Case Report: presentation of pleomorphic liposarcoma arising in a borderline phyllodes tumor.

INTRODUCTION: The stromal component of Phyllodes tumors represents the neoplastic portion of the lesion. A variety of associated malignancies can arise from PTs, with its dual population of cells. PRESENTATION OF CASE: We share a very rare case of "borderline"breast phillodes tumour with a 75% liposarcoma component. A 48-year-old woman presented at the surgical clinic with a mass in the left breast. On mammograms, the lesion was dense with radiolucent areas inside which were thought to be compatible with fat. The mass was assumed to be breast imaging-reporting and data system (BIRADS) 3 on sonography as it was well contoured. The needle biopsy was reported to be consistent with a fibroadenomatous lesion. The lesion was completely excised. On microscopic examination, the lesion has benign mammary duct epithelium lining the slit-like spaces. The stroma composed of fibrous and adipous tissue. The fibrous part was cellular, and several cells appeared bizarre. Adipous tissue replaced most of the stroma and was diagnosed as pleomorphic liposarcoma. DISCUSSION: According to the 3 tiered grading criteria of PTs, our case normally suits in borderline category, without liposarcoma component. Heterologous sarcomatous elements usually accompany high grade PTs. Rare cases of benign and borderline PTs with sarcoma component have been reported. CONCLUSION: The presence of a malignant heterologous component places the tumour into the malignant category regardless of other histological features.

Membranous lipodystrophy: case report and review of the literature.

Membranous lipodystrophy is a distinct type of membranocystic fat necrosis. It is associated with many local and systemic diseases, including vascular disorders. The histopathological changes which characterize this phenomenon are variably sized cysts in the fat lobules of the subcutaneous tissue, which are surrounded by eosinophilic membranes projecting into the cystic space. We report a case of secondary membranous lipodystrophy associated with both hypertension and venous insufficiency.

Membranous lipodystrophy: case report and review of the literature

Membranous lipodystrophy is a distinct type of membranocystic fat necrosis. It is associated with many local and systemic diseases, including vascular disorders. The histopathological changes which characterize this phenomenon are variably sized cysts in the fat lobules of the subcutaneous tissue, which are surrounded by eosinophilic membranes projecting into the cystic space. We report a case of secondary membranous lipodystrophy associated with both hypertension and venous insufficiency.

Rho-kinase levels in testicular ischemia-reperfusion injury and effects of its inhibitor, Y-27632, on oxidative stress, spermatogenesis, and apoptosis.

OBJECTIVE: To investigate testicular Rho-kinase levels and the effects of its inhibitor, Y-27632, on oxidative stress, spermatogenesis, and apoptosis in testicular ischemia-reperfusion rat model. METHODS: The study included 29 adult Wistar-Albino male rats weighing 150-200 g. The rats were divided into 3 groups. Group 1 underwent sham operation (n = 10). In group 2, left testicular torsion-detorsion was performed (n = 9). In group 3, Rho-kinase inhibitor Y-27632 (5 mg/kg) was injected intraperitoneally 30 minutes before detorsion (n = 10). Two months later, bilateral orchiectomy was performed in all the groups. Rho-kinase levels by Western blotting, apoptosis with terminal deoxynucleotidyl transferase dUTP nick end labeling method, testicular damage and spermatogenesis with modified Johnsen score, testicular total antioxidative status, and total oxidative status were measured. RESULTS: In the torsion-detorsion (T/D) group, Rho-kinase level increased significantly, compared with the sham group (P = .025). In the Y-27632 treatment group, Johnsen scores were significantly higher, and apoptosis indexes were significantly lower, compared with the T/D group (P = .001). Significantly higher total antioxidative status levels and lower total oxidative status levels were observed in the Y-27632 treatment group, compared with the T/D group (P = .001 and P = .002, respectively). CONCLUSION: Testicular ischemia-reperfusion significantly increased Rho-kinase levels in rats, and administration of Rho-kinase inhibitor, Y-27632, before detorsion might prevent ischemia-reperfusion injury.

Nasopharyngeal tuberculosis presenting as massive cervical lymphadenopathy and hearing loss.

Lymphadenitis is the most common form of tuberculosis in the head and neck region, but it can be seen in the other areas of the head and neck. Nasopharyngeal tuberculosis is a rare condition without pulmonary and systemic involvement. The majority of patients present with neck mass. A 17-year-old female patient admitted to our outpatient clinic with the complaints of swelling on both sides of the neck and hearing loss. The endoscopic examination revealed a nasopharyngeal mass, and biopsies were taken from the mass. The result of pathologic examination was reported as caseating granulomatous inflammation compatible with tuberculosis. In this report, a nasopharyngeal tuberculosis case associated with massive cervical lymphadenopathy was reported, and etiopathogenesis and treatment were also discussed.

Schneiderian carcinoma developing in an inverted papilloma of the palatine tonsil: an unusual case.

Schneiderian papillomas are among the most common benign tumors of the nose and paranasal sinuses. These lesions frequently originate in the lateral nasal wall, and they have a tendency toward recurrence and malignant transformation. Carcinomas arise in association with schneiderian papillomas in approximately 10% of cases. Outside the sinonasal tract, the ectopic occurrence of a schneiderian papilloma is extremely rare. We describe the case of a 52-year-old man with an invasive schneiderian carcinoma that arose within an inverted papilloma in the palatine tonsil. To the best of our knowledge, no such case has been previously reported in the English-language literature.

Mycobacterium tuberculosis infection within parotid gland Warthin tumor.

Tuberculosis of the parotid gland is extremely unusual. Tuberculosis comprises 2.5% to 10% of parotid gland lesions. Two clinical forms of parotid gland tuberculosis infection exist. One is a diffuse parenchymatous disease (either primary or secondary to nodal disease), resembling common infection. The second is a chronic, slow-growing, painless, and firm parotid mass mimicking a neoplasm. Most of these patients were diagnosed after parotid gland surgery and histopathologic evaluation. Warthin tumor is a well-known benign neoplasm of the salivary glands. It is the second most common tumor of the parotid gland. Mycobacterium tuberculosis within Warthin tumor is also unusual. Five cases with parotid gland tuberculosis within Warthin tumor were reported in the literature. In this report, we present a new patient with parotid gland tuberculosis within the Warthin tumor. This type parotid gland pathology is an extremely rare entity, and to the best of our knowledge, this is the second documented case using polymerase chain reaction. We also discussed the possible mechanisms of development of infection within Warthin tumor.

Unilateral parotid gland involvement with synchronous multiple Basal cell adenomas.

Basal cell adenoma (BCA) is a rare benign epithelial tumor of the salivary gland. BCA is seen most frequently in the parotid gland and less commonly in the submandibular gland and minor glands of the upper lips, oral cavity, and hard palate. Salivary gland tumors are observed as single tumors in one salivary gland. Double or multiple tumors of the salivary gland tumors are unusual and metachronous or bilateral salivary gland tumors are more observed than synchronous or unilateral tumors. The most commonly seen multiple tumor unilaterally or bilaterally is the Warthin's tumor. A 65-year-old woman with a painful, slowly enlarging mass in front of the left ear, which was present for 6 months, was evaluated. Physical examination revealed two solid and well-delineated masses in the preauricular region, which were 1.5 x 1 cm in diameter and in the tail of the parotid gland, which is 2.5 x 2 cm in diameter. Excision of the superficial lobe of the parotid gland was performed. The macroscopic examination of the specimen showed the two discrete nodular masses. Histologic examination of the two nodular solid lesions was reported as BCA. Multiple synchronous nonmembranous-type BCAs of the unilateral parotid gland is a rare entity. More extensive excision of the parotid gland tumor, careful macroscopic perioperative examination of the surgical specimen, and histologic evaluation of all surgical specimens might be necessary for reducing revision operations and surgical complications.

Beta-catenin and CD44 expression in keratoacanthoma and squamous cell carcinoma of the skin.

CD44 and beta-catenin are adhesion molecules expressed on a wide variety of cells. Failure of this expression is believed to lead to disruption of cell-cell adhesion and to neoplasia. The aim of this study was to investigate the staining intensity of CD44 and beta-catenin in keratoacanthomas and squamous cell carcinomas of the skin. The proliferation index, PCNA staining, was also evaluated in these cases. The abnormal expression of beta-catenin significantly predominated in squamous cell carcinomas (n = 20, 76.9%) compared with keratoacanthomas (P = 0.002, chi2 = 7.8). Most keratoacanthomas (n = 11, 61.1%) more frequently showed strong staining intensity with CD44 compared with squamous cell carcinoma (P= 0.001, chi2 = 13.7). The proliferation index was higher in squamous cell carcinoma (P = 0.000, chi2 = 12.8). These findings suggest that CD44 and beta-catenin expression may have an important role in the development of malignancy and in the determination of biological features of keratoacanthoma and squamous cell carcinoma of the skin.

The changes in expression of ICAM-3, Ki-67, PCNA, and CD31 in psoriatic lesions before and after methotrexate treatment.

Although the effectiveness of methotrexate (MTX) in the treatment of psoriasis is very well established, the mechanism of action is poorly understood. It was suggested that the therapeutic effect of MTX in psoriasis might be mediated by inhibition of adhesion molecule expression. The aim of our study was to investigate the different effects of MTX treatment on cell proliferation, inflammatory infiltrate, adhesion molecules, and angiogenesis in psoriasis, and to clarify the mechanism by which MTX exerts its therapeutic effects. Clinical response, the morpho-phenotypic changes, epidermal thickness, and mitosis count were analyzed and the expression of CD31 and ICAM-3, proliferative markers such as Ki-67, PCNA, were evaluated by immunohistochemical techniques in lesional psoriatic epidermis, before and after the treatment with MTX in ten patients. In posttreatment biopsies a decrease in the degree of epidermal hyperplasia and a significant reduction in the severity of the inflammatory infiltrate (P<0.05) were observed. In addition, CD31 and ICAM-3 expression was significantly decreased on dermal cellular infiltrate, (respectively; P<0.05, P<0.01). Ki67 and PCNA expression were suppressed concurrently in about 90% of cases (P<0.01). We suggest that MTX may have an inhibitory effect on an initial integral component of the pathways that lead to psoriasis. Immunopharmacologic intervention in adhesion event has the potential to improve psoriasis. Inhibition of revascularization may be another mechanism of action of MTX.

Peripheral giant cell granuloma of the mandibular condyle presenting as a preauricular mass.

Preauricular mass is a common symptom for patients presenting to the otorhinolaryngologist with parotid disease. Some rare extraparotid lesions, originating from the temporomandibular joint and the mandible itself, also share the same localization and therefore are to be taken into consideration for the differential diagnosis with parotid lesions. Giant cell granuloma (GCG) was first described by Jaffe in 1953. Peripheral GCG (PGCG) is an exophytic soft tissue lesion originating from the periodontal ligament and periosteum. It is located only within the oral cavity. Central GCG (CGCG) is an uncommon benign fibro-osseous lesion generally presenting as an expansible mass with cortical bone defect. It is generally located in the mandible. The brown tumor of hyperparathyroidism and giant cell tumor must be ruled out because of the microscopic similarities of these lesions. The first case of PGCG of the mandible condyle is presented, and attention is drawn to mandibular diseases for the differential diagnosis of the preauricular mass.

The effect of N-acetylcysteine (NAC) on liver and renal tissue inducible nitric oxide synthase (iNOS) and tissue lipid peroxidation in obstructive jaundice stimulated by lipopolysaccharide (LPS).

Morbidity and mortality rates are very high in obstructive jaundice when it is associated with sepsis and multiple organ failure. Nitric oxide (NO) formation and increased expression of inducible nitric oxide synthase (iNOS) also take place in obstructive jaundice (OJ). N-Acetylcysteine (NAC) has a beneficial effect by demonstrating anti-inflammatory activity such as inhibits cytokine expression/release, inhibiting the adhesion molecule expression and inhibiting nuclear factor kappa B (NFkappaB). The aim of this study was to investigate the effects of NAC on liver and renal tissue iNOS, and liver tissue lipid peroxidation in lipopolysaccharide (LPS) induced obstructive jaundice. We randomized 48 rats into six groups. Group A: Sham group; group B: OJ group; group C: OJ+NAC; group D: OJ+LPS (Escherichia coli LPS serotype L-2630, 100mg, Sigma) group E: OJ+NAC+LPS; group F: OJ+LPS+NAC. NAC was started subcutaneously 100mg/kg. LPS was injected intraperitoneally and then at the tenth day we sacrificed the rats. Liver malondialdehyde (MDA) increased and liver ATPase decreased in groups B-D when compared to group A. After the administration of NAC (groups C-E), liver MDA levels decreased, tissue ATPase levels increased as compared to other groups. The liver and renal tissue iNOS expression was increased in groups B, D, and F. After the administration of NAC (groups C-E) the liver and renal tissue iNOS expression were decreased. Our results indicated that NAC prevented the deleterious effects of LPS in OJ by reducing iNOS expression via lipid peroxidation in liver and renal tissue; if it was administrated before LPS. But NAC failed to prevent the iNOS expression and lipid peroxidation if there was established endotoxemia in OJ.

Pediatric lobular capillary hemangioma of the nasal cavity.

Lobular capillary hemangioma (LCH), also called pyogenic granuloma, is a benign vascular tumor that is pedunculated on the skin and the mucous membranes of the oral cavity. This disease occurs in all ages, but more often in the 3rd decade, and is seen in females more than males. LCH commonly appears in early childhood and affects males more than females in the pediatric age group. The gingiva, lips, tongue and buccal mucosa are the most common sites of mucosal LCH, but the nasal cavity is rare. Micro-trauma and hormonal factors are the most common etiologic factors. Epistaxis and nasal obstruction are the most marked symptoms. We describe the case of a 6-year-old girl with intra-nasal lobular capillary hemangioma presented with epistaxis and nasal obstruction. This should be considered in the differential diagnosis of childhood endonasal masses with bleeding. Total excision using endoscopic technique is the treatment of choice.

The protective effects of acetylsalicylic acid on free radical production in cisplatin induced nephrotoxicity: an experimental rat model.

Cisplatin-induced nephrotoxicity is closely associated with an increase in lipid peroxidation. In several previous reports it was claimed that acetylsalicylic acid (ASA) shows its therapeutic potential as a free radical scavenger. The aim of the study was to investigate effects of ASA on cisplatin induced nephrotoxicity in an experimental rat model. Control animals (n:7) were administered 1 mL saline solution intraperitoneal (i.p.). Cisplatin group (n:7) was treated with a single dose of cisplatin i.p. (6 mg/kg), ASA group (n:7) was treated with i.p. (2.5 mg/kg) per day during the study, cisplatin plus ASA group (n:7) was administered single dose cisplatin i.p. (6 mg/kg) plus ASA (2.5 mg/kg) during 5 days. At the end of the study, Catalase (CAT), Glutathione Peroxidase (GSH-Px), Superoxide Dismutase (SOD), Nitric Oxide Synthase (NOS) enzymes activities and Malondialdehyde (MDA), Antioxidant Potential (AOP) levels were measured in both erythrocytes and renal tissues. Urea and creatinine levels and renal tissue necrosis in cisplatin plus ASA group were significantly lower than cisplatin group (p = 0.000, p = 0.014, p = 0.015). SODr activities and MDAr levels of cisplatin plus ASA group were also significantly lower than cisplatin group (p = 0.000, p = 0.029). These results show that cisplatin and ASA combination decreases the levels of urea and creatinine, reduces necrosis and improves antioxidant enzyme activities, MDA and AOP in rat kidney.

Bullous erythema ab igne.

Erythema ab igne is a localized, cutaneous condition, consisting of reticulate hyperpigmentation, dusky erythema, epidermal atrophy, and telangiectasia, all the result of repeated exposures to heat. We describe a patient with a bullous form of erythema ab igne: bullae and crusts within a localized area of reticular, brown, macular pigmentation on the lateral side of the left leg, an area that had repeated close exposure to an electrical heater over the previous 3 months. We believe that bullous erythema ab igne, something rarely reported in the literature, should be considered a well-defined variant of erythema ab igne; it may be more common than the literature suggests.

Expression of inducible nitric oxide synthase in antrochoanal polyps.

OBJECTIVE: Antrochoanal polyp (ACP) is a polypoid lesion originating from the maxillary sinus, emerging from the ostium and extending to the choana. Although the etiologic causes of ACP are not known completely, it presents a fairly uniform clinical appearance. Nitric oxide (NO) has an important role in non-specific immunoreactions and inflammation in various tissues and has a main regulatory role in airway function and seems to involve in pathomechanism of several respiratory system diseases. NO is synthesized by the effect of three isoforms of nitric oxide synthase i.e. inducible NOS (iNOS). Some studies revealed that ACP has some different characteristics from the ordinary nasal polyps. In the present study, in order to compare ACP with allergic and non-allergic nasal polyps (NANP), we detected and localized the iNOS expression and also evaluate some histological parameters. METHODS: Twenty-six cases were chosen from the files and four controls were used. The cases were separated as follows: normal inferior turbinate mucosa as control (n=4) ACPs (n=8), allergic nasal polyps (ANP) (n=9), and NANP (n=9). Five-micrometer thick sections were prepared from the paraffin sections of polyps and normal nasal mucosa to quantify the iNOS expression. iNOS protein was observed in the cytoplasm of epithelial and stromal inflammatory cells. iNOS protein expression in the groups was assessed according to the intensity of staining and histomorphological parameters, oedema, lymphocytic and eosinophilic cell infiltration were detected semi quantitatively. RESULTS: iNOS expressions, either stromal or epithelial, were not different from each other among the four groups. Although it is not statistically significant, we noted that ANP and ACP frequently showed moderate and severe iNOS protein expression in epithelial and stromal parts when compared with NANPs and controls. Also, iNOS expression was significantly higher in the stroma of the ANPs than NANPs (P=0.012). CONCLUSIONS: ACPs and ANPs have frequently showed moderate and significant epithelial and stromal iNOS expression. Further studies are needed in large groups to elucidate differences between ACP and the other nasal polyps.

Effect of fexofenadine, a mast cell blocker, in infertile men with significantly increased testicular mast cells.

AIM: To investigate the role of fexofenadine, a mast cell blocker, on semen quality in the treatment of infertile men. METHODS: The study included 16 Turkish idiopathic infertile men with azoospermia or oligozoospermia who underwent testicular biopsy to examine mast cells containing tryptase. In all patients, a complete medical history, clinical examination, semen analysis and serum hormone assay were carried out. The biopsy specimens were immunohistochemically stained with antihuman tryptase for mast cells. The number of total mast cells per seminiferous tubule was calculated and recorded as mast cell index. The patients were divided into two groups according to their mast cell index: the higher (> or =1, n=9) and the lower (<1, n=7) index groups. Fexofenadine was administered orally at a dose of 180 mg/day for 4 to 9 months. Pre- and post-treatment semen parameters, including total motile sperm counts (TMC) were recorded and compared. Spontaneous pregnancies after the treatment were registered. RESULTS: There was no statistically significant difference in TMC between the pre-treatment and post-treatment values in patients with higher and lower mast cell index (P> or =0.05). In both groups, nobody had a significant response to the treatment and there was no spontaneous pregnancy after the treatment. CONCLUSION: Although testicular dysfunction is closely associated with increased number of testicular mast cells, fexofenadine, a mast cell blocker, appears not having any benefit in the treatment of Turkish infertile men with a significant increase in testicular mast cells.