Rare diagnosis of an Epstein-Barr virus-positive extracavitary/solid variant of primary effusion lymphoma by duodenal endoscopic biopsy in a human immunodeficiency virus-seronegative and immunocompetent patient: A case report.

Primary effusion lymphoma and its tissue-based subtype extracavitary/solid variant was first described in human immunodeficiency virus (HIV)-seropositive patients. We report the case of a 50-year-old HIV-seronegative male patient who presented with icterus and cholestasis. Computed tomography revealed a 80 × 56 mm abdominal mass. Fine-needle aspiration biopsy was performed from the celiac lymph nodes and pancreatic head, under endoscopic ultrasonography guidance. A duodenal endoscopic biopsy was taken from the infiltration area, and a core biopsy was performed for the portal hilar mass. All biopsies showed similar cytohistopathological features. LCA-positive lymphoid neoplasia had a plasmacytoid/anaplastic morphology and null cell phenotype. HHV-8 and Epstein-Barr virus-encoded small RNAs (EBER) were diffuse positive. The patient, who did not have an effusion, was diagnosed with an extracavitary/solid variant of primary effusion lymphoma. Virus-associated lymphoproliferative disorders should be considered in the differential diagnosis of patients without a history of immunosuppression or HIV infection.

Therapist and treatment credibility in treatment outcomes: A systematic review and meta-analysis of clients' perceptions in individual and face-to-face psychotherapies.

OBJECTIVE: No systematic review was identified investigating the influence of perceived therapist credibility on treatment outcomes. Extant treatment credibility reviews have focused on early perceptions without considering influence of various therapy phases. This study aimed to examine the relationship between perceived treatment and therapist credibility and treatment outcomes, while considering the timing of the credibility assessment as a potential moderator. METHOD: Articles published in English peer-reviewed journals containing at least one quantitative measure of credibility and treatment outcome regarding face-to-face therapist-delivered interventions were eligible. PsycINFO, MEDLINE and Embase online databases were last searched on April 5th, 2023, and the Effective Public Health Practice Project tool was used to assess the study quality. Correlations between treatment credibility and outcomes, and therapist credibility were calculated separately. RESULTS: Analysis of 27 studies revealed a positive association between perceived treatment credibility and treatment outcome (r = 0.15,95%CI = 0.09,0.21,p < 0.001,n = 2061). Nine studies showed a strong association between perceived therapist credibility and outcome (r = 0.35,95%CI = 0.18,0.51;p < .001,n = 1161). No significant moderator found in both meta-analyses. CONCLUSION: Findings suggest that clients' perceptions of higher credibility - whether concerning the treatment or the therapist - are associated with better therapeutic outcomes. Constraints in inclusion criteria and the small sample size in eligible studies were notable limitations.

A case report of Tangier disease presents with acute sensorimotor polyneuropathy and its treatment approach.

Polyneuropathy is a frequently encountered clinical presentation where peripheral nerves are affected due to the same cause and physiopathological processes. We report a case of acute sensorimotor polyneuropathy in a patient with Tangier disease (TD) who was treated with miglustat which is a glycosphingolipid synthesis inhibitor. TD is a very rare genetic disorder caused by mutations in the ATP-binding cassette transporter A1 (ABCA1) gene which encodes the cholesterol efflux regulatory protein. It leads to accumulation of cholesterol esters within various tissues and affects lipid metabolism by deficiency of high-density lipoprotein (HDL) in the blood. Due to the accumulation of cholesterol esters in Schwann cells, it could provoke polyneuropathy in TD. Our case presented to our clinic with quadriparesis and after treated with miglustat therapy his weakness regressed.

The role of IgG4-positive plasma cell population in classic Hodgkin lymphoma.

The effect of IgG4, which constitutes the least of the IgG subclasses, on the pathogenesis and prognosis of lymphoma or solid tumors is one of the research topics of interest in recent years. The role of IgG4, which has been reported to suppress antitumor immunity, in classic Hodgkin's lymphoma (cHL), which is recognized by its pathognomonic microenvironment, is not yet clearly known. The aim of this study was to determine IgG4-positive plasma cell density in the cHL microenvironment and to compare it with histopathological and clinical parameters. In addition, the role of the increase in IgG4-positive cells in the development of relapse after treatment was also investigated. A retrospective cross-sectional study. Ninety-four patients with the initial diagnosis of cHL who had no comorbidity or no treatment history and forty-one reactive lymph nodes with follicular hyperplasia findings were included in the study. Three hot-spot areas were identified with reference to the IgG4 sections. Mean IgG4-positive plasmacyte counts and IgG4/IgG ratios were determined and compared with histopathological characteristics. The mean IgG4 + plasma cell count was 33.57 in cHL cases and 47.04 in the control group (p = 0.233). IgG4/IgG ratio was significantly higher in cHL compared with the control group (0.27 vs. 0.21, p = 0.021). The IgG4/IgG ratio was found to be higher in younger patients with classic Hodgkin lymphoma, with a low correlation (p = 0.028, r = - 0.226). There was no relationship with gender, lymph node location, histological subtype, EBV positivity and bone marrow infiltration. It was observed that IgG4/IgG ratio was higher in early-stage patients (p = 0.022). No significant IgG4 + cell increase was detected in the initial diagnosis and relapse slides of six patients who developed relapse after standard treatment, resulting in a cure. Novel therapeutic modalities targeting microenvironmental components have been reported to show dramatic effects, particularly in relapsed or refractory patients. Detailed characterization of the cHL inflammatory milieu will be useful for the identification of alternative targets. IgG4 subclass antibodies, which have been described to have anti-inflammatory effects, may have prognostic significance in a proportion of cHL patients.

Core Needle Biopsy in the Diagnosis of Thyroid Nodules.

BACKGROUND: Core needle biopsy (CNB) is a relatively new technique for the diagnosis of thyroid nodules, and there are currently no large clinical series available. CNB results from 3000 cases are presented in this article. METHODS: A spring-loaded 20-gauge needle was used for CNB under local anesthesia and ultrasonography guidance for 3000 patients with nodular goiter (584 males, 2416 females, mean age: 48.5). One physician performed all biopsy procedures without conducting on-site pathological examinations. RESULTS: There were non-diagnostic 22 (.7%), benign 2620 (87.4%), atypia of undetermined significance and/or, follicular lesion of undetermined significance 90 (3%), follicular neoplasms and/or suspicious for follicular neoplasm 53 (1.7%), suspicious for malignancy 160 (5.4%), and malignant 55 (1.8%) cases. The CNB procedure was repeated in 19 non-diagnostic cases, and 17 of these patients were benign and two had malignancy. Thyroidectomy was performed on patients who had malign CNB results. All final pathology reports, except for one, were malignant for the patients who had malignant CNB results. The specificity and the sensitivity of CNB were found to be 99.9% and 100%, respectively. There were no serious complications. CONCLUSION: In thyroid nodules, core needle biopsy is a highly sensitive, specific, and reliable method that could be performed by a single physician. It does not require on-site pathological analysis and has a low incidence of complications and non-diagnostic rates.

Social Contact, Academic Satisfaction, COVID-19 Knowledge, and Subjective Well-being Among Students at Turkish Universities: a Nine-University Sample.

Adverse effects of COVID-19 are seen not only on the physical health of infected individuals but also on their subjective well-being. Sudden changes in social lives, lockdowns, and shifts towards online education have had a negative impact on many people, especially university students. As part of an international study, the current study focused on the well-being of students at Turkish universities in relation to social contact, academic satisfaction, and COVID-19 knowledge. A total of 7363 students from nine universities (86.6% from state universities, 71.04% female, and 73.52% at bachelor's level) participated in an online survey. Results revealed that females had lower levels of subjective well-being and academic satisfaction. According to a mediation model in the study, the relationship between social contact and well-being was mediated by academic satisfaction and COVID-19 knowledge. Our findings can guide future researchers, mental health professionals, universities, and policymakers to understand and improve subjective well-being of university students.

The histopathologic checkpoints for thyroid core needle biopsy compared with resection sections.

INTRODUCTION: The nuclear features that are thought to be classic indicators of thyroid nodules are not fully observed in core needle biopsies (CNB). The aim of this study was to evaluate the histopathological differences between CNB samples and resection sections. MATERIAL AND METHODS: The haematoxylin and eosin-stained CNB and resection sections of thyroid nodules were retrospectively re-evaluated in terms of nuclear and architectural parameters. The evaluations were conducted by 2 pathologists. Statistical analysis was applied in 80 selected cases diagnosed as benign (n = 37) and papillary carcinoma/suspicious for papillary carcinoma (n = 43). RESULTS: The nuclear findings in the CNB were more subtle than in the resection sections. The nuclei were smaller (measurements of the nuclear areas, major axes, and minor axes in CNB and resection sections were 52.62 µm2, 9.89 µm, 6.75 µm, 129.18 µm2, 14.53 µm, and 10.79 µm, respectively). Hypochromia was detected in 46.5% of the papillary carcinoma cases. Grooves and pseudoinclusions were the other nuclear features that could be detected. However, nuclear contour irregularity was the most reliable finding that could predict papillary carcinoma diagnosis in the CNB sections (v: 0.82, p < 0.001). CONCLUSIONS: We believe that the histopathological differences we found have an important place in diagnostics and should be emphasized, and new diagnostic algorithms should be developed.

Living with schizophrenia: Perspectives of Turkish people with schizophrenia from two Patient Associations on how the illness affects their lives.

BACKGROUND: Schizophrenia is a chronic mental illness affecting the social and occupational lives of the sufferers and posing a considerable burden on the patients and their families. Furthermore, negative societal reactions and the internalization of these attitudes exacerbate the difficulties encountered. This study examines the perspectives of Turkish people with schizophrenia on how they view the impact of the illness on their lives, the societal reactions and attitudes to schizophrenia and whether they agree with these reactions. METHODS: Twenty-three adult participants, all members of two schizophrenia associations in Ankara, capital of Turkey, were recruited. Semistructured interviews were used to find out their perspectives on how the illness affected their lives, how the society reacts to them and their views on these reactions. Interviews were recorded, transcribed and thematic analysis was used to capture the general and the subthemes. RESULTS: The findings suggest that causal attributions for the illness, the impact of illness on various life domains, challenges of living with the illness and finally stigmatization are general categories that capture the perspectives of the participants. CONCLUSION: People diagnosed with schizophrenia experience the impacts and burdens of their illness in various domains of their lives and negative societal reactions heighten these burdens. It seems important to consider the challenges faced by people with schizophrenia in living with their illness and the impacts of negative societal behaviors and attitudes in offering psychosocial interventions programs for supporting this group. Furthermore, combating negative societal attitudes also seems to be necessary.

Using a corkscrew-tipped telescopic nail in the treatment of osteogenesis imperfecta: a biomechanical study and preliminary results of 17 consecutive cases.

High complication rates were reported with the telescopic nail technique systems. To overcome such technical difficulties, we designed a corkscrew-tipped telescopic nail (CTTN). We biomechanically compared its pullout strength with that of two other tip designs. We used CTTN in 17 patients with osteogenesis imperfecta and reported their preliminary results. Average patient age was 82.6 months, and mean follow-up was 32.0±6 months. Telescoping and osteotomy site healing were assessed using radiological studies. Successful telescoping with event-free osteotomy site healing was achieved in 94.1% of patients; limited telescoping and delayed union were detected in one case each. Our results show that CTTN provides sufficient pullout strength and reduced complication rates compared with other designs.

Use of peritoneal washing cytology for the detection of free peritoneal cancer cells before and after surgical treatment of gastric adenocarcinoma.

AIM: Cytological detection of peritoneal-free gastric cancer cells is considered as the gold standard with variable sensitivity. Seeding of cancer cells after radical surgery for gastric cancer is a controversial issue. In this study, it was aimed to detect the rate of positive peritoneal washing cytology and the incidence of spreading of tumor cells after radical surgery. MATERIALS AND METHODS: Patients with pathologically proven and surgically treated gastric adenocarcinoma were enrolled. Three peritoneal washing samples were examined cytologically: at the beginning, after completion of resection, and before closure of the abdomen. Identification of peritoneal-free gastric cancer cells was regarded as the main outcome. RESULTS: Thirty-four patients with a mean age of 60.7 ± 12 years were enrolled. T3 and N0 were the most common stages seen in 16 (47%) and 12 patients (35.3%), respectively. There were two positive results (5.9%) as the first peritoneal sample. Considering T3- or N-positive patients, the incidence increased to 9.1%. There was no conversion of negative to positive cytology. Cytological positivity remained only in one case (2.9%) after the second and the third peritoneal samples. CONCLUSION: Rate of positive peritoneal washing cytology in patients with gastric cancer is influenced by clinicopathological findings and the technique used. Use of cytology alone is thought to be failed to detect free cancers cells within the peritoneal cavity.

Effect of a combination of mometasone furoate, levofloxacin, and retinyl palmitate with an in situ gel-forming nasal delivery system on nasal mucosa damage repair in an experimental rabbit model.

BACKGROUND: In this study a combination of Mometasone Furoate (MF)+Levofloxacin hemihydrate (LH)+Retinyl palmitate (RP) with an in situ gel-forming delivery system was evaluated at different stages of nasal mucosal damage repair in a rabbit maxillary sinus model. METHODS: In this study, 28 rabbits were included and assigned randomly to four groups. In all rabbits, a standard ostium was opened in the medial wall of the maxillary sinus by using a drill. Two different subsequently prepared gels with an in situ gel-forming delivery system were used. Of these 14 nasal cavities, combination 1 (active combination) was applied daily to 5, combination 2 (placebo) to 5, while 4 did not receive any pharmaceutical treatment. The diameter of the ostium was measured. Histopathological assessment was performed. RESULTS: After 2, 3 and 4 weeks, the ostium diameter was significantly wider in the group where gel 1 had been applied compared to both the placebo group and control group. In the group treated with gel 1, after 2, 3 and 4 weeks the presence of superficial cilia was significantly greater, surface epithelium significantly less. In the 4th week, histologic scores for fibroblastic proliferation and vascular proliferation in the group treated with gel 1 were better than in either the control group or the placebo group. With gel 1, chronic inflammation parameters were also significantly lower than in the other groups. CONCLUSION: The MF+LH+RP mixture with an in situ gel-forming nasal delivery system applied for wound healing after FESS prevents the formation of stenosis and is favorable for proper wound healing.

Vulvar granular cell tumor.

Granular cell tumors (GCTs) are rare and approximately half of the all lesions arise from head and neck, especially from the tongue. However, they are rarely seen in the vulva. They can occur in patients of any age, but peak age incidence is in the fourth to sixth decades. They generally occur as small, slow growing, and skin-colored nodule. GCTs are usually benign, but malignant cases were reported. Recurrence can be seen in benign tumors with clear margins, but rates increase with positive margins. The treatment is complete surgical excision. We report a case of benign GCT of the vulva. A 41-year-old patient presented with vulvar mass, and biopsy was consisted with GCT.

Prognostic Value of Angiogenesis and Survivin Expression in Patients with Glioblastoma.

AIM: Glioblastoma (GBM) is the most common and the most aggressive primary brain tumor with poor prognosis. We aimed to evaluate the association between immunohistochemical expression of survivin and angiogenic parameters (microvessel density and vascular pattern) in patients who underwent surgery for GBM. MATERIAL AND METHODS: The pathology reports and also clinical and follow-up data of patients with GBM were retrospectively evaluated. Control tissues were obtained from the archive for each antibody (Survivin, CD 34). Then, control staining of these antibodies was performed. Vessels were evaluated according to the standardized assessment of vascular pattern. RESULTS: Mean survival for classical vascular pattern was longer than bizarre vascular pattern (p < 0.001). The survival time of patients decreased with increasing score of survivin staining. There was a significant correlation between survivin and survival time (p < 0.001). There was no significant correlation between microvessel density and survival time (p > 0.05). CONCLUSION: With these findings, it is considered that high expression of survivin, bizarre vascular pattern and development of secondary GBM correlates with the low survival rates, however microvessel density has no correlation with the survival rates. Since only malignant cells express survivin, it might be a target protein for the development of novel therapies.

Should Core Needle Biopsy be Used in the Evaluation of Thyroid Nodules?

Fine needle aspiration (FNA) is the first choice in thyroid nodules suspected of harboring malignancy on sonography in routine practice. However, sampling with core needle biopsy (CNB) is also being used, especially in cases with repeated nondiagnostic/indeterminate diagnoses. The aim of this study was the retrospective evaluation of CNB samples. A total of 604 thyroid CNB samples registered in the Department of Pathology at Bezmialem Foundation University Medical Faculty within the 1-year period between June 2014 and June 2015 were re-evaluated by correlation with previous FNA and later resection results. CNB was divided into diagnostic groups of insufficient, malignant, suspicious for malignancy, no evidence of malignancy/benign, atypia of uncertain significance (AUS)/follicular lesions of uncertain significance (FLUS), and follicular neoplasm (FN)/suspicious for follicular neoplasm (SFN). Among the 604 cases, 15 cases (2.48 %) were classified as malignant and 9 cases (1.49 %) as suspicious for malignancy. No evidence of malignancy was seen in 512 cases (84.76 %). There were 26 (4.3 %) cases in the AUS/FLUS-FN/SFN group, and the sample was inadequate in 42 cases (6.95 %). Resection was performed for 17 of the cases classified as malignant or suspicious for malignancy, and all were found to be malignant. There were also 10 resected cases with a diagnosis of no evidence of malignancy, and all were found to be benign. We think that sampling with CNB may be useful especially in repeating inadequate biopsies or cases diagnosed with AUS/FLUS that have hesitations regarding clinical management. Larger series including comparisons with FNA and resection results are required.

Histopathological Evidence of Lymph Node Metastasis in Papillary Thyroid Carcinoma.

Prophylactic lymph node dissection is still controversial due to the potentially surgery-related morbidity in management of papillary thyroid carcinomas. So, some histopathological predictors for lymph node metastasis in thyroidectomy specimens may reveal importance. The objective of this study was to define histomorphological indicators of lymph node metastasis in the patients who had been performed thyroidectomy without lymph node dissection. Clinicopathological features of patients archived in Department of Pathology at Trakya University Medical Faculty were reviewed. A total of 211 patients who had been diagnosed as papillary carcinoma and had been performed total thyroidectomy/lobectomy with central/cervical lymph node dissection were included in the study. Clinical features (age, gender, preoperative/postoperative clinical, and laboratory findings) and histopathological features (histological variant, tumor size, focality, extrathyroidal extension, tumor border, lateral tubular growth, intraglandular dissemination, stromal and lymphocytic tumor response, lymphocytic thyroiditis, lymphovascular invasion, lymph node metastasis, number of metastatic lymph nodes, extranodal extension, size of the metastatic foci) were evaluated. Male gender, conventional variant, tumor size greater than 10 mm, multifocality, extrathyroidal extension, lateral tubular growth, intraglandular dissemination, lymphocytic and stromal tumor response, and absence of lymphocytic thyroiditis were predictive, and older age (≥45 years) and follicular variant PTC were protective for lymph node metastasis. In order to optimize the management of papillary thyroid carcinomas, pathologists should search for the clues of lymph node metastasis particularly intraglandular dissemination, lateral tubular growth, tumor border and lymphocytic/stromal tumor response, multifocality, concomitant lymphocytic thyroiditis besides the actual prognostic criteria especially in younger aged male patients.

Histopathological Features of Gastrointestinal Stromal Tumors and the Contribution of DOG1 Expression to the Diagnosis.

BACKGROUND: Gastrointestinal stromal tumors (GIST) have KIT or platelet-derived growth factor receptor α (PDGFRα) mutations affecting receptor tyrosine kinase activity and do not benefit from classic treatment regimens. AIMS: The aim of this study was to review the algorithm that may be followed for the diagnosis and differential diagnosis in GISTs by investigating the histomorphological parameters and expression characteristics of classical immunohistochemical antibodies used in routine tests in addition to DOG1 expression. STUDY DESIGN: Diagnostic accuracy study. METHODS: We reevaluated the histological and immunohistochemical parameters of 37 GISTs. The standard immunohistochemical diagnosis and differential diagnosis panel antibodies (CD117, PDGFRα, CD34, vimentin, desmin, SMA, S-100, and Ki67) were studied on the tumor sections. We also used the popular marker DOG1 antibody with accepted sensitivity for GISTs in recent years and the PDGFRα immune marker for which the benefit in routine practice is discussed. RESULTS: Classification according to progressive disease risk groups of the 37 cases revealed that 54% were in the high risk, 19% in the moderate risk, 16% in the low risk, 8% in the very low risk and 8% in the no risk group. Cytological atypia, necrosis, mucosal invasion and the Ki67 index were found to be related to the progressive disease risk groups of the tumors (p<0.05). Positive immunoreaction was observed with CD117 and PDGFRα in all GISTs in the study (100%). Positivity with the DOG1 antibody was found in 33 (89%) cases. CD34 was positive in 62% (23) of the cases. CONCLUSION: The CD117 antibody still plays a key role in GIST diagnosis. However, the use of DOG1 and PDGFRα antibodies combined with CD117 as sensitive markers can be beneficial.