Follow-up results in tuberculous cervical lymphadenitis.

OBJECTIVE: To investigate the efficacy of medical antituberculous treatment in patients with tuberculous cervical lymphadenitis (TCL). METHODS: In the period 1996-2002, 73 TCL patients were reviewed and the results of clinical and laboratory testing were documented. The efficacy of a four-drug chemotherapy regimen was investigated. RESULTS: Purified protein derivatives (PPD) skin test results were positive in 58 (79 per cent) patients. Chest X-rays revealed changes consistent with tuberculosis in nine (12.3 per cent) patients. The mean duration of medical treatment was 10.04 months. In follow-up evaluation, 14 (20 per cent) patients were considered suspicious for resistant TCL and total excision of all nodes was performed. Histopathology confirmed TB in only 10 of these cases. CONCLUSION: The high incidence of residual disease in our study indicates that medical treatment (at least nine months of four combined antituberculous drugs) did not seem to be effective. If lymphadenopathy persists, total surgical excision of lymph nodes should be the treatment of choice.

Does the analysis based on a histological and immunohistochemical grading system in the model of BDL kidney allow the quantification of the degree of injury?

The aim of this study is to evaluate histopathological findings induced by Nomega-nitro-L-arginine methyl ester (L-NAME) and molsidomine (MOL) on the kidney of bile duct ligated rats. Forty Sprague-Dawley rats, each weighing 125 to 140 g, were included in the study. Extent of histological glomerular injury scores (GIS), arterial injury scores (AIS), and tubulointerstitial injury scores (TIS) in each animal were graded. Alpha-smooth muscle actin (alpha-SMA), tenascin, lectin (Ulex europaeus agglutinin-1), and vimentin were used to determine extent of the injury. The cholestasis was evidenced by a significant increase in the levels of serum total bilirubin in BDL rats (p < 0.01). Malondialdeyde MDA levels increased by the bile duct ligation (BDL) to 12.10 +/- 0.45. This value was significantly higher than the other groups (p < 0.01). Changes in the BDL kidney were marked at 7 days after surgery. GIS were observed to have the highest score, especially at juxtamedullary region in BDL/L-NAME rats, and AIS were also the highest score in this region. These observations were lower in BDL/MOL rats. There is a correlation between GIS and AIS scores (r = .2, p < .01). TIS revealed that BDL/L-NAME rats were significantly more damage than rats in the other groups (p<.001). MOL-treated rats showed considerably fewer lesions in the tubules and interstitium (p < .001). The tubular injuries observed in BDL and BDL/L-NAME rats were significantly attenuated by MOL treatment. Lectin was more and extensively stained in tubular epithelia of the BDL/L-NAME group than in the other (p <.05). Expression of tenascin in tubular epithelia was significantly higher in BDL and BDL/L-NAME as compared with controls (p < .01). Fibrous tissue was only observed in the BDL and BDL/L-NAME group. These areas were weakly stained with vimentin. alpha-SMA staining was more reduced in the L-NAME-treated arterioles than in BDL/MOL (p < .05). In conclusion, the analysis of cell injury based on a histological grading system in the model of BDL kidney allows the quantification of the degree of injury.

Prognostic value of PCNA and mutant p53 expression in laryngeal squamous cell carcinoma.

The objective of this study was to investigate the prognostic significance of p53, and proliferative cell nuclear antigen (PCNA) in laryngeal squamous cell carcinoma (LSCC). Sixty pathologic specimens from the patients with LSCC were examined for the expression of the p53 and PCNA, with complete follow-up data. Sixty-three percent of the cases displayed nuclear p53 overexpression. There was a correlation between p53 overexpression and histological grades (p = 0.03), and localization site (p = 0.05). Median of PCNA index was 42.2 (range 5.9 to 85.2). There was no difference between the p53 overexpression group and the normal group in proliferative activity determined by PCNA (p = 0.73). In univariate analyses, localization site, grade, stage, invasion pattern, lymph node status, were significant factors in estimating disease free survival (DFS). Grade was the most important factor affecting recurrence (p = 0.002). In multivariate analyses, grade was the only significant predictor for DFS (p = 0.001). Grade (p = 0.001) and invasion pattern (p = 0.03) were found to be significant predictors of overall survival. In conclusion, the histological grade was the most reliable important prognostic factor. Further studies are necessary to facilitate understanding of the mechanisms of laryngeal carcinogenesis.

Non-Hodgkin's lymphoma in southeast Turkey: clinicopathologic features of 490 cases.

We have carried out a retrospective analysis of 490 non-Hodgkin's lymphomas (NHLs), followed at our clinic, with the purpose of evaluating the clinicopathologic features of these patients. The patients were assessed with regard to their characteristics including age, gender, histologic distribution, stage, extranodal involvement, presenting symptoms, and biopsied site. Of the patients 314 (64%) were male and 176 (36%) were female. The overall median age was 43 years (range: 14-90). The patients were classified according to the Working Formulation (WF) system: 71 (14.4%) were low grade, 342 (69.8%) were intermediate grade, 43 (8.7%) were high grade, and 34 (6.7%) had other lymphomas. Intermediate-grade non-Hodgkin's lymphomas formed the largest group, of whom 320 patients' paraffin blocks were available for Revised European and American lymphoma (REAL) classification: 78% were B-cell lymphomas, whereas 16% were T/NK lymphomas. Six percent of cases were unclassified lymphomas. Diffuse large B-cell lymphoma (DLBCL) was the most commonly observed histopathologic type in 132 (41%) patients. Extranodal involvement was found in 218 (44.5%) patients. The most commonly affected extranodal sites were small bowel, stomach, and tonsil in 72 (33%), 63 (29%), and 19 (8.7%) patients, respectively. According to the Ann Arbor staging system, the vast majority of patients (89.4%) were advanced stage. In conclusion,The characteristics of NHLs in our region show some differences from the other sites of Turkey and the world.

Fibrovascular polyp of the esophagus: diagnostic dilemma.

A 51-year-old female patient was admitted to our department. She had symptoms of dysphagia, regurgitation of a fleshy mass into the mouth, and attacks of dyspnea. Every effort was made for diagnosis. At cervical exploration, upper esophageal polyp was discovered incidentally, and removed. We present this case because of rarity and emphasize the clinical presentation. The physician should be aware of the presence of this rare esophageal tumor.

Spinal cord compression by primary amyloidoma of the spine.

In this report, we presented a case of solitary spine amyloidoma, its clinical and radiological findings and management, and a review of the literature on vertebral amyloidosis.

Value of tenascin-C content and association with clinicopathological parameters in uterine cervical lesions.

To determine whether the content of the matrix protein tenascin-C (Tn-C) is of diagnostic or prognostic value in cervical lesions, we evaluated increases in Tn-C immunoreactivity in 80 formalin-fixed, paraffin-embedded biopsies and surgical specimens of the uterine cervix. Tn-C content in the basement membrane zone and in the stroma was graded and compared to some prognostic parameters. In the normal cervix, Tn-C formed a thin continuous band. In cervicitis, Tn-C bands thickened in the basement membrane zone and the adjacent stroma in the form of thin filaments. In 30 squamous intraepithelial lesions (SILs) of various grades, Tn-C bands were either slightly (1+) or moderately (2+) thickened in the basement membrane zone, while slight stromal Tn-C immunoreactivity in the form of thin bands was observed in 12 cases, regardless of grade and inflammatory stromal reaction. In invasive carcinoma, Tn-C content was markedly increased in the stroma and around the invasive nests of tumors. The intensity of Tn-C immunoreactivity was significantly higher in grade I tumors than in others (p < 0.04). The intensity of increase in Tn-C immunoreactivity was 10.5-fold (95% CI 3.39-32.5) higher in invasive cervical carcinomas than in others (cervicitis, low-grade SIL and high-grade SIL) (p = 0.0001). A significant correlation was found between weak Tn-C immunoreactivity and lymphatic space invasion (p = 0.001), lymph node metastasis (p = 0.01), desmoplastic stromal component (p = 0.0001) and stromal inflammation (p = 0.002). In conclusion, increase in Tn-C immunoreactivity may be of value in the assessment of noninvasive and invasive cervical lesions and the appearance of Tn-C may be an indicator of adequate biologic defense in cervical cancer patients.