. Methods We divided 42 female Wistar albino rats (aged three months; average weight 275±25 g) into three major groups of 14. Each major group was further divided into two subgroups of seven rats to be sacrificed at seven days for early changes and 21 days for late changes. We performed autologous blood pleurodesis in all rats at a dose of 3 mL/kg. Group C (control group) was administered saline, group P was administered paracetamol, and group D was administered diclofenac for the postoperative five consecutive days as a single dose intraperitoneally. We sacrificed the rats at the designated dates and removed the thoracic cages en bloc. Results According to macroscopical and microscopical evaluation of the specimens, paracetamol led to a similar degree of adhesions with saline, whereas diclofenac significantly reduced the intensity of the desired adhesions between the two pleural sheets (p=0.05). Conclusion Using anti-inflammatory analgesics following autologous blood pleurodesis may lead to unsuccessful outcome of the procedure.

Purpose: In this study we aimed to review urological soft tissue sarcomas of genitourinary tract that were diagnosed in our institution and their prognostic factors for survival. Materials and Methods: The clinical and pathological records of 31 patients who had diagnosis of soft tissue sarcomas primarily originating from the genitourinary tract between 2005-2011 were reviewed. Results: The most common site was kidney (17 cases, 54.8%), and most common diagnosis was leiomyosarcoma (11 cases, 35.4%). A total of 24 patients (77.4%) had surgical excision. The surgical margins were positive in 7 patients who presented with local recurrence after primary resection. Twelve patients developed metastatic disease. During follow-up (range 9-70 month), 26 of the 31 patients (88.9%) were alive. Significant survival differences were found according to histological type (p: 0.001), with lower survival rates for malignant fibrous histiocytoma. The tumor size, the presence of metastasis at the time of diagnosis and tumor localization were not statistically significant for overall survival. Conclusions: In our series, prostate sarcomas, paratesticular rhabdomyosarcoma and malignant fibrous histiocytoma had poor prognosis, especially in patients presenting with metastatic disease.

Objective: Fibrous dysplasia is a slowly progressing bone lesion resulting from displacement of the normal medullary bone with abnormal fibroosseous tissue. The aim of this study was to assess the similarities and differences of our cases in relation to published reports. Material and Method: In this study, the archives of the Uludag University Medical Faculty Department of Pathology were screened for fibrous dysplasia cases between 2004 and 2016. Results: Within the mentioned period, there were 36 cases diagnosed as fibrous dysplasia. There were 21 male, and 15 female cases with an average age of 27.8±14.8 years (range 7-79 years). The most frequently affected sites were femur, costae, and craniofacial bones. There was one case localized to metacarpal bone, a very rare affection site. There were 4 polyostotic cases including 2 cases of McCune-Albright syndrome. Pelvic bone was affected in the polyostotic type, similar to published reports. Unlike former reports, however, long tubular bones were affected in male patients in our series. In our series, 32 cases had classical fibrous dysplasia, 3 cases had fibrocartilaginous, and one case had fibroosseous variants. Four cases localized to costae were accompanied by aneurysmal bone cyst. The presenting symptom was pathological fractures in a total of 4 cases, 3 localized to the femur, and 1 to the costa. Recurrence occurred in 5 cases treated with curettage. Two of the monostotic fibrous dysplasia cases developed malignant transformation into osteosarcoma. Conclusion: We conclude that our series of fibrous dysplasia cases have slight differences and mainly similar characteristics with the series reported earlier, when all features are taken into consideration.

Background: Osteoarthritis (OA) is the most frequent chronic joint disease causing pain and disability. Recent reports have shown that statin may have the potential to inhibit osteoarthritis. This study of early stage OA developed in an experimental rabbit model, aimed to evaluate the chondroprotective effects of intraarticularly applied atorvastatin on cartilage tissue macroscopically and histopathologically by examining intracellular and extracellular changes by light and electron microscope. Materials and Methods: The experimental knee OA model was created by cutting the anterior cruciate ligament of the 20 mature New Zealand rabbits. The rabbits were randomly allocated into two groups of 10. Study group: The group that received intraarticular statin therapy; Control group: The group that did not receive any intraarticular statin therapy. The control group received an intraarticular administration of saline and the study group atorvastatin from the 1 st week postoperatively, once a week for 3 weeks. The knee joints were removed including the femoral and tibial joint surfaces for light and electron microscopic studies of articular cartilages. Results: The mean total points obtained from the evaluation of the lesions that developed in the medial femoral condyle were 11.33 ± 0.667 for the control group and 1.5 ± 0.687 for the study group. The mean total points obtained from the evaluation of the lesions that developed in medial tibial plateau cartilage tissue were 11.56 ± 0.709 for the control group and 1.40 ± 0.618 for the study group. Electron microscopic evaluation revealed healthy cartilage tissue with appropriate chondrocyte and matrix structure in study group and impaired cartilage tissue in control group. Conclusion: Chondroprotective effect of statin on cartilage tissue was determined in this experimental OA model evaluated macroscopically and by light and electron microscope. There are some evidences to believe that the chondroprotective effect of the statin is that, by protecting the structure of the endoplasmic reticulum and the Golgi complex.

Synovial sarcoma (SS) is a type of soft-tissue sarcoma, often linked to poor survival. Although overexpression of enhancer of zeste homologue 2 (EZH2) has been associated with poor prognosis in different tumors, a few studies investigated this link in SS. Here, we analyzed the relationship between EZH2 expression and prognostic factors in SS. We included 29 patients with SS. Immunostaining of EZH2 was performed with (D2C9) XPTM Rabbit mAb antibody, and the results were classified as low EZH2 expression (negative or weak expression) and high EZH2 expression category (moderate or strong expression). Analysis of survival in relation to prognostic factors was performed with Kaplan-Meier survival curves and Cox proportional hazard regression analysis. Our sample included 19/29 female and 10/29 male patients, with age range 16-63 years. The tumor diameter ranged from 2 to 15 cm. Necrosis was observed in 15/29 cases. Sixteen cases had >10 mitoses per 50 high-power fields (HPFs). Out of 29 cases, 14 showed low and 15 had high EZH2 expression. Statistically significant results were obtained for the association between the presence of metastasis and necrosis (p = 0.042), high EZH2 expression and distant metastasis (p = 0.018), high EZH2 expression and necrosis (p = 0.016), and high EZH2 expression and the tumor size >5 cm versus tumor size ≤5 cm (p = 0.014). Patients with all of the following: the tumor size ≤5 cm, low EZH2 expression, and without necrosis and distant metastasis had significantly longer survival time. Our results are consistent with previous studies, suggesting that EZH2 overexpression is an indicator of poor prognosis in SS.

OBJECTIVES: In the present study, we aimed to deterimine the dose-related effects of ticagrelor, the first reversible inhibitor of the P2Y(12) receptor, found in smooth muscle cells as well as platelets, during neointimal hyperplasia in a rabbit carotid anastomosis model. METHODS: This study was an experimental, prospective, randomized controlled study including 20 New Zealand white female rabbits (6-months old; weighing 2300 +/- 300 g). Under general anaesthesia, the rabbits underwent transection of the right carotid artery and subsequent anastomosis of both ends. The study animals were divided into the following 4 groups: T1 (ticagrelor 5 mg/kg, orally, daily), T2 (ticagrelor 10 mg/kg, orally, daily), T3 (ticagrelor 20 mg/kg, orally, daily) and control (no ticagrelor treatment). The single oral doses were administered in phosphate-buffered saline. The control group received sterile phosphate-buffered saline (2 ml/kg/day, orally) for 3 weeks postoperatively. At the end of the study, the animals were killed, and the anastomosed segment of the right carotid artery and part of the left carotid artery were excised from each animal. Antibodies against transforming growth factor-beta were used in staining of arterial sections, which was followed by histomorphological and immunohistochemical studies. RESULTS: The median intimal thickness (2.0 +/- 0.14 m left vs 73.4 +/- 35.8 m anastomosed right arteries; P

Plexiform fibrohistiocytic tumor is an extremely rare soft tissue tumor with a low malignancy potential. The patient is usually a child or a young adolescent and the tumor is usually localized in the upper extremities. We report on a case of a 21-year old male with a plexiform fibrohistiocytic tumor in the left fibula admitted to our hospital due to a swelling and pain in the left lower extremity. Radiologically a lytic lesion in the distal end of left fibula consistent with a non-aggressive lesion with low biological activity was found. Treated with curettage, the specimen revealed plexiform proliferation of mononuclear histiocyte-like cells, multinucleated osteoclast-like cells, and spindle fibroblast-like cells in variable proportions histopathologically. Immunohistochemical stains were positive for CD68 in scattered fashion in histiocytes and giant cells, and spindle like cells showed positivity for smooth muscle actin. Under electron microscopy, rough endoplasmic reticulum and collagen bundles in the spindle cells suggested fibroblastic differentiation. Also multiple large electron-dense lysosomal granules in histiocytoid cells were found. Multinucleated giant cells exhibited osteoclast-like appearance. All these findings suggested plexiform fibrohistiocytic tumor. Interestingly, the tumor was localized in bone. During the follow up for 27 months after the resection, there was no recurrence or metastasis.

Introduction: Hyperbaric oxygen and platelet-rich plasma are used in the treatment of diabetic wounds. The aim of this study is to evaluate the effects of hyperbaric oxygen therapy and autologous platelet concentrates in healing diabetic wounds. Material and methods: Thirty-six female Wistar albino rats were used in this study. Diabetes mellitus was induced chemically with an intraperitoneal injection of streptozotocin. The rats were divided into a control group, a hyperbaric oxygen group, a platelet-rich plasma group, and a combined therapy group. Platelet-rich plasma was applied just after the creation of the wound; hyperbaric oxygen treatment was carried out daily over 7 days. Wound healing was evaluated according to four parameters: ulcerations, epidermal thickness, density of dermal collagen fibers, and proliferation of dermal blood vessels. Results: The number of active ulcers in the combined therapy group was fewer than in the control group (p = 0.039), and the wound area was greatest in controls (p < 0.001). The epidermal thickness in platelet-rich plasma and combined therapy groups was non-significantly greater than in the control group (p = 0.097 and p = 0.074, respectively). The amount of fibrous collagen in these two groups was greater than in the control group (p = 0.002). Conclusions: Combined hyperbaric oxygen and platelet-rich plasma therapy was found to be successful in diabetic wound healing. The combination therapy had no additive effect in terms of angiogenesis and the development of new collagen fibers. © 2016 Termedia & Banach.

Most of the orbital osteomas arise from the adjacent paranasal sinuses. Some of them may contain osteoblastoma-like areas and may be misdiagnosed as osteoblastoma, both radiologically as well as histopathologically. Sino-orbital osteomas with osteoblastoma-like features show a typical radiological appearance. They have a distinct zonal pattern, in which less dense osteoblastoma-like areas are located at the base of the lesion and dense mature bone is located at the periphery. These broad-based bone lesions also have a tendency for extracavitary polypoid growths from the paranasal sinus into the adjacent orbit. We report here the CT and MR imaging findings of three cases with sino-orbital osteoma with osteoblastoma-like features.

A 1-day-old female newborn presenting with a severe left proptosis was found, on imaging, to have a cranial mass extending in both orbits and ethmoid sinuses. Tumor debulking and biopsy were performed through a lateral orbitotomy. Based on histologic findings, a diagnosis of infantile myofibroma was made. No involvement was found in other areas of the body. The patient died because of respiratory arrest after intracranial surgery that was performed 45 days after the orbital surgery. To the authors' knowledge, only one similar case of cranio-orbital myofibroma has been reported previously. This tumor should be considered in the differential diagnosis of congenital proptosis and cranio-orbital tumor. In such cases, tumor debulking can be performed through orbitotomy.

Objectives: The aim of this study was to compare the effects of autoclaving and pasteurization on bone healing. Methods: Twenty-five full-grown male rabbits were included in the study; all 25 had bone blocks resected and reimplanted. In group 1, bone blocks were autoclaved; in group 2, bone blocks were pasteurized; and in group 3 (controls), resected bone blocks were reimplanted without sterilization. Results: Heiple scores of the proximal parts of the fusion surfaces in group 1, group 2, and group 3 were 12.8 +/- 0.4, 6.8 +/- 1.2, and 10.2 +/- 1.9, respectively. Heiple scores of the distal parts of the fusion surfaces in group I, group 2, and group 3 were 10.8 +/- 0.8, 6.0 +/- 1.1, and 9.8 +/- 1.5, respectively. Differences in radiologic scores were not statistically significant between the groups for proximal or distal fusion surfaces at 3 and 6 weeks. Conclusion: In conclusion, pasteurization has a less negative effect on bone healing than autoclaving, and can be considered for bone sterilization in certain circumstances.

We present a case of a 44-year-old woman with an unusual location of a brown tumor in the sacral vertebrae due to parathyroid adenoma. She was admitted to our clinic with the complaint of low-back pain and was later diagnosed to have a brown tumor. The patient underwent surgery and partial sacrectomy and iliac wing resection was performed in Orthopedic Surgery Department. Subsequently the patient underwent parathyroid adenoma excision in General Surgery Department. On her control examination at postoperative 3 months, she had no pain and was able to perform daily activities without any problem. We believe it is an interesting clinical case both because it shows a very rare localization of brown tumor and points out the importance of employing a wide clinical scope in the differential diagnosis of back pain.

Objective: The aim of this study was to investigate the effect of an orally applicable hypoxia-inducible factor (HIF) stabilizer on distraction osteogenesis (DO) in a rat model.Methods: The study included 24 Wistar albino rats undergoing osteotomy of the left tibia diaphysis. Rats were divided equally into experiment and control groups. Tibias were fixed using an external fixator. HIF stabilizer was administered to the experiment group. On the 5th postoperative day, distraction with increased rate (0.4 mm twice a day) was commenced and continued for 10 days. Histological and immunohistochemical evaluation was performed.Results: Vascular endothelial growth factor levels of the experiment group were higher than those of the control group (p, Amaç: Çalışmamızda sıçandaki distraksiyon osteogenezi (DO) modelinde oral olarak uygulanabilen hipoksi ile indüklenebilir faktörün (HİF) etkisinin incelemeyi amaçladık.Çalışma planı: Çalışmada sol tibia diyafizine osteotomi uygulanan 24 Wistar albino sıçan kullanıldı. Denekler deney ve kontrol olmak üzere iki gruba ayrıldı. Eksternal fiksatör ile tespit sağlanarak, deney grubuna HİF stabilizatörü verildi. Cerrahi sonrası 5. günlük latent dönemi takiben, 10 gün boyunca hızlandırılmış distraksiyon (günde iki kez 0.4 mm) uygulandı. Histolojik ve immünohistokimyasal değerlendirmeler yapıldı.Bulgular: Deney grubundaki vasküler endotelial büyüme faktörü (VEBF) düzeyi kontrol grubuna kıyasla daha yüksek idi (p

Here, we present a case of aneurysmal bone cyst of the third metatarsal that has been infrequently reported in the literature. Its characteristics can mimic various other bone tumors. While the radiographic appearance usually typifies this lesion, microscopic evaluation is paramount for a definitive diagnosis. There are various treatment alternatives for this lesion depending on size, patient’s age and localization. In this report, we recommend total excision of the lesion and reconstruction of the defect by transfer of fibular segment. We obtained satisfactory clinical and radiological results, after 3 years of postoperative evaluation.

Summary In this study, we aimed to investigate the clinicopathological characteristics with special emphasis on c-kit expression and the treatment results of patients with extrapulmonary small cell carcinoma (EPSCC). The medical records of the patients with EPSCC were reviewed, and the data regarding patient and tumour characteristics, treatment and clinical outcome were retrieved and analysed. A total of 28 patients with the diagnosis of EPSCC were identified. There were 19 males and 9 females, with a mean age of 56.5 years. Patients with limited disease (LD) (n = 13) were treated with surgery, chemotherapy (CT) and radiotherapy with different sequences. Patients with extensive disease (ED) (n = 15) were mainly treated with combination CT. The median overall survival was 14.5 months in patients with LD compared to 11 months in those with ED (p = 0.029). Ten patients (36%) showed c-kit overexpression. There was no significant difference between the survival of c–kit-positive and c–kit-negative patients (p = 0.367). In conclusion, our study demonstrates that the prognosis of EPSCC is poor despite currently available treatments. C-kit may be considered as a potential target for novel therapeutical approaches.

Pigmented villonodular synovitis commonly occurs in synovial joints of the appendicular skeleton but rarely affects the synovial joint of the spine, and thus information regarding its natural history, treatment and prognosis remains limited. This case report illustrates a male patient with lumbosacral spinal pigmented villonodular synovitis who presented with lower back pain. It was treated by radical surgical excision and posterior instrumentation. Surgical decompression and follow-up of a patient with magnetic resonance imaging (MRI) constitute a satisfactory treatment of pigmented villonodular synovitis.

Glomus tumors in the gastrointestinal tract are unusual, as the previous series in the literature have been mainly limited to the stomach. Less than 10 cases of esophageal glomus tumors have been described in the literature. Oncocytic glomus tumors are a recently identified, rare variant of the glomus tumor. We report a 47-year-old female who presented with an approximately 3-month history of dysphagia and weight loss. Upper gastrointestinal endoscopy showed a black-purple, hypervascular, protruding lesion measuring approximately 65 mm at the 37th cm of the esophagus. The patient underwent an Ivor Lewis operation via open thoracotomy. The resected specimen had a protuberant, ulcerated mass measuring 80 × 35 mm in the posterior wall of the esophagus. Based on the histopathological, immunohistochemical and electron microscope findings, the final diagnosis was a malignant glomus tumor with oncocytic features. To our knowledge, this is the first report of a malignant glomus tumor with oncocytic features in an esophageal location.

Patients with a newly detected solitary bone metastasis and no history of cancer need extensive diagnostic testing. One hundred and twenty biopsy samples of patients with metastatic bone disease were referred to the authors' pathology department between June 2005 and December 2012. Thirty-three (27.5%) of these patients with a solitary metastasis of unknown origin, and without visceral metastases, were studied retrospectively. Most metastases were found in the spine (14/33 or 42.4%), or in the pelvis (7/33 or 21.2%). The lung was the most common primary site, but this is not universal in the literature. A useful flowchart for the clinician, confronted with a bone metastasis from an unknown primary site, is the following, according to the literature: history and physical examination, biochemistry with tumor markers and immunoelectrophoresis, chest radiograph, CT-scan of chest and abdomen, and bone scan.

Osteoid osteoma and osteoblastoma are histologically similar, benign bone-forming tumors. In this retrospective study, we aimed to evaluate the natural history; clinical, pathologic, and radiologic findings; and treatment results in 204 patients between 1959 and 2006 in a single institution. According to the World Health Organization's definition, tumors = 2 cm, as osteoblastoma. For tumors between 1 cm and 2 cm, other criteria, such as the bone involved, the site, the presence of a nidus, and presence of peripheral sclerosis, were used for diagnosis. There were 131 patients with osteoid osteoma (93 male, 38 female) and 73 patients with osteoblastoma (40 male, 33 female). The mean age in the osteoid osteoma and osteoblastoma groups was 16.4 +/- 7 and 19.6 +/- 9.9 years, respectively. The osteoid osteoma cases were mostly localized in the extremities, whereas the osteoblastoma cases involved the vertebral column and sacrum. The nidus size varied between 0.2 and 1.5 cm in osteoid osteoma cases, and the tumor size range was 1.3-10 cm in the osteoblastoma cases. The pain was encountered in 89% of osteoid osteoma and 45% of osteoblastoma patients. Histopathology was similar in both cases. The treatment of choice was conservative surgery for both diagnoses. In conclusion, osteoblastoma is clinically and radiologically more aggressive than osteoid osteoma.

Objective: The aim of this study was to analyze the effect of low-dose irradiation on fibrous cartilage and to obtain a hyaline cartilage-like fibrocartilage (HCLF) with similar structural and mechanical properties to hyaline cartilage.Methods: An osteochondral defect was created in 40 knees of 20 rabbits. At the 7th postoperative day, a single knee of each rabbit was irradiated with a total dose of 5.0 Gy in 1.0 Gy fractions for 5 days (radiotherapy group), while the other knee was not irradiated (control group). Rabbits were then divided into four groups of 5 rabbits each. The first three groups were sacrificed at the 4th, 8th and the 12th postoperative weeks and cartilage defects were macroscopically and microscopically evaluated. The remaining group of 5 rabbits was sacrificed at the 12th week and biomechanical compression tests were performed on the cartilage defects.Results: There was no significant biomechanical difference between the radiotherapy and the control group (p=0.686). There was no significant macroscopic and microscopic difference between groups (p=0.300). Chondrocyte clustering was observed in the irradiated group.Conclusion: Low-dose irradiation does not affect the mechanical properties of HCLF in vivo. However, structural changes such as chondrocyte clustering were observed., Amaç: Bu çalışmanın amacı düşük doz X ışınının fibröz kıkırdak üzerindeki etkilerini araştırmak ve hiyalin kıkırdak ile aynı mekanik ve yapısal özelliklere sahip hiyalin kıkırdak benzeri fibrokıkırdak (HKBF) geliştirmek idi. Çalışma planı: Yirmi tavşanın 40 diz ekleminde osteokondral defekt oluşturuldu. Ameliyat sonrası 7. günde başlanarak her tavşanın tek bir dizine, 5 gün boyunca, günlük 1.0 Gy'lik dozlarla toplam 5.0 Gy X ışını uygulanırken (radyoterapi grubu), diğer dizi uygulama dışı bırakıldı (kontrol grubu). Tavşanlar daha sonra her birinde 5 adet olacak şekilde 4 gruba ayrıldı. İlk üç grup, sırasıyla, 4., 8. ve 12. haftada sakrifiye edildi ve kıkırdak defektleri makroskopik ve mikroskobik olarak incelendi. Kalan 5 tavşanın oluşturduğu grup da 12. haftada sakrifiye edilerek kıkırdak defektlerine biyomekanik sıkıştırma testleri uygulandı. Bulgular: Radyoterapi ve kontrol grupları arasında biyomekanik açıdan anlamlı bir fark saptanmadı (p=0.686). Yine, gruplar arasında makroskopik ve mikroskopik açıdan da anlamlı bir fark yoktu (p=0.300). Işınlanan grupta kondrosit kümelenmesi gözlendi. Çıkarımlar: Düşük doz X ışını HKBF dokusunun mekanik özelliklerini in vivo etkilememekle birlikte, kondrosit kümelenmesi gibi yapısal değişikliklere yol açmaktadır.

Background: Liposarcomas are among the most common soft tissue sarcomas in adulthood. Aim: The purpose of the study is to perform a histopathologic typing according to World Health Organization (WHO) classification of cases diagnosed with liposarcoma and to examine the difference of p53 and MDM2 expressions. Materials and Methods: The haematoxylin-eosin stained sections of 48 subjects enrolled in the study have been evaluated on the basis of the WHO classification for liposarcoma and sections stained using p53 and MDM2. Statistical Analysis Used: Chi-Square test was applied. Results: 20 subjects were diagnosed with well-differentiated liposarcoma (WLS), 16 myxoid liposarcoma (ML), 7 pleomorphic liposarcoma (PL), and 5 de-differentiated liposarcoma (DLS). The number of cases stained positive with MDM2 and p53 were positive correlated in all subjects ( P = 0.02). p53 and MDM2 positivity increased in high grade tumors ( P = 0.01). Conclusion: p53 and MDM2 immuno-reactivity was found to be potentially useful in liposarcoma diagnosis but a definitive implication would be rather unhealthy due to the small number of cases in our study.

Plexiform fibrohistiocytic tumor is an extremely rare soft tissue tumor with a low malignancy potential. The patient is usually a child or a young adolescent and the tumor is usually localized in the upper extremities. We report on a case of a 21-year old male with a plexiform fibrohistiocytic tumor in the left fibula admitted to our hospital due to a swelling and pain in the left lower extremity. Radiologically a lytic lesion in the distal end of left fibula consistent with a non-aggressive lesion with low biological activity was found. Treated with curettage, the specimen revealed plexiform proliferation of mononuclear histiocyte-like cells, multinucleated osteoclast-like cells, and spindle fibroblast-like cells in variable proportions histopathologically. Immunohistochemical stains were positive for CD68 in scattered fashion in histiocytes and giant cells, and spindle like cells showed positivity for smooth muscle actin. Under electron microscopy, rough endoplasmic reticulum and collagen bundles in the spindle cells suggested fibroblastic differentiation. Also multiple large electron-dense lysosomal granules in histiocytoid cells were found. Multinucleated giant cells exhibited osteoclast-like appearance. All these findings suggested plexiform fibrohistiocytic tumor. Interestingly, the tumor was localized in bone. During the follow up for 27 months after the resection, there was no recurrence or metastasis.

Ossified cephalhematoma is a rare clinical entity. Even though cephalhematoma is frequently encountered, ossified cephalhematoma occurs only sporadically. We report a 13-week-old boy who was admitted to neurosurgery clinic with deformity of the skull. A plain skull radiograph showed radiolucent areas in the right parietal region. CT scan of the head showed thickened right parietal bone and a low-density lesion between bony layers. 3D CT of the skull showed bony protrusion of the right parietal bone. A cosmetic surgical procedure was performed for the patient, and biopsy of the bony lesion confirmed ossified cephalhematoma. We discuss diagnosis, pathogenesis, and treatment of ossified cephalhematoma.

Angiomyofibroblastoma-like tumor is a rare mesenchymal tumor of men. It commonly occurs during the fifth to eighth decades of life and mainly involves the inguinoscrotal region. It is derived from perivascular stem cells and has capacity of lipoid and myofibroblastic differentiation. Histopathologically this tumor in the male genitalia mimics female angiomyofibroblastoma but there are morphological and immunohistochemical differences between these lesions. We report a case of an angiomyofibroblastoma-like tumor that arose in the scrotal region in a 40-year-old man.

A case of POF in the maxilla of a 10-year-old child is presented. This case is reported in view of its absence in the maxilla and the difficulty in diagnosis due to its radiological resemblance to lymphoma and osteosarcoma, further aggravated by the clinical scenario.

We reviewed cases of primary colorectal adenocarcinoma to document synchronous colon and rectum adenocarcinoma (SCRC).In a retrospective setting, 764 cases underwent surgical resection for primary colorectal adenocarcinoma and referred to the Department of Surgical Pathology, Uludag University, Medical Faculty for diagnoses between 1997 and 2006, were reviewed. Tumor site, depth of invasion, coexistence of adenoma, distance between these multiple primary tumors, degree of p53 expression, and p53 expression pattern indicating polyclonal or monoclonal origins were noted in order to establish a possible effect on prognosis.There were 28 cases with SCRC of colon and rectum. Nine cases were female, 19 cases were male (female to male ratio was 1:2). Most of the cases were within the 5th and the 6th decades. There were statistically significant relationships between p53 expression and differentiation status (p=0.001), and invasion depth (p=0.03). Forty of 62 colorectal carcinomas showed immunohistochemical positivity for p53. Six cases showed a discordant pattern of p53 mutation among individual lesions indicating polyclonal origin.Synchronous colon and rectum adenocarcinoma is not rare. The incidence is 3.6% in our series. We believe that further studies with larger series are needed for p53 to prove useful in predicting prognosis of SCRCs and assessing the polyclonal origin of SCRC at a genetic level.

Osteoid osteoma arising in the phalanx is rather uncommon, and although the clinical and radiographic findings can be characteristic, the diagnosis is not always clear. In this article, we describe the case of a 9-year-old female who presented with a painful toe that, after careful evaluation and excisional biopsy, was determined to be caused by subperiosteal osteoid osteoma. The lesion was treated successfully with excision of the nidus. Level of Clinical Evidence: 4

Background. During off-pump coronary bypass grafting, local vascular control of the target vessel and a bloodless field are crucial. The aim of this study is to asses the histopathological outcomes of intracoronary shunts and bulldog clamping on the beating heart in a canine model. Methods. Twelve healthy adult mongrel dogs weighing between 15 to 25 kg were included in the study. Following left thoracotomy, proximal left anterior descending artery segment 1 cm to distal of diagonal branch was marked. Arteriotomy at this site was performed and a shunt was inserted for 10 min in the shunt group. The bulldog clamp was applied 3 cm distal to the mark for 10 min after heparinization in the bulldog group. Thirty days after the procedure, the specimens of left anterior descending artery from both regions were collected and were examined. Vascular damage, presence of intimal hyperplasia, and denudation were noted. Results. Only intimal denudation was found significantly higher in the shunt group (P < 0.05). In this group, only one case had grade 0 endothelial damage. In the bulldog group, all cases had endothelial damage of various grades. Conclusion. The proven advantages of temporary intracoronary shunts are well-known, e.g., preserving the ventricular functions. Despite these advantages, our study revealed an ultimate bad result for an off-pump coronary by pass patient: intimal denudation. We conclude that further studies with a larger number of subjects are needed to decide whether routine shunt insertion into coronary arteries during off-pump coronary bypass surgery is appropriate or not.

Gastrointestinal stromal tumors are non-epithelial tumors originating from the gastrointestinal tract walls. They expose a wide spectrum of histological properties from benign to poorly differentiated malignant tumors.In this study 41 cases of gastrointestinal stromal tumors were reviewed for p53 expression using immunohistochemical stains. Immunoreactivity properties of the tumors were compared to prognostic factors such as mitotic index, tumor size, tumor site, presence of necrosis, mucosal invasion, proliferative index, telomerase activity, hemorrhage, cellularity, and histological pattern.There was a significant difference in positive immunostaining of three case groups (12.2% in benign, 19.5% in borderline, and 68.3% in malignant group). Statistical analysis revealed a statistically significant positive correlation between p53 immunostaining properties and tumor size (p = 0.01), mitotic index (p=0.05), cellularity (p = 0.042), and diagnosis (p = 0.01).We conclude that p53 expression may be a useful tool in classifying and predicting the prognosis of gastrointestinal stromal tumors as it is well correlated with tumor size, mitotic index, cellularity, and diagnosis according to our study results.