Toxocara related peritonitis: A case report and review of literature.

Toxocariasis is a clinical syndrome caused by the larvae of two ascarid nematodes, namely, Toxocara canis and T. cati that live in dogs and cats as definitive hosts. Humans acquire Toxocara infection by accidental consumption of eggs contaminated foods, soil, water or larvae encapsulated in the viscera or meats of various paratenic hosts e.g., chicken. After oral ingestion, the ova hatch and the free larvae penetrate the intestinal wall to migrate to distant tissues throughout the body. Larvae may also infiltrate the intestinal wall and cause enteritis and mass occupying lesions. Here, we present a T. canis related gastroenteritis and peritonitis case successfully treated with albendazole. We reviewed the literature and found seven previously published Toxocara related peritonitis cases. To our knowledge, this is the first review about non-disseminated toxocariasis that restricted to the intestine and presented as eosinophilic ascites due to peritoneal inflammation. The most common abdominal symptoms were abdominal pain and nausea, and the most common findings were eosinophilic infiltrations on endoscopic biopsy specimens and eosinophilia in the peripheric blood samples.

A new immunohistochemical marker, insulinoma-associated protein 1 (INSM1), for Merkel cell carcinoma: Evaluation of 24 cases.

Merkel cell carcinoma (MCC) is an uncommon primary neuroendocrine carcinoma of the skin. Nowadays, pathologists are required to perform immunohistochemistry to demonstrate neuroendocrine and epithelial differentiation for diagnosis of MCC. Insulinoma-associated protein 1 (INSM1) is a zinc-finger transcription factor expressed in tissues undergoing terminal neuroendocrine differentiation, and INSM1 immunohistochemistry is a well-validated nuclear marker of neuroendocrine differentiation. We evaluated 24 cases of MCC for the expression of INSM1 and compared it with frequently used neuroendocrine markers, Chromogranin A, Synaptophysin, and CD56. INSM1 was positive in all cases, and its expression was stronger, more extensive, clean and homogeneous compared to other markers. As a consequence, INSM1 can be used to serve as a solitary marker for neuroendocrine differentiation due to high sensitivity and specificity in MCC cases.

Is it always blepharitis? Urbach-Wiethe syndrome (lipoid proteinosis).

A 12-year-old girl presented with recurrent crusty debris and dandruff at the base of both eyelashes despite having completed different medical treatments. She had had a hoarse voice since her early childhood. Upon anterior segment examination of the eyes, we found yellow-white, bead-like papules on the margins of the eyelids. An otolaryngologist detected multiple nodules on the vocal cords and buccal mucosa. Ultrasonography revealed salivary stones in the main parotid ducts. And a dermatological examination revealed thickened skin lesions on the elbows and knees with a biopsy showing histopathological findings of lipoid proteinosis. We diagnosed the patients as having Urbach-Wiethe syndrome or lipoid proteinosis, a rare autosomal recessive multisystem disorder with variable manifestations vary that difficult the diagnosis. The ocular manifestations are not well known among ophthalmologists, but the typical lid lesions are pathognomonic and ophthalmologists should be aware of this presentation to identify patients with Urbach-Wiethe syndrome.

A comparison of the type IX collagen levels of the intervertebral disc materials in diabetic and non-diabetic patients who treated with lumbar microdiscectomy.

PURPOSE: The purpose of this study was to compare type IX collagen levels in the intervertebral disc (IVD) materials of diabetic and non-diabetic patients with lumbar disc herniation and to determine whether there is a relationship between diabetes mellitus (DM) and type IX collagen levels in degenerated discs. METHODS: Overall, 30 non-diabetic patients and 30 type II diabetic patients who underwent lumbar microdiscectomy were included in this study. All patients underwent lumbar microdiscectomy, and IVD samples were obtained during the surgery. Deparaffinization, macroscopic digestion, and staining procedures were performed immunohistochemically. Fractional area stained, staining intensity, and total staining score were graded semi-quantitatively. The results were evaluated within a 95% confidence interval, and significance was evaluated as bidirectional at 0.05 and 0.01 significance levels. RESULTS: The type IX collagen staining intensities and fractional area stained were lower in the diabetic group than those in the non-diabetic group (p = 0.001). The total immunoreactivity staining scores of type IX collagen in the diabetic group were statistically lower at higher significance levels than the total immunoreactivity staining scores of type IX collagen in the non-diabetic group (p = 0.001). The duration of DM of the patients with DM was increased, the total immunoreactivity staining score of type IX collagen was decreased (p = 0.001). CONCLUSIONS: Diabetes reduces the type IX collagen level in the intervertebral disc and the duration of diabetes is the most important factor for this reduction. Diabetes may play a role in the development of disc herniation by reducing type IX collagen levels in the intervertebral disc. However, the causes of increased herniation in diabetic patients still have to be determined.

An Unusual Location of Neuroendocrine Tumour: Primary Hepatic Origin.

Although neuroendocrine tumours (NETs) of primary hepatic origin are extremely rare, most of NETs present with liver metastasis. When a NET is found in the liver, it must be treated to exclude metastasis from extrahepatic primary sites. The patient was a 38-year-old female. Abdominal ultrasound showed an 8 cm tumour in liver during a routine examination. Liver biopsy was done. The tumour was first considered a metastatic hepatic tumour on histopathological examination. No clues to the origin of a primary tumour were found. Upper and lower endoscopy of the GI tract and chest CT were performed to search for a primary tumour and were negative for any tumour. One month later, more extensive areas of the tumour were seen on histopathological examination of second liver biopsy with the same morphologic characteristics as the first biopsy. Immunohistochemically, there was positive staining for synaptophysin, CD 56, and S-100 in the tumour cells. These findings suggested the diagnosis of NET. The diagnosis of primary liver NET was considered in a multidisciplinary meeting. Then, left hepatectomy was performed. The final pathologic diagnosis of the tumour in the resected liver specimen was Grade II NET. The patient was doing well at postoperative 28-month follow-up.

Role of cd56 and e-cadherin expression in the differential diagnosis of papillary thyroid carcinoma and suspected follicular-patterned lesions of the thyroid: the prognostic importance of e-cadherin.

INTRODUCTION: The pathological diagnosis of papillary thyroid carcinoma (PTC) is generally easy on routine sections stained with hematoxylin and eosin (H&E). However, the differentiation of the follicular variant of PTC (FVPTC) from other suspected follicular-patterned lesions of the thyroid is highly difficult. Among these, the lesions for which FVPTC cannot be excluded are classified as well-differentiated tumors of uncertain malignant potential (WDT-UMP). The most common immunohistochemical (IHC) markers used in the differential diagnosis include HBME-1, galectin-3, and CK19. However, none of these markers provide a 100% differential diagnosis. OBJECTIVE: The present study compared the diagnostic value of CD56 and E-cadherin for the differentiation of FVPTC from the other benign follicular-patterned lesions, with HBME-1, galectin-3, and CK19. Using these markers, the controversial cases within the WDT-UMP group were reclassified. Additionally, the relationship between the reductions in E-cadherin expression with poor prognostic factors was investigated. MATERIALS AND METHODS: The IHC expressions of CD56, E-cadherin, HBME-1, galectin-3, and CK19 were evaluated in 181 thyroid lesions, including 101 PTCs (45 classical variant PTCs and 56 FVPTCs), 20 WDT-UMPs, 20 follicular adenomas (FAs), 20 hyperplastic nodules (HN), and 20 hyperplastic foci of lymphocytic thyroiditis. The results were statistically compared via SPSS. RESULTS: The expressions of all of the markers were statistically significantly different in PTC and follicular-patterned lesions (P<0.05). It was found that the only marker with both sensitivity and specificity above 90% was CD56 negativity (sensitivity 91.1%, specificity 91.7%). The most sensitive and also the most specific double panel was CD56 negativity and galectin-3 positivity (sensitivity 96%, specificity 85%), and the most sensitive and specific triple panel was CD56 negativity, HBME-1 positivity, and galectin-3 positivity (97% and 70%, respectively).

Evaluation of bcl-2, bax and c-erbB-2 Levels in Chronic Otitis Patients with or without Cholesteatoma.

OBJECTIVE: The aim of this study was to evaluate bcl-2, bax, and c-erbB-2 expressions in primary and secondary acquired cholesteatoma and to indicate the role of apoptosis and accompanying increased cellular proliferation in the pathogenesis of cholesteatoma. METHODS: Samples obtained from the skin of the external ear canal (EEC) of patients operated for chronic otitis media (COM) without cholesteatoma constituted Group 1; samples from the EEC skin of patients in Group 3 operated for COM with cholesteatoma and from the EEC skin of patients in Group 4 constituted Group 2; samples obtained from the cholesteatoma matrix of patients operated for COM with primary acquired cholesteatoma constituted Group 3; and samples obtained from the cholesteatoma matrix of patients operated for COM with secondary acquired cholesteatoma constituted Group 4. The assessment of the positive cell ratio was based on the presence of the following findings and was semiquantitatively classified into four groups: 0, no staining; + cell staining (weak positive staining: 1%-33%); ++ cell staining (moderately positive staining: 34%-66%); and +++ cell staining (strong positive staining: 67%-100%). RESULTS: Comparison of the staining scores of bcl-2, bax, and c-erbB-2 revealed a statistically insignificant difference in the staining of samples obtained from the EEC skin (p>0.05). Decreased bcl-2 expression and increased bax and c-erbB-2 expressions were determined in primary and secondary acquired cholesteatoma epithelium compared with the EEC skin of patients operated for COM with or without cholesteatoma, and the differences were found to be statistically significant (p<0.05). CONCLUSION: In acquired cholesteatoma epithelium, the finding of decreased bcl-2 expression as well as increased bax and c-erbB-2 expressions compared with the EEC skin is an indicator of the increase in both cellular proliferation and apoptosis.

Mullerian inhibiting substance expression in papillary thyroid cancer.

OBJECTIVE: To examine the expression of Mullerian inhibiting substance (MIS) in papillary thyroid cancer. MATERIALS AND METHODS: The MIS expression was examined by studying the immunohistochemistry in deparafinized sections prepared from tissue blocks of patients who were diagnosed with papillary thyroid cancer, as given in the pathology archive records (n = 23). RESULTS: In all the cases studied, 50% (n = 10) showed strong staining and 50% showed moderate staining. The percentage of staining was found to be 94.2 ± 3.1% in strongly stained cases and 92.2 ± 2.1% in moderately stained cases. Normal thyroid tissues neighboring the tumor did not display any staining. CONCLUSION: The MIS expression can be used as a significant tool in differential diagnosis of papillary thyroid cancer and also to shed light on its etiopathogenesis.

Primary hydatid cyst of the scaphoid: case report.

Hydatid cyst caused by Echinococcus granulosus is a parasitic disease that can affect different organs. It is difficult to diagnose and has a tendency to recur. Primary bone involvement occurs in 0.5% to 4.0% of all patients with hydatid cysts. We present a 31-year-old woman with a primary hydatid cyst in the left scaphoid. Despite the availability of advanced imaging and laboratory investigation modalities (such as magnetic resonance imaging and serological studies) to make an adequate differential diagnosis of a cystic lesion in our case, intraoperative clinical suspicion led to the diagnosis. This was followed by a successful outcome without recurrence after 12 months.

Effects of coenzyme Q10 and α-lipoic acid supplementation in fructose fed rats.

This study was conducted to investigate the effects of α-lipoic acid and coenzyme Q10 on plasma levels of lipids, asymmetric dimethylarginine, oxidative stress in fructose fed rats which provide a model of dietary-induced insulin resistance and to evaluate vascular changes developing in these rats by histologically. Male Sprague Dawley rats were used in this study. The animals were divided into 4 groups. Group 1 did not receive any medication and served as a control. Group 2 received a regular diet and water ad libitum and fructose was administered as % 10 solution in drinking water. Group 3 received α-lipoic acid (100 mg/kg/day) i.p. for 5 weeks and Group 4 received coenzyme Q10 (10 mg/kg/day) i.p. for 5 weeks. For determination of plasma asymmetric dimethylarginine, glutathione and malondialdehyde levels, high-performance liquid chromatography system was used. Homeostatic model assessment as a measure of insulin resistance was calculated. Lipid profile measurements were determined using enzymatic assay on an Auto analyzer. The high fructose diet was significantly associated with an increase in levels of plasma LDL, VLDL and total cholesterol and decrease in level of HDL cholesterol. Plasma asymmetric dimethylarginine, malondialdehyde and glutathione levels were also increase in these rats. α-lipoic acid or coenzyme Q10 supplementation was found to have some positive effect on these parameters. These findings were also demonstrated by morphological observation of the aorta. We demonstrated that administration of α-lipoic acid and coenzyme Q10 notably suppresses oxidative and nitrative stress, hyperinsulinemia, insulin resistance developing in fructose fed rats, a model of metabolic syndrome (MS). These positive effects of α-lipoic acid or coenzyme Q10 can be attributed to its antioxidant activity.

Sclerosing stromal tumor of the ovary: ultrasound elastography and MRI findings on preoperative diagnosis.

Sclerosing stromal tumor (SST) is a benign stromal tumor of the ovary. Preoperative diagnosis of this benign tumor mainly depends on imaging findings. Dynamic computed tomography (CT) and magnetic resonance imaging (MRI) show typical contrast enhancement of SST with peripheral enhancement in the early phase and centripetal progression in the delayed phases. We present the imaging findings of ultrasonography, ultrasound elastography, and dynamic MRI in the diagnosis of SST. Abdominal ultrasound elastography is a novel technique that depicts the stromal structure of SSTs by comparing the elasticity of the tumor and the myometrium using quantitative strain values.

Human telomerase reverse transcriptase expression in colorectal tumors: correlations with immunohistochemical expression and clinicopathologic features.

Human telomerase reverse transcriptase (hTERT) proteins in colorectal cancer investigated in several studies, but to our knowledge, hTERT expression has not been evaluated in all of colorectal tumors, including hyperplastic polyps (HPs), adenomas, and carcinomas, on paraffin-embedded tissue sections. The aim of the present study is to investigate immunohistochemical hTERT expression and its relationship with the clinicopathologic features in a spectrum of colorectal tumors. In this study, hTERT expression was determined in HP (n = 20), adenomatous polyp (AP) (n = 20), colorectal adenocarcinomas (n = 20), and normal mucosa (n = 20) by immunohistochemical method. The findings were correlated with the clinicopathologic features. The staining level of hTERT in adenomas and carcinomas was significantly higher than in normal tissues (P < .05). There was also significant difference between HP and AP (P < .05). Level of hTERT in carcinomas was higher than in adenomas, but the difference was of no statistical significance (P > .05). There was no significant association of hTERT expression in cancerous, precancerous, or normal mucosa related to clinicopathologic parameters including age, sex, and size of lesion, (P > .05), but only association with histologic grade for carcinoma was found (P < .05). Levels of hTERT by immunohistochemistry demonstrated that the expression of hTERT was very little in normal mucosa and HP, moderate in AP, and highest in carcinoma. Thereby, hTERT expression may use the aggressiveness of the colorectal tumors as a marker, but it is not related to clinicopathologic data.