Calcifying fibrous tumor of the pancreas: A case report.

A calcifying fibrous tumor (CFT) is a rare benign mesenchymal tumor characterized by a hypocellular fibroblastic proliferation with associated chronic inflammation and variably prominent calcification. Gastrointestinal (GI) tract is the most common predilection site of CFT. English-language literature reveals approximate 50 such reports of GI-CFTs. In addition, the most frequently identified sites of the GI tract are stomach, small bowel, and colon. However, CFT has not been reported in the pancreas. In addition, we present the first pancreatic-CFT in this case report.

Rare cases of benign tumors of the head and neck: lipoma of larynx and sternocleidomastoid muscle.

In this article, we report two rare cases of lipoma in the head and neck region. Thirty-four-year-old case 1 presented with hoarseness and sensation of foreign body in throat. While 54-year-old case 2 presented with complaint of a mass in left side of neck. The imaging methods showed the masses in false vocal fold and the sternocleidomastoid muscle. Diagnosis and treatment of the masses were discussed in light of the literature.

Palmoplantar lichen planus successfully treated with acitretin.

Palmoplantar lichen planus (PPL) is an uncommon type of lichen planus (LP) that exclusively affects the palms and soles. We report a case of a 50-year-old man who had palmoplantar hyperkeratotic papules and plaques. The patient was diagnosed as a case of PPL by skin biopsy, and treated with acitretin. He showed a good response to acitretin within 2 months. Clinical appearance and some features of PPL may differ from classic LP. Acitretin may be a favourable treatment option for PPL.

First and only symptom of undiagnosed diabetes mellitus: eruptive xanthoma.

Eruptive xanthoma (EX) is a very rare dermatosis mostly occurring due to high levels of serum triglycerides or uncontrolled diabetes mellitus. When EX is encountered, it is important to keep in mind that it could be a sign of severe underlying metabolic derangements. Early recognition can help avoid serious complications such as pancreatitis. After treatment of the underlying metabolic disorders, lesions mostly disappear without leaving scars. We present a case of a 55-year-old woman who presented with solely EX lesions and who was eventually diagnosed with diabetes mellitus and severe hypertriglyceridaemia.

Is Immunohistochemical Sex Hormone Binding Globulin Expression Important in the Differential Diagnosis of Adenocarcinomas?

Adenocarcinomas (AC) are the most frequently encountered carcinomas. It may be quite challenging to detect the primary origin when those carcinomas metastasize and the first finding is a metastatic tumor. This study evaluated the role of sex hormone binding globulin (SHBG) positivity in tumor cells in the subclassification and detection of the original organ of adenocarcinomas. Between 1994 and 2008, 64 sections of normal tissue belonging to ten organs, and 116 cases diagnosed as adenoid cystic carcinoma and mucoepidermoid carcinoma of the salivary gland, lung adenocarcinoma, invasive ductal carcinoma of the breast, adenocarcinoma of stomach, colon, gallbladder, pancreas and prostate, endometrial adenocarcinoma and serous adenocarcinoma and mucinous adenocarcinoma of the ovary, were sent to the laboratory at the Department of Pathology at the Yuzuncu Yil University School of Medicine, where they were stained immunohistochemically, using antibodies against SHBG. The SHBG immunoreactivity in both the tumor cells and normal cells, together with the type, diffuseness and intensity of the staining were then evaluated. In the differential diagnosis of the adenocarcinomas of the organs, including the glandular structures, impressively valuable results are encountered in the tumor cells, whether the SHBG immunopositivity is evaluated alone or together with other IHC markers. Further extensive research with a larger number of cases, including instances of cholangiocarcinoma and cervix uteri AC [which we could not include in the study for technical reasons] should be performed, in order to appropriately evaluate the role of SHBG in the differential diagnosis of AC.

Bilateral lower eyelid basosquamous cell carcinoma: a rare case.

Basosquamous cell carcinoma is a subtype of basal cell cancer. It is known to be more aggressive than basal cell cancer. A 70-year-old male patient was admitted to our clinic for evaluation of cosmetic problems caused by masses on both lower eyelids for at least two years. The mass excision from and reconstruction of lower eyelids were performed. Histopathological examination of the resected masses was consistent with basosquamous cell carcinoma. We present a case of basosquamous cell carcinoma involving bilateral lower eyelids with a different clinical appearance. To the best of our knowledge, this is the first report of bilateral basosquamous cell carcinoma in a patient.

A case of verru plana on tattoo.

Tattoo is a popular cosmetic decoration, however several different tattoo-induced complication have been described. Several tattoo related cutaneous reactions such as allergic, granulomatous, lichenoid reactions, and infections have been reported. A 20 year-old male presented with multiple papules on the dragon shaped tattoo. The clinical and histopathological assessments were consistent with verrucas. Tattoo has become increasingly popular among young people. People interested in tattoos should be informed on its related infections and complications during and following tattooing. Herein, we present this rare tattoo induced verru plane to point out tattoo related complications and its treatments.

Relationship of PCNA, C-erbB2 and CD44s expression with tumor grade and stage in urothelial carcinomas of the bladder.

In the present study, the intention was to reveal the relationship of histological grade and stage with c-erbB2, CD44s, and PCNA immunoreactivity in bladder urothelial carcinomas (UC). In our study, we evaluated 46 items of transurethral resection material of patients submitted by YYU Faculty of Medicine, Main Department of Pathology, with a mass revealed in their bladder after clinical and radiological studies at our laboratories and who were diagnosed with urothelial carcinomas. PCNA, c-erbB2, and CD44s were applied in an immunohistochemical manner comprised from nine low-malignant potential papillary urothelial neoplasia, 23 low-grade papillary urothelial carcinoma, and 14 high-grade papillary urothelial carcinoma. Immunostaining was scored according to the percentage of positive cells. The immunohistochemical study demonstrated that the c-erbB2 and PCNA staining ratio increased when an increase occurred in stage and grade. The CD44s staining ratio decreased. C-erbB2, PCNA, and CD44s appear to be a useful marker in the assessment of the prognosis and treatment options in urothelial carcinomas.

Comparison of cutaneous mastocytosis with onset in children and adults.

BACKGROUND/AIM: Mastocytosis is a heterogeneous group of diseases characterized by the abnormal infiltration of mast cells in the skin and sometimes other organs. This study aimed to compare the demographic, clinical, and histopathological findings of cutaneous mastocytosis with onset in children and in adults. MATERIALS AND METHODS: Patients diagnosed with cutaneous mastocytosis in 2 different dermatology clinics between 2007 and 2011 were included in the study. Demographic characteristics of the patients as well as localization and type of the cutaneous lesions, presence of symptoms, Darier's sign, family history, systemic involvement, and histopathological evaluations were retrospectively examined. RESULTS: Out of the 30 cases of cutaneous mastocytosis, 60% of patients were male (n = 18) and 40% were female (n = 12). Twenty-two patients had childhood-onset mastocytosis (≤15 years) and 8 patients had adult-onset mastocytosis. The onset of the disease occurred before the age of 2 years in all cases of childhood onset. Patients with adult-onset mastocytosis had statistically significantly more systemic involvement than those with childhood-onset mastocytosis (P < 0.05). CONCLUSION: Cutaneous mastocytosis is a benign disease in children without systemic involvement and is usually sporadic.

A case of generalized lichen nitidus successfully treated with narrow-band ultraviolet B treatment.

Lichen nitidus (LN) is a rare skin disorder presenting with multiple, small and bright papules located on the chest, abdomen, penis glans and upper extremities. It usually presents with limited involvement; however, it can present as generalized involvement. There is no consensus on treatment. Corticosteroid, astemizole, phototherapy has been used; however, the results are controversial. A 15-year-old male with clinical and histopathological diagnosis of LN was treated with narrow-band ultraviolet B (NB-UVB). The lesions completely regressed with post-inflammatory hypopigmentation on the second month of the therapy (25 sessions). We believe that NB-UVB is an effective treatment on generalized LN.

A case of levetiracetam induced bullous pemphigoid.

Bullous pemphigoid is a chronic, acquired autoimmune skin disease. Certain drugs such as furosemide, penicillins, sulfonamides, ciprofloxacins, penicillamines, angiotensin converting enzyme inhibitors, chloroquine, and phenacetin were reported to cause bullous pemphigoid. This is a case report of a 70-year-old female, who presented with the formation of diffuse cutaneous blister in month after starting to use levetiracetam. Dermatological exam and histopathological findings were consistent with bullous pemphigoid. To the best of our knowledge this is the first case of bullous pemphigoid in the literature associated with levetiracetam use.

Chronic effects of environmental biomass smoke on lung histopathology in Turkish non-smoking women: a case series.

Biomass is widely used for fuel in developing countries. Particles and gases of biomass burning may cause changes in the lung. In this prospective study we investigated histopathological changes in the lungs of 42 non-smoking women [mean age (59±10) years] caused by biomass smoke. We valuated exposure to biomass smoke, case histories, and the findings of physical examination, radiology, bronchoscopy, and lung histopathology. Mean exposure to biomass smoke was (28±9) hour-year (1 hour-year equals 365 hours of exposure per year with average exposure of 1 hour a day). The radiological findings were mass (42 %), reticulonodular opacities (31 %), mediastinal lymphadenopathy (26 %), pleuro-parenchymal fibrotic banding (19 %), widening of the pulmonary artery (14 %), ground glass (11 %), mosaic perfusion (9 %), consolidation (9 %), segmental or subsegmental atelectasis (7 %), and bronchiectasis (7 %). The patients were diagnosed with lung cancer (35 %), interstitial lung disease (31 %), sarcoidosis (9 %), tuberculosis (9 %), chronic obstructive pulmonary disease (4 %), chronic bronchitis (9 %), and metastasis (4 %). Bronchoscopy showed pilies, oedema, erythema, bronchus narrowing, endobronchial tumour, mucosal irregularity, increased vascularisation, blue-black anthracotic plaques, mucosal oedema, and purulent secretion. Transbronchial biopsies revealed neutrophil and lymphocyte leucocytes in the perivascular, peribronchiolar, and interalveolar septa, slightly enlarged connective tissue, thickening of the basal membrane, thickening of interalveolar septa, intimal and medial thickening of the vascular wall and vascular lumen narrowing, anthracosis between the cells and in the bronchiole epithelium. These findings confirm that biomass smoke has important toxic effects on the lung parenchyma, interstitium, and pulmonary vessels that may result in malignancies.

Analysis of Ki-67 immunoreactivity in recurring and nonrecurring nasal polyps.

OBJECTIVE: Nasal polyps are common, abnormal lesions. Recurrence of the nasal polyposis is prevalent and a severe problem. The aim of this study was to investigate the relationship between Ki-67 immunoreactivity and the risk of recurrence of nasal polyps. Ki-67 staining of polypectomy material was tested as a risk factor for recurrence independent of etiologic factors or treatment modalities. DESIGN: Retrospective study. SETTING: University hospital. MAIN OUTCOME MEASURE: Ki-67 immunoreactivity. METHODS: Pathologic specimens from patients with nonrecurrent and recurrent nasal polyps archived at the Department of Pathology were reviewed, and the most suitable blocks were chosen among the excision materials. Ki-67 antibody staining was investigated immunohistochemically using the avidin-biotin-peroxidase method. The percentages of nuclei immunostained for Ki-67 of at least 1000 epithelial cells in the most intensive staining areas at final magnification (x400) were calculated and defined as the labeling index. The Mann-Whitney U-test was used to compare the Ki-67 labeling index in the nonrecurring and recurring nasal polyp groups. RESULTS: The mean Ki-67 labeling index was 1.4 +/- 1.972 (range 1-87 in 1000 epithelial cells) in the nonrecurrent nasal polyp group and 17.8 +/- 5.67 (range 82-446 in 1000 epithelial cells) in the recurrent nasal polyp group; the difference between the nonrecurrent and the recurrent group was significant (p < .01). CONCLUSION: The results of this study clearly demonstrate that proliferative activity in the surface epithelial cells of recurring nasal polyps is significantly higher than that in nonrecurring nasal polyps.

Significance of VEGF and microvascular density in gastric carcinoma.

BACKGROUND/AIMS: The aim of this study is to observe the relationship between the expression of vascular endothelial growth factor (VEGF), microvascular density (MVD) and the pathological characteristics of gastric carcinoma. METHODOLOGY: A total of 87 cases of gastric carcinomas were examined by immunohistochemical staining, using anti-VEGF and anti-CD34 antibodies. RESULTS: VEGF positive staining was obtained in 62 out of 87 cases (71.2%). The MVD was 64.00 +/- 15.51 (mean +/- SE) in VEGF-positive group and 48.33 +/- 12.71 in VEGF-negative group. CONCLUSIONS: The expression of VEGF is correlated with tumor angiogenesis, and VEGF plays an important role in new blood vessels formation. The expression of VEGF and MVD wereclosely correlated with the degree of differentiation and lymphatic metastasis, but not related to depth of cancer invasion, size of tumor, age or sex.

Renal involvement in Brucella infection.

OBJECTIVES: To examine our patients with brucellosis and renal involvement. Although brucellae have been recovered from the urine of patients with brucellosis, renal involvement is uncommon. METHODS: The data from 15 patients (8 males and 7 females, mean age 43 +/- 18.9 years, range 16 to 80), who had been admitted to our hospital with the diagnosis of brucellosis with renal involvement from 1998 to 2006, were retrospectively evaluated. RESULTS: In almost all cases, urinalysis revealed hematuria and variable amounts of proteinuria; some of the patients had pyuria. Of the 15 patients, 14 had renal failure. The etiology of renal failure was prerenal azotemia in 1, acute tubular necrosis because of nonsteroidal anti-inflammatory drug use in 1, anuric tubulointerstitial nephritis due to rifampin use in 1, nephritis accompanied by brucellar endocarditis in 3, brucellar endocarditis and tubulointerstitial nephritis-associated vasculitis in 1, brucellar membranoproliferative glomerulonephritis in 1, and brucellar tubulointerstitial nephritis clinically in 6 patients. Hemodialysis was required in 5 patients. Chronic renal failure developed in 1 patient, 2 patients were lost to follow-up, and renal function completely recovered in 11 patients. Two patients underwent renal biopsy and membranoproliferative glomerulonephritis with intraglomerular infiltration of histiocytes was identified in 1 patient and chronic tubulointerstitial nephritis associated with vasculitis and immune complex nephritis features was identified in the other. CONCLUSIONS: In areas endemic for brucellosis, this infection can be associated with hematuria, proteinuria, and renal failure. In addition, many diverse etiologies can play a role in the renal involvement associated with Brucella infection.

Conjunctival myxoma: a clinicopathologic report.

A conjunctival myxoma was identified in a specimen obtained from a 45-year-old woman via excisional biopsy. The patient presented with a slowly growing painless epibulbar mass. The paucicellular tumor included stellate and spindle-shaped cells, mast cells, and dilated lymphatic channels embedded in a loose collagenous matrix. The differential diagnosis of conjunctival myxoma should include tumors that have myxoid patterns and richly myxoid malignant neoplasms.

Treatment of mucoepidermoid carcinoma of the parotid gland and successful repair of iatrogenic facial nerve paralysis.

A 15-year-old female patient developed facial nerve paralysis following surgical excision of a right parotid mass at another center. The histopathologic diagnosis of the lesion was mucoepidermoid carcinoma. On admission to our clinic, she underwent extended total parotidectomy and functional neck dissection. For facial nerve reanimation, cervical plexus nerve grafting was performed for frontal and buccal branches, and ansa hypoglossi anastomosis for the marginal mandibular branch. Postoperative radiotherapy was administered. Facial nerve functions returned to normal in the postoperative sixth month (House-Brackmann grade II). No locoregional recurrence or distant metastasis occurred in the follow-up period.

Effects of topical mitomycin and trimetazidine on myringosclerosis.

INTRODUCTION: Myringosclerosis, one of the most common complications of ventilation tube placement, is a kind of tympanosclerosis and is defined as subepithelial hyalinization of the tympanic membrane. There are two arguments in the development of myringosclerosis: inflammation triggering the development of myringosclerosis and free oxygen radicals released during inflammation causing myringosclerosis. OBJECTIVE: The aim of the present study was to explore the effects on the development of myringosclerosis of mitomycin, which has anti-inflammatory effects, and trimetazidine, which is believed to inhibit free oxygen radicals when given systemically. MATERIALS AND METHOD: The study was carried out on rabbits. Animals were divided into five groups, with six rabbits in each group: three control groups (paracentesis only, paracentesis+tube placement, and no intervention), a trimetazidine group, and a mitomycin group. Mitomycin (0.4 mg/mL) and trimetazidine (20 mg/mL) were applied topically to the tympanic membrane, and the presence and degree of sclerosis were graded histopathologically after Masson's trichrome staining. RESULTS: In the histopathologic examination, sclerosis that developed in the tympanic membranes of rabbits that had undergone paracentesis or paracentesis plus tube application or received trimetazidine was significantly more extensive than sclerosis in the membranes of unoperated animals and those that had been administered mitomycin. CONCLUSIONS: Paracentesis in rabbits, independent of tube placement, causes sclerosis of the tympanic membrane. Results show that topical use of mitomycin, due to its anti-inflammatory effect, had alleviating effects on myringosclerosis, whereas topical trimetazidine did not.