Does locally applied epidermal growth factor stop anastomotic leak in the colon?

AIM: Anastomosis leakage is one of the most common complications after colorectal surgery. Studies have shown that the incidence of anastomotic leakage is between 0.5-30%. The aim of our study was to investigate the efficacy of local application of of epidermal growth factor (EGF) on colon anastomosis healing. MATERIAL AND METHODS: 28 Wistar rats were randomly divided into 4 groups. Sham group, control group, saline injection group, EGF injection group. Anastomosis line was determined as 3 cm distal to ilealcecal junction. The rats were reoperated on the 7th postoperative day. The colon segment was cut out 3 cm proximal and distal to the anastomotic line.The bursting pressure of each removed colon segment was measured and the segments were fixed with 10% formaldehyde for pathology examination. Anastomosis line was stained with hematoxylin eosin and histopathological evaluation was performed. Evaluation parameters were inflammatory cells, fibroblast, angiogenesis (neovascularization) and collagen amounts. RESULTS: Bursting pressure was higher in the EGF group than in the control group and saline injection group. There was statistically significant difference between EGF and positive control group. (p<0,05) Histopathological examination revealed that the inflammatory cell density was higher in the positive control group than in the other groups. Fibroblast cell density, neovascularization and collagen content were higher in EGF group than the others. However, no statistically significant difference was found between the control group,saline injection group and EGF injection group. CONCLUSION: As result of our study,we think that local application of EGF may have a positive effect on healing of colon anastomosis. KEY WORDS: Colonic Anastomosis, Egf, Experimental, Healing.

Acute lower gastrointestinal bleeding due to low-grade mucinous neoplasm of appendix.

INTRODUCTION: Lower gastrointestinal tract (GIT) bleeding originating from the appendix is rare and may be difficult to diagnose. PATIENTS AND METHODS: In this case report, we present an 88-year-old male patient who was admitted with hematochezia due to appendiceal bleeding. A colonoscopy revealed bleeding in the appendix orifice so an appendectomy was performed, and bleeding did not recur in the postoperative period. RESULTS: The results of the microscopic examination showed low-grade mucinous neoplasm (LGMN) of the appendix. CONCLUSION: It should be kept in mind that bleeding may originate from the appendix in patients presenting with GIT bleeding. Our patient is the first to present with an acute lower GIT bleed who was diagnosed as having LGMN in the appendectomy specimen.

Predictive Value of Additional Clinical and Radiological Parameters for Discrimination of Malignancy in Bosniak 3 Cysts.

INTRODUCTION: Almost half of the cystic renal lesions are still overdiagnosed and overtreated. New clinical and radiological parameters are needed to distinguish the malignant Bosniak 3 lesions from the benign ones. We aimed to evaluate the clinical and radiological parameters that may be related to malignancy risk for Bosniak category 3 renal cysts. MATERIALS AND METHODS: Patients who underwent surgical resection of a histopathologically confirmed Bosniak 3 renal cyst between March 2007 and September 2019 were evaluated. Two experienced uro-radiologists have reevaluated the last preoperative computed tomography and/or MRI images of the patients and reclassified the lesions according to the Bosniak classification. They also reported cystic features such as nodularity, septation, focal thickening, enhancement, and calcification. Clinical, pathological, and oncological outcomes were recorded. Then patients were divided into 2 groups as Group 1 (benign pathology) and Group 2 (malignant pathology) according to final histopathological report. RESULTS: A total of 79 patients were included in this study. Mean follow-up time was 47 ± 34 months. There were 30 patients in Group 1 and 49 patients in Group 2. Hypertension (p = 0.001) and smoking history (p = 0.008) were more common in malignant group. Among the radiological findings, lower tumor diameter (p = 0.024), presence of cyst wall enhancement (p = 0.025), presence of nodularity (p = 0.002), and presence of focal thickening (p = 0.031) were found to be statistically significant for malignancy. Most of the tumors were at pathological T1 stage and Fuhrmann Grade 1-2. Only nodularity was found to be independent predictive factor for malignancy in multivariate analysis. CONCLUSION: Clinical factors including hypertension and smoking, radiological factors including lower lesion size, cyst wall enhancement, nodularity, and focal thickening were predictors for malignancy of Bosniak 3 cysts.

The evaluation of the distribution of CD133, CXCR1 and the tumor associated macrophages in different molecular subtypes of breast cancer.

Breast cancer has different molecular subtypes, which determine the prognosis and response to the treatment. CD133 is a marker for cancer stem cells in tumor microenvironment with diagnostic/therapeutic importance. The tumor associated macrophages (TAMs) interact with the cancer stem cells through the CXCR1 receptor. In this study, we wanted to investigate the expression of these markers in patients with different molecular subtypes, in order to detect pathophysiological mechanisms and new molecular targets for the prospective targeted therapies. In this study we hypothesized a difference in expression of these antigens among different subtypes. We investigated expression of antigens in breast cancer patients with luminal A (LA), luminal B (LB), HER2 overexpressing (HER2OE), triple negative (TN) subtypes (n=70) and control patients (n=10) without cancer diagnosis. We applied indirect immunohistochemistry and evaluated immunostaining. CD133 expression was at the periphery and CXCR1 expression was at the central area of the tumor. The cytoplasmic CXCR1, CD133 expressions and nuclear CD133 expression, which is prominent in the TN subtype, were observed in patients. There was a statistically significant difference between the groups for CD133 (p=0.004), CXCR1 (p=0.002) H-Score values and M2 macrophages/whole TAM ratios (p=0.022). Between the CD133 and CXCR1 H-scores, there was a weak positive correlation (r=0.249, p=0.035). This study showed the compartment specific expression of the CD133 and CXCR1 antigens in neoplastic cells. The use of CD133 as a stem cell marker may be limited to TN subtype, due to its heterogeneous expression.

The Histopathologic Correlation of Bosniak 3 Cyst Subclassification.

OBJECTIVE: To evaluate the histopathologic correlation of recently described subclassification of Bosniak category 3 cysts (3s and 3n). MATERIALS AND METHODS: A total of 106 patients who underwent partial/radical nephrectomy due to a complex renal cyst (≥Bosniak 3) were retrospectively reviewed. All the scans of the patients were reevaluated by 2 experienced uroradiologists. Bosniak 3 cysts were reclassified as 3n (nodularity on the cyst wall/septae) and 3s (septated cysts without nodularity) as described in a recently published paper. Group 1 consisted of patients with Bosniak 3s, Group 2 consisted of patients with Bosniak 3n, and Group 3 consisted of patients with Bosniak 4 cysts. Three groups were compared according to patients' characteristics, radiological findings, histopathologic results, and survival outcomes. RESULTS: There were 52 patients in Bosniak 3 group and 54 patients in Bosniak 4 group. Mean follow-up was 35.3 months. Among Bosniak 3 cysts, 37 lesions were classified in 3s and 15 were classified in 3n. Malignancy was higher in 3n group than 3s (86.7% vs 54.1%, P= .026). Lesion size was significantly lower for malignant cysts compared to benign ones in the patients with Bosniak 3 lesions (44.2 ± 27.5 vs 80 ± 55.9 P= .005). In the subgroups, malignant lesions were significantly smaller than benign lesions in 3s group similar to general Bosniak 3 group. Most of the Bosniak 3 lesions were organ confined and low grade. CONCLUSION: The subclassification of Bosniak 3 cysts as 3s and 3n can help to differentiate highly suspicious malignant lesions from the relatively less suspicious ones.

Phyllodes Tumor of Anogenital Mammary-like Glands with Diffuse Pseudoangiomatous Stromal Hyperplasia.

Anogenital mammary-like glands may give rise to various pathologic lesions identical to those known in mammary pathology. Tumor occurring in the anogenital region is extremely rare. The histogenetic origin of this tumor is controversial as it is being debated whether such lesions evolve from ectopic breast tissue and most recently, anogenital mammary-like gland. We report a 28-year-old girl who presented with a painless mass in the anogenital region, which was subsequently excised. Microscopic examination revealed morphologic pattern characteristic of benign phyllodes tumor with pseudoangiomatous stromal hyperplasia. We present this case to emphasize the importance of recognizing this uncommon lesion occurring at an extremely unusual site. We also discuss the histogenesis of phyllodes tumor and related lesions occurring in the anogenital region in light of the current literature along with a brief review of the previously reported cases of anogenital mammary-like glands.

Neutrophil-to-lymphocyte and neutrophil-to-monocyte rates in the decision for a prostate re-biopsy in patients with a previous benign pathology and consistently 2,5-10 ng/ml PSA value.

OBJECTIVES: In this study we compared neutrophil-to-lymphocyte ratio (NLR) and neutrophilto- monocyte ratio(NMR) between patients with prostate cancer after first transrectal ultrasound (TRUS)- guided biopsy and patients with benign prostate hyperplasia(BPH) after second TRUS-guided biyopsy. METHODS: A total of 224 patients who underwent multi (≥12)-core TRUS -guided biopsy at our clinic for elevated PSA or abnormal digital rectal examination in between January 2008 and March 2015 were retrospectively analyzed. There were 2 groups. Group 1 consisted of 146 patients with a diagnosis of prostate cancer after the first TRUSguided biyopsy and group 2 consisted of 78 patients with a diagnosis of benign prostate hyperplasia after second TRUS-guided biyopsy. Age, PSA, NLR and NMR values were compared between the two groups. RESULTS: There were no statistically significant correlation between PSA and NLR(p=0.46). The mean of age, PSA, NLR, NMR values in the group 1 and 2 were respectively 64.6±7.7 and 61.6±6.9, 6.5±1.9 and 5.3±1.2, 2.8±1.5 and 2.3±1.1, 9.2±3.9, 8.1±2.9 (p=0.03, p=0.001, p=0.012 and p=0.30). The mean PSA, NLR ,NMR values of the group 1 were significantly higher than those in group 2 (p=0.002). Gleason grade and pathological stage were significantly increases as NLR increases. CONCLUSION: NLR and NMR in patients with BPH after second TRUS-guided biopsy were lower than that of those with a diagnosis of prostate cancer after the first TRUS-guided biopsy.White blood test subtypes can be considered for the decision to perform a second TRUSguided biopsy in patients with previous negative biopsy with persistently elevated PSA.

The Prognostic Significance of FoxP3+ T Cells and CD8+ T Cells in Colorectal Carcinomas.

Recent studies report that tumor microenvironment effects prognosis of colorectal cancers. We analyzed the densities of FoxP3+ cells and CD8+ cells, the ratio of FoxP3+/CD8+ cells and the relationship between these parameters, clinicopathological features, and prognosis. A total of 186 colorectal adenocarcinoma were evaluated in terms of clinicopathological features. Immunohistochemically, densities of intratumoral (IT; IT-FoxP3) and nontumoral (NT; NT-FoxP3) FoxP3+ cells and IT-CD8 and NT-CD8 CD8+ cells were calculated. The ratio of Foxp3/CD8 was recorded. IT-FoxP3 and the ratio of IT-FoxP3/IT-CD8 were higher than NT-FoxP3 and the ratio of NT-FoxP3/NT-CD8, respectively. In multivariate analysis, high FoxP3+ cell density is the most important predictive marker after clinical stage and surgical margin positivity in disease-free survival and the most important predictive marker after clinical stage in overall survival (OS). Short OS time was correlated with clinical stage, decrease in IT-FoxP3, increasing age, number of metastatic lymph nodes, surgical margin positivity, satellite tumor nodule, medullary carcinoma, and the number of pericolorectal lymph nodes. The ratio of FoxP3/CD8 increased noticeably in the IT area, but no relationship was found with survival. The relationships of the cells with one another in the tumor microenvironment seem to have many secrets. Studies in large series supported by molecular techniques can illuminate those secrets to some extent.

The prognostic significance of survivin expression in gallbladder carcinoma.

Gallbladder cancers (GBC) are characterized by rapid progression, early metastasis, and poor prognosis; the molecular mechanisms of the various signaling pathways involved should be elucidated to develop effective therapies. Survivin, an apoptosis inhibitor protein expressed in the G2/M phase of the cell cycle, plays a role in cell division and affects both cell survival and proliferation. Survivin has been investigated in many types of cancer, and this study aims to examine the relationship of survivin expression in gallbladder cancer patients with clinicopathological features and prognosis. We evaluated demographic characteristics (age, gender), tumor characteristics (histopathological type, differentiation, perineural, and lymphovascular invasion; serosal invasion, surgical margin positivity and lymphocytic response), and Survivin expression immunohistochemically, and we analysed the relationship between these characteristics and prognosis in 47 gallbladder carcinoma cases from 2000 to 2011. Immunohistochemically, while survivin expression was observed in 36 cases, it was absent in 11 cases. Follow-up data were obtained from 32 patients. Two (8.7%) of 23 cases with a Survivin-positive tumor were alive at 74th and 35th months, whereas 5 (%55.6) of nine cases with Survivin-negative tumor were alive at 50th, 89th, 124th, 126th, 131th months. Survivin expression was correlated with short survival (p = 0.043), and the univariate analysis showed that reduced overall survival was associated with age (p = 0.043), male gender (p = 0.038), infiltrative pattern (p = 0.019), lymphovascular invasion (p = 0.004), perineural invasion (p = 0.009), serosal invasion (p = 0.027), ulcer (p = 0.033), and surgical margin positivity (p = 0.022). Despite the low number of patients in our study, the analysis results suggest that survivin positivity might actually be a significant prognostic factor. This finding could be a reference point for targeted treatment studies. However, further studies involving broader series and longer follow-up are still required for highly lethal gallbladder cancers.

Primary Gastric Invasive Micropapillary Carcinoma: A Case Report.

Invasive micropapillary carcinoma is a recently identified neoplasm. A 77-year-old-female was admitted to the hospital due to progressive loss of weight and nausea. Endoscopic biopsy of the antral/prepyloric located mass was diagnosed as moderately differentiated adenocarcinoma. Subtotal gastrectomy and regional lymph node resection were performed. The tumor was composed of moderately differentiated cells arranged in micropapillary structures with only a few poorly formed glandular foci in lamina propria. Immunohistochemically, neoplastic cells of micropapillary and focal conventional adenocarcinoma areas were diffusely positive for pancytokeratin, cytokeratin 7 and epithelial membrane antigen. In micropapillary areas, membranous and peripheral cytoplasmic positivity with epithelial membrane antigen in outside of the cell clusters called "inside-out polarity" pattern that is characteristic for invasive micropapillary carcinoma were seen. Invasive micropapillary carcinoma is very rare in the stomach in the English literature.

Relationship between MLH-1, MSH-2, PMS-2,MSH-6 expression and clinicopathological features in colorectal cancer.

Colorectal cancers are the third most common in both sexes and they are the second most common cause of cancer-related death. 12-15% of colorectal cancers develop through microsatellite instability (the hereditary mutation in at least one of DNA mismatch repair genes) pathway and they are 2-5% hereditary. In this study, we investigated the correlation between the clinicopathological features themselves and also the correlation between them and the immunohistochemical MLH-1, MSH-2, PMS-2, MSH-6 expressions in a total of 186 resection materials with colorectal adenocarcinoma between 2008 and 2012. All the cases were retrospectively evaluated in terms of age, sex, localization, size, accompanying polyp, multiple tumor, arising from polyp, differentiation, mucinous differentiation, pathological tumor stage, lymphovascular and perineural invasion, lymphocyte amount in the tumor microenvironment, surgical border and lymph node metastasis. We prepared multiple tissue blocks which had 4-millimeter tumor. Immunohistochemically, MLH-1, MSH-2, PMS-2, MSH-6 primary antibodies were studied. Statistically, "Kruskal-Wallis" ve "Pearson's chi-squared" tests were used. We found a positive correlation between loss of MLH-1 and PMS-2 expressions and the right-colon location, poor and mucinous differentiation and dense lymphocytic infiltration. In addition, loss of MSH-2 and MSH-6 expressions was correlated with the right-colon location, poor and mucinous differentiation. We found a meaningful relationship between immunohistochemical markers and clinicopathological features usually observed in tumors with microsatellite instability. This finding may arouse suspicion for MSI. However, the findings in our study must be supported with studies conducted in large series including molecular methods.

Evaluation of late antibody-mediated rejection (C4d-mediated rejection): a single-center experience.

OBJECTIVES: There has been no improvement in long-term graft survival rates in renal transplant-recipients during the past decade. We evaluated patients who underwent renal transplant and experienced late (≥ 3 years) antibody-mediated rejection, after an immunologically uneventful course early after transplant. MATERIALS AND METHODS: Between 2003 and 2010, twenty-one of 312 patients who had kidney transplants at our center were diagnosed with antibody-mediated rejection according to the Banff 97 criteria. The patients' information from their files was retrospectively evaluated. RESULTS: Of the 7 male and 3 female patients (mean age, 33 ± 11, range, 18-52 y), 5 received deceased-donor kidneys, and 5 had living-related donor kidneys. The average basal and third-year serum creatinine levels were 1.24 ± 0.31 mg/dL and 1.36 ± 0.43 mg/dL (P < .001). The mean follow-up until rejection was 64 ± 23 months (range, 37-101 mo). Medical history revealed recurrent bacterial infections in 4 , cytomegalovirus infection and posttransplant diabetes each in one patient and drug withdrawal in 2 patients. For this reason, maintenance immunosuppressive therapy was reduced and/or replaced. In kidney biopsies, 6 patients had acute findings of antibody-mediated rejection, and chronic features were predominant in 4 cases. Renal function improved in 8 patients after treatment, but rejection remained progressive in 2 patients. Three patients lost their grafts during follow-up. Noncompliance was the cause of graft loss in 2 cases. In the remaining 7 patients, the mean follow-up after rejection treatment was 18 ± 14 months (range, 6-48 mo), and the average serum creatinine level was 3.0 ± 0.93 mg/dL (range, 2.3-4.7) . CONCLUSIONS: Late antibody-mediated rejection can emerge soon after the modification of immunosuppressive drug dosages and may be responsible for graft dysfunction or loss.

Clinical features and outcomes of nontransitional cell carcinomas of the urinary bladder: Analysis of 125 cases.

OBJECTIVES: The aim was to evaluate pathologic diagnosis, treatment and prognosis of 125 patients with nontransitional cell carcinoma of the urinary bladder. MATERIALS AND METHODS: A total of 3590 patients with bladder tumors operated in our clinic between September 1998 and May 2013 were retrospectively evaluated. A total of 125 patients (107 men and 18 women) with nontransitional cell bladder cancer, confirmed by histopathology, were included in this study. The patients' characteristics, including age, gender, smoking history, tumor size, and localization, histological types, pathological tumor stages, treatment modalities, and survival rates were all recorded. RESULTS: Of these tumors, 47 (37.6%) were adenocarcinoma (AC), 42 (33.6%) were squamous cell carcinoma (SCC), 23 (18.4%) were undifferentiated carcinoma (UC), 13 (10.4%) were other types of bladder carcinoma. Sixty-three (50.4%) patients had undergone radical cystectomy and pelvic lymphadenectomy ± adjuvant treatment (chemotherapy [CT]/radiotherapy) and 52 (41.6%) patients received radiotherapy ± CT. The median survival time of patients with AC and SCC were significantly higher than patients with UC (AC vs UC, P = 0.001; SCC vs UC, P = 0.000; AC vs. SCC, P = 0.219). Median survival time was significantly higher in radical cystectomy ± adjuvant treatment group (P < 0.05) in all histological types. CONCLUSION: Prognosis of urinary bladder tumors was directly related to histological type and stage of the tumor. CT or radiotherapy has limited response rates. Early radical cystectomy should be performed to improve prognosis.

Characteristics of Emergency Gastrointestinal Stromal Tumor (GIST).

BACKGROUND/AIMS: Gastrointestinal Stromal Tumors (GISTs) are the most common mesenchymal tumors of the gastrointestinal tract (GIT). Importance of GISTs is increasing while surgeons are facing with more frequent either in emergency setting of elective cases. Delineating the presentation and management of emergency GIST is important. METHODOLOGY: From 2005 to 2014, emergency cases with final diagnosis of GIST were examined retrospectively. Total of 13 operated cases were evaluated by patients characteristics, clinical presentation, operational findings and postoperative prognosis. RESULTS: There were 9 male and 4 female with the mean age of 48.15 years. The most frequent presentations are ileus and GIT hemorrhage both covering the 84% of patients. Small bowel was the dominating site with ileus. Stomach was the second frequent site of the disease with the finding of hemorrhage. CONCLUSION: Emergency patients are more likely to come with small bowel GIST and obstruction symptoms. Hemorrhage is the most frequent symptom for emergency GIST of stomach and duodenum.

Molecular Classification of Breast Carcinoma: From Traditional, Old-Fashioned Way to A New Age, and A New Way.

Breast carcinoma comprises a group of diseases with specific clinical, histopathologic and molecular properties. Traditional classification use morphology to divide tumors into separate categories with differing behavior and prognosis. However, there are limitations of traditional classification systems, and new molecular methods are expected to improve classification systems. Molecular subtypes of breast carcinomas have been characterized in the last 11 years, and have been studied extensively. Much of the information accumulated in recent years, and molecular taxonomy seems to be still developing and undergoing change. The main question is whether new molecular techniques such as gene expression profiling will be accepted as gold standard in determining breast cancer subtypes, and whether molecular classification is useful in specific subtypes of breast cancer as it is in ductal carcinoma (nonspecific type). In addition, critical review of the literature reveals major problems such as poor definition, lack of reproducibility and lack of quality control in current molecular techniques and classifications. Therefore, current molecular approaches are not yet used in routine clinical practice and treatment guidance since they are immature and can even lead to incorrect assessment.

Basosquamous carcinoma: is it an aggressive tumor?

Basosquamous carcinoma is a rare cutaneous tumour that is considered an aggressive type of basal cell carcinoma with an increased risk of recurrence and metastases. This impression has been perpetuated in the literature, despite limited scientific data and conflicting results of some authors. This present study was aimed to evaluate the clinical-pathological features of this tumour and follow-up of a series of basosquamous carcinoma. Basosquamous carcinoma patients who underwent surgical excision between January 2000 and February 2012 were analyzed retrospectively. Their medical files were reviewed and the corresponding routinely stained sections (with hematoxylin-eosin) were re-evaluated by two pathologists. Thirty-five patients with basosquamous carcinoma were operated on in this period. Most tumurs were located in the head and neck area (94%), and the mean age of the patients was 69.8 years. Margin involvements were seen in 11 patients (31.4%) and all of them underwent re-excision. There was only one local recurrence. There was neither regional lymph node nor distant metastasis in this series. The recurrence rate of basosquamous carcinoma is found as 4%, lower than that of most other similar studies. Further pathologic studies are needed to better classify basosquamous carcinoma and to increase consistency between the results of studies. Surgical excision and regular follow-up are considered as the treatment of choice.

Comparison of the clinicopathological features of invasive ductal, invasive lobular, and mixed (invasive ductal + invasive lobular) carcinoma of the breast.

BACKGROUND: In this retrospective analysis, the clinicopathological features and pattern of metastatic spread of invasive ductal carcinoma (IDC), invasive lobular carcinoma (ILC), and mixed ductal/lobular carcinoma (MDLC), together with the type and outcome of surgical intervention, were comparatively evaluated. METHODS: A total of 633 breast cancer patients with histopathological subtype IDC, ILC or MDLC were included in the study. The mean age was 52.6 ± 12.7 years. Follow-up period ranged between 0 and 33 (median 6.0) years. The groups were compared with respect to age, tumor size, nodal involvement, stage, hormonal therapy, multicentricity, multifocality, bilaterality, estrogen receptor (ER), progesterone receptor (PR), human epidermal growth factor receptor 2 (HER2)/neu, p53, and Ki67 expression, disease-free survival (DFS) and overall survival (OS) rates, and surgical approach. RESULTS: The distribution of patients was as follows: IDC 508 (80.3 %), ILC 78 (12.3 %), MDLC 47 (7.4 %). Among the parameters evaluated, statistically significant differences were observed in mean tumor size (IDC 2.5 ± 1.98 cm, ILC 3.0 ± 1.8 cm, MDLC 3.2 ± 2.4 cm), advanced T stage (T3 + T4) at diagnosis (IDC 14.7 %, ILC 21.4 %, MDLC 25.6 %), N stage (N0 was dominant in IDC and ILC; N3 was dominant in MDLC), tumor-node-metastasis (TNM) stage (stage II was dominant in IDC and ILC; stage III was dominant in MDLC), HER2/neu expression (IDC 23.8 %, ILC 11.8 %, MDLC 21.4 %), and frequency of bone metastasis (IDC 14.3 %, ILC 17.9 %, MDLC 25.5 %). CONCLUSIONS: MDLC-type tumors have different histopathological characteristics and are often diagnosed at advanced stage. However, their survival outcomes do not vary significantly from ILC and IDC.

The role of IgG4 (+) plasma cells in the association of Hashimoto's thyroiditis with papillary carcinoma.

Hashimoto's thyroiditis (HT) is considered to be a risk factor for the formation of papillary carcinoma. The association of IgG4-related sclerosing disease with tumor is reported to be as sporadic cases in many organs. In this study, it was intended to re-classify the HT diagnosed cases on the basis of the existence of IgG4 (+) plasma cells; to investigate the clinicopathologic and histopathologic features of the both groups; and in addition, to evaluate the papillary carcinoma prevalence in IgG4 (+) and IgG4 (-) HT cases as well as the prognostic parameters between these groups. Totally 59 cases between the years 2008-2013, 29 of which contain Hashimoto thyroiditis diagnosis in total thyroidectomy materials, and 30 of which contain the diagnosis of HT+papillary carcinoma, were included in the study. The materials were immunohistochemically applied IgG and IgG4; and the cases were classified in two groups as IgG4-positive HT and IgG4-negative HT containing cases, on the basis of IgG4/IgG rate. All histopathologic and clinicopathologic parameters between these two groups, as well as their association with papillary carcinoma were investigated. Thirty eight (64.4%) of total 59 cases were NonIgG4 thyroiditis, and 21 (35.5%) were IgG4 thyroiditis. Tumors were detected in 14 (36.8%) of the NonIgG4 thyroiditis cases, and in 16 (76.1%) of the IgG4 thyroiditis cases. The association of IgG4 thyroiditis with tumor is statistically significant (p < 0.004). Multifocality was found to be at a higher rate in IgG4 thyroiditis cases. Perithyroidal extension was detected in six of the cases with tumor, and five of the six cases were IgG4 thyroiditis cases. The association of IgG4 (+) HT cases with increased papillary carcinoma prevalence is suggestive of that IgG4 (+) plasma cells can play a role in carcinogenesis in papillary carcinomas developed in HTs, without a chronic sclerosing ground. In addition, although the number of cases is limited, the high-association of IgG4 (+) plasma cells with adverse prognostic parameters such as multifocality and extrathyroidal extension is attention-grabbing. To render these possibilities evaluable, studies to be carried out with larger case series are needed.

Pseudo-angiomatous stromal hyperplasia of the breast detecting in mammography: case report and review of the literature.

Pseudoangiomatous stromal hyperplasia (PASH) of the breast is a benign lesion that can present as a palpable nodule or as an incidental finding in breast biopsies. The development of PASH is subject to hormonal influence and is most commonly seen in premenopausal woman. Imaging findings are indistinguishable from those of the more common type of fibroadenoma, and they are categorized as BIRADS type 3 lesions (probably benign lesions). Their benign condition and behavior compared with other similar cases, allows the recommendation that surgical excision be avoided, and the patients monitored with periodic follow-up. Here we report a case of PASH presenting in a 41-years-old woman who had breast mass which was sent for intra-operative frozen-section procedure by surgery to our pathology laboratory.