The relationship between DNA mismatch repair gene and other prognostic parameters in pancreatic adenocarcinoma.

The aim of the study was to determine DNA mismatch repair (MMR) proteins by immunohistochemically using MLH1, MSH2, MSH6, and PMS2 antibodies in patients diagnosed as pancreatic ductal adenocarcinoma and to assess its relationship with histopathological and clinical prognostic parameters. Fifty cases with a diagnosis of pancreatic ductal adenocarcinoma who underwent surgical resection, were included in the study. Demographic and histopathological features of the patients were collected from the medical records. The relationships between microsatellite status and prognostic parameters were determined. The mean age of the patients was 66.5 ± 9.5 years (range: 47-87) and male/female ratio was 1.63 (31/19). No errors were detected in DNA MMR proteins in any of the cases, and were classified as microsatellite stable. The mean tumor diameter was 4.01 ± 1.77 cm and 74% of the tumors were localized in the pancreatic head. All of the cases had lymphatic invasion, whereas vascular invasion was detected in only 78% and perineural invasion in 98% of the patients. When the relationship between prognostic parameters and survival was evaluated, statistically significant correlation was observed in patient age and histopathological parameters such as tumor diameter, status of surgical margins, and vascular invasion (p < 0.05). Age, tumor size, presence of tumor at surgical margins, vascular invasion, and adjuvant treatment were correlated with survival. Although microsatellite instability was not detected in our cases, it is important to determine the microsatellite status by immunohistochemistry for predicting the chemotherapy response and determining the immunotherapy option in pancreatic adenocarcinomas.

[The Relationship of Enterotoxigenic Bacteroides fragilis and Fusobacterium nucleatum Intestinal Colonization with Colorectal Cancer: A Case-Control Study Performed with Colon Biopsies]. / Enterotoksijenik Bacteroides fragilis ve Fusobacterium nucleatum Bagirsak Kolonizasyonunun Kolorektal Kanser ile Iliskisi: Kolon Biyopsileri ile Yapilan Bir Olgu Kontrol Çalismasi.

In recent years, it has been shown that some bacteria may be associated with colorectal cancer (CRC). In this study, it was aimed to investigate the role of Fusobacterium nucleatum and enterotoxigenic Bacteroides fragilis (ETBF) in the etiology of CRC by comparing the amounts of these bacteria in colon biopsy tissues of patients with CRC and healthy individuals. The amounts of F.nucleatum and ETBF were determined by quantitative polymerase chain reaction (qPCR) in colon biopsy samples taken from 35 CRC and 35 healthy individuals, and the results were compared in the patient and control groups. The detection rate and amounts of F.nucleatum were found to be statistically significantly higher in tissues of female patients with CRC compared to male patients (p= 0.003, p= 0.013, respectively). There was no statistically significant difference between the tissues of female and male patients with CRC in terms of detection rate and amount of ETBF (p= 0.521, p= 0.515, respectively). It was found that in the 50-74 age group, the amount of ETBF was statistically significantly higher in women and men with CRC compared to the controls (p= 0.005, p= 0.047, respectively), while the amount of F.nucleatum was statistically significantly higher in female patients compared to controls. However, no difference was found between male patients and controls (p= 0.009, p= 0.083). It was determined that the detection rate and amount of F.nucleatum in the tissues of patients with CRC, regardless of age and gender, were not statistically different from the controls (p= 0.473, p= 0.995, respectively), however, the detection rate of ETBF and the amount of ETBF were found to be statistically significantly higher (p= 0.002, p= 0.004, respectively). It has been determined that ETBF can play a role in the etiology of CRC in both men and women, and F.nucleatum only in women, in the age range of 50-74 years, when routine screenings for CRC are performed.

The Relationship between Gastroduodenal Pathologies and Helicobacter pylori cagL (Cytotoxin-Associated Gene L) Polymorphism.

BACKGROUND: The polymorphisms in the region between 58 and 62 amino acids of the 194-amino acid CagL protein (CagL hypervariable motif) affect the binding affinity of CagL to integrin α5ß1 (ITGA5B1) receptor in host epithelial cells and have an effect on the development of various gastrointestinal diseases. We aimed to evaluate the associations of gastroduodenal pathologies, with the polymorphisms of cagL gene of Helicobacter pylori (H. pylori) and also associations between vacA genotypes and cagL polymorphisms. METHODS: A total of 19 gastric cancer, 16 duodenal ulcer, and 26 non-ulcer dyspepsia patients were included in this case-control study. All cases had H. pylori. A fragment of 651 bp from gene cagL (hp0539) and cagA, vacA genes was amplified by polymerase chain reaction. Purified polymerase chain reaction products were sequenced by Sanger sequencing, and nucleotide sequences were translated into amino acid sequences. RESULTS: All of the H. pylori strains had cagL and cagA genes. In the 16 (84%) gastric cancer cases, the D58 amino acid polymorphism was significant than the 4 (15.4%) duodenal ulcer cases (P = .029), and the D58/K59 amino acid polymorphism was significant in 12 (63.1%) of the gastric cancer cases than 1 (3.85%) duodenal ulcer case (P = .008). D58/K59 and DKIGQ (n = 10; 52.63%) were the most common polymorphisms in the gastric cancer and were associated with the vacA genotype s1/m2, respectively (P = .022 and P = .008). The D58/K59 amino acid polymorphism was found to have a significant Odds Ratio (OR) value of 8.9 (P = .0017) in multivariate logistic regression analysis. CONCLUSIONS: The risk of gastric cancer development is 8.9 times higher with D58/K59 polymorphism.

Clinical Contribution of Standardized Terminology for Pancreatic Lesions' Cytopathology.

INTRODUCTION: Demonstration of diagnostic contribution of Papanicolaou Society of Cytopathology-standardized nomenclature for pancreaticobiliary cytology (PSC-PC) in endoscopic ultrasonography (EUS) fine-needle biopsy (FNA) biopsies is important for widespread use and further development. METHODS: 179 EUS-FNA biopsies (89: solid, 90: cystic) and PSC-PC categories were compared with surgical definite histopathology and definite clinical diagnosis. Overall risk of malignancy (oROM) was calculated for each PSC-PC category. Diagnostic accuracy was evaluated. RESULTS: The cytopathology of lesions was nondiagnostic in 27%. Ductal dilatation, lymphadenopathy, and solid characteristic (independently) were associated with diagnostic result, while lesion size was not. PSC-PC categories had 89% diagnostic consistency with surgical definite histopathology. Category mismatch was detected in 3 patients (11%), of which 2 had adenocarcinoma. oROM was 14.3% for nondiagnostic group, 46% for cat. III (atypia), and 12% for cat. IVB (neoplastic - other). In terms of malignancy, the PSC-PC system had 100% specificity; PPV, 92% sensitivity, and 81% NPV; and the diagnostic accuracy was 94%. CONCLUSION: Using PSC-PC in EUS-FNA biopsies, pancreatic malignancy can be diagnosed with high diagnostic accuracy. In mucinous cystic lesions, some malignancies may be missed. To predict the malignancy risk of cat. IVB, assessment of dysplasia seems important. Although PSC-PC is not the only parameter in terms of diagnosing malignancy, its contribution to the clinical decision is quite high.

The Effect of Genistein on Anastomotic Healing in Intestinal Ischemia/Reperfusion Injury.

INTRODUCTION: Genistein is a natural isoflavonoid and has several pharmacological effects, such as antioxidant, antitumor activity, and improvement of glucose metabolism. The safety of intestinal anastomosis after ischemia-reperfusion (I/R) injury is a critical issue for surgeons. This experimental study aimed to investigate the effects of genistein on anastomotic healing after intestinal I/R injury. METHODS: A total of 36 male Wistar Albino rats were divided into four groups: control, I/R, genistein, and genistein + I/R. The control group received segmental ileal resection and ileoileal anastomosis. The I/R group received resection + anastomosis after intestinal I/R. The genistein group was administered subcutaneous injection of 1 mg/kg genistein 12 h and 1 h before the procedure and received ileal resection + anastomosis. The genistein + I/R group received I/R + ileal resection + anastomosis after genistein injection. Anastomotic bursting pressure, hydroxyproline, superoxide dismutase, and glutathione peroxidase levels and histopathological wound healing scores of all rats were measured on postoperative day 5. RESULTS: The anastomotic bursting pressure was significantly higher in the genistein and genistein + I/R groups (P < 0.001). Genistein increased the hydroxyproline concentration and the superoxide dismutase and glutathione peroxidase levels in the intestinal anastomosis (P < 0.001). In histopathological assessment, the mean wound healing score was significantly higher in the genistein group than in the other groups (P < 0.001). CONCLUSIONS: Genistein, with its anti-inflammatory and antioxidant properties, shows protective effects against increased oxidative stress after intestinal I/R injury and contributes positively to intestinal anastomotic healing.

Comparison of the effectiveness of i-scan and conventional endoscopy in the detection of the endoscopic signs of atrophic gastritis: A clinical trial.

BACKGROUND AND STUDY AIMS: This study aimed to determine whether the use of i-scan endoscopy provides additional benefits to conventional endoscopy in the diagnosis of gastric precancerous lesions. PATIENTS AND METHODS: A total of 120 patients with histologically-verified intestinal metaplasia (IM) or atrophic gastritis (AG) were prospectively evaluated by esophagogastroduodenoscopy. Endoscopic examinations were performed using i-scan and high-definition white-light endoscopy (HD-WLE). The diagnostic yields of both techniques and the number of targeted biopsies per patient were compared. RESULTS: A total of 318 suspicious lesions were detected in 108 patients with i-scan (n = 186) and 81 patients with HD-WLE (n = 132). The diagnostic yields of i-scan and HD-WLE were 81.6% (98/120) versus 77.5% (93/120), respectively (p > 0.05). When only targeted biopsies were taken into account, the diagnostic yields of i-scan and HD-WLE were 89.8% versus 65.4%, respectively (p < 0.05). The mean number of biopsies per patient for i-scan and HD-WLE were 3.27 (393/120) and 7.3 (882/120), respectively (p < 0.05). The mean endoscopic procedure times were 16 and 17 min for i-scan and HD-WLE, respectively (p > 0.05). CONCLUSIONS: Although targeted biopsies with i-scan were not found to be significantly superior to either targeted or random biopsies with HD-WLE, the number of biopsies required to confirm these lesions was much lower.

Role of Immunohistochemistry in the Differential Diagnosis of Pediatric Renal Tumors: Expression of Cyclin D1, Beta-Catenin , PDGFR-Alpha, and PTEN.

OBJECTIVE: Pediatric renal tumors overlap histomorphologically and may cause misdiagnosis. We aimed to determine the role of immunohistochemical staining of Cyclin D1, PTEN, beta-catenin and PDGFR-alpha on pediatric renal tumors. MATERIAL AND METHOD: Thirty-six cases of 8 different tumors were included in the study. Four blocks of paraffin tissue microarray were constructed. Cyclin D1, PTEN, beta-catenin and PDGFR-alpha were used in all cases. Staining intensity and extent were graded. RESULTS: All cases of clear cell sarcoma (CCS) and epithelial components of Wilms tumor (WT) showed immunopositivity for Cyclin D1 but blastemal and stromal components of WT were negative. All cases of CCS and most cases of WT consisting of blastemal and stromal components demonstrated loss of expression with PTEN. CONCLUSION: Cyclin D1 is not a specific immunohistochemical marker due to its strong and diffuse positivity in CCS cases. It may be useful to differentiate CCS from blastemal and stromal components of WT. Other markers except cyclin D1 do not have a role in the differential diagnosis.

Classification of rat mammary carcinoma with large scale in vivo microwave measurements.

Mammary carcinoma, breast cancer, is the most commonly diagnosed cancer type among women. Therefore, potential new technologies for the diagnosis and treatment of the disease are being investigated. One promising technique is microwave applications designed to exploit the inherent dielectric property discrepancy between the malignant and normal tissues. In theory, the anomalies can be characterized by simply measuring the dielectric properties. However, the current measurement technique is error-prone and a single measurement is not accurate enough to detect anomalies with high confidence. This work proposes to classify the rat mammary carcinoma, based on collected large-scale in vivo S[Formula: see text] measurements and corresponding tissue dielectric properties with a circular diffraction antenna. The tissues were classified with high accuracy in a reproducible way by leveraging a learning-based linear classifier. Moreover, the most discriminative S[Formula: see text] measurement was identified, and to our surprise, using the discriminative measurement along with a linear classifier an 86.92% accuracy was achieved. These findings suggest that a narrow band microwave circuitry can support the antenna enabling a low-cost automated microwave diagnostic system.

The Effect of Adipose-Derived Stromal Vascular Fraction Cells to Abdominal Wall Fascia Defects in Rats: An Experimental Study.

OBJECTIVE: Various synthetic and biological meshes have been developed to reduce recurrence and complications in ventral incisional hernia repairs. Adipose tissue is a rich reserve for mesenchymal stromal cells. In the present study we aimed to examine the effects of adipose-derived mesenchymal stromal cells (AD-MSCs) on abdominal incisional hernia repairs in rats. MATERIALS AND METHODS: The study involved 32 male Wistar-Albino rats, weighing 200-250 g, which were divided into three groups. In Group 1 (control group) only an incisional hernia model was created. In Group 2, the incisional hernia model was created and 1 ml stromal vascular fraction (SVF), obtained from inguinal lipectomy material and containing mesenchymal stromal cells, was injected into the edges of the defect in the same session. In Group 3, only the incisional hernia model was created in the first stage and after 14 days, 1 ml of SVF was injected into the edges of the defect. Skin incisions of rats in Group 1 and 2 were opened on postoperative day 28 while in group 3 were opened on day 42. Peritoneal formation in abdominal wall defect was evaluated macroscopically and histopathologically. RESULTS: Peritoneal formation was significantly superior in Groups 2 and 3 than in Group 1 (p: 0.031). In histopathological evaluation, the structural distortion and polymorphonuclear leukocyte (PMNL) levels were significantly higher in Group 1 than in Group 3 (p: 0.048 and p: 0.046, respectively). Granulation, capillary density, fibrosis and collagen organization were higher in Group 2 and 3, however this difference was not statistically significant (p > 0.05). CONCLUSIONS: Adipose-derived stromal vascular fraction cells obtained from inguinal lipectomy material in rats positively affect the repair of abdominal incisional hernias by increasing peritoneal formation, and reducing structural distortion and PMNL infiltration.

Epstein-Barr Virus and Helicobacter pylori co-infection in patients with gastric cancer and duodenale ulcer.

We aimed to detect EBV/Hp (Epstein-Barr Virus/Helicobacter pylori) co-infection by determining the number of copies of EBV/EBER-1 in the gastric biopsy samples of the Hp (+) GC, peptic ulcer (PU), and non-ulcer dyspepsia (NUD) cases. The patient group (PG), with 34 patients (34 GC and 30 PU patients) and a control group with 40 NUD cases were included. All patients and controls were Hp positive. EBV/EBNA-1 IgG were measured by the Anti-EBNA-1 ELISA IgG kit. Determination and quantification of EBV/EBER-1 gene region was performed by qPCR. EBV/EBER-1 positivity was 35.29% (12/34), 6.6% (2/30) and 2.5% (1/40) in GC, PU and 40 NUD cases, respectively. A significant difference was found between the GC and NUD cases (p=0.001). A significant difference was found between the groups for mean EBV/EBER-1 copy numbers (p=0.019). No significant difference was found between GC and the NUD cases (p=0.1455) for EBV/EBNA-1 IgG antibody positivity. EBV/EBER-1 positivity (OR=3.319), and age ≥55 years old (OR=2.331) were found to be a significant in multivariate logistic regression. In conclusion, our data suggest that the GC risk by EBVand Hp co-infection increased 3.3 times.

Effects of hypertonic saline replacement on colonic anastomosis in experimental hemorrhagic shock model in rats.

BACKGROUND: Inadequate intestinal perfusion resulting from hemorrhagic shock negatively affects wound healing. In this experimental study, we aimed to evaluate the effects of resuscitation with hypertonic saline on colonic anastomosis in rats with controlled hemorrhagic shock. METHODS: A total of 24 male Wistar albino rats weighing between 200 and 250 g were used in this study. The rats were divided into four groups as: Control, hypotonic, isotonic, and hypertonic. Median laparotomy, colon resection, and colocolonic anastomosis were performed to the rats in the control group. After creating controlled hemorrhagic shock to rats in other three groups, resuscitation was achieved with hypotonic, isotonic, and hypertonic saline. After resuscitation, median laparotomy, colon resection, and colocolonic anastomosis were performed on rats in these three groups. On the 5th post-operative day, a median laparotomy was applied to the rats in all groups and anastomosis lines were evaluated. Anastomotic bursting pressure, tissue hydroxyproline level, and tissue fibrosis degree were compared between the groups. RESULTS: There was no statistically significant difference between the groups in terms of anastomotic bursting pressure, tissue hydroxyproline level, and tissue fibrosis degree (respectively; p=0.320, p=0.537, p>0.05). CONCLUSION: In rats with controlled hemorrhagic shock, resuscitation with hypertonic saline does not differ significantly from isotonic or hypotonic saline in terms of healing of colonic anastomosis.

Incidental lesions in appendectomy specimens: Rare or rarely sampled?

OBJECTIVE: During the microscopic examination of the specimens after appendectomy operations performed due to acute appendicitis, pathologists may encounter some incidental and unusual lesions. Appendectomy specimens are sampled as 3 sections/1 paraffin block in many centers. In this study, we aimed to evaluate whether multiple and dense sampling of appendix specimens has an impact on the incidence of incidental lesions of the appendix. METHODS: This study is a retrospective study of 1154 patients who underwent appendectomy with presumed acute appendicitis at the Department of General Surgery, Istanbul University-Cerrahpasa, Cerrahpasa Faculty of Medicine, had histopathological evaluation between 2007-2011 and 2014-2018. Group 1 was made up of the patients whose appendix specimens were examined as 3 sections/1 paraffin block. Group 2 was made up of the patients whose appendix specimens were sampled completely. In this study, it was evaluated whether there was a difference between the two groups concerning incidence of incidental benign and malign appendix lesions. RESULTS: There were 579 patients in Group 1, 575 patients in Group 2, and the mean age of the groups was 26 and 28, respectively. Neither acute appendicitis findings nor any of the other unusual lesions were found in 57 specimens (9.8%) in Group 1 and 58 specimens (10.1%) in Group 2. Unusual pathological findings were detected in six specimens in Group 1 and 21 in Group 2. All unusual lesions, including benign and malignant, were significantly higher in Group 2 than in Group 1 (p=0.013). Concerning the incidence of malignant incidental lesions alone, there was no significant difference between the two groups (p=0.136). CONCLUSION: Multiple and dense sampling of appendectomy specimens increases the likelihood of detecting unusual lesions of the appendix.

Hepatocellular adenomas in the Turkish population: reclassification according to updated World Health Organization criteria.

AIMS: Hepatocellular adenoma (HCA) is an uncommon liver neoplasm, and studies of HCA subtypes have been primarily limited to France, the USA, and Japan. The aim of this study was to describe the clinicopathological features of HCA subtypes in Turkey. METHODS AND RESULTS: The resection specimens of 59 cases diagnosed as 'hepatocellular adenoma' collected from 15 institutions were reviewed to confirm the diagnosis and to classify them according to the current World Health Organization 2019 classification. Immunostaining for glutamine synthetase, liver fatty acid-binding protein, C-reactive protein, ß-catenin and reticulin was performed. Of the 59 cases, 48 (81%) were diagnosed as HCA. We identified 24 (50%) hepatocyte nuclear factor 1α (HNF1α)-inactivated HCAs, five (10%) inflammatory HCAs, 15 (32%) ß-catenin-activated HCAs, three (6%) ß-catenin-activated inflammatory HCAs, and one (2%) unclassified HCA. HCA patients were predominantly female (female/male ratio of 5:1); they had a median age of 34 years and a median tumour diameter of 60 mm. In the ß-catenin-activated HCA group, nine cases (19%) showed cytoarchitectural atypia, and were also referred to as atypical hepatocellular neoplasms. In the ß-catenin-activated HCA group, three cases (6%) showed focal areas supportive of transition to HCA. The original diagnosis of HCA was changed to well-differentiated hepatocellular carcinoma in nine cases and to focal nodular hyperplasia in two cases. CONCLUSION: In our series, the major HCA subtype was HNF1α-inactivated HCA. We found a low incidence of inflammatory-type HCA. Our data also showed that ß-catenin-activated hepatocellular neoplasms, including cases with atypical histology, constituted a relatively high proportion of the cases. These findings are in contrast to those of most other studies of HCA subtypes.

A rare tumor of the gallbladder: Small cell neuroendocrine carcinoma.

Small cell neuroendocrine carcinoma of the gallbladder is a rare, aggressive malignancy that does not yet have a standard treatment protocol. In this case report, we aimed to share our experience about a 74-year-old male patient presented to our clinic with the complaint of episodic abdominal pain and underwent cholecystectomy under elective conditions due to a polyp with a diameter of 4 cm visualized in the gallbladder on ultrasound and diagnosed with neuroendocrine carcinoma as a result of histopathological examination.

Programmed Death Ligand 1 Expression in Laryngeal Squamous Cell Carcinomas and Prognosis.

AIM: We aimed to show the immunohistochemical expression of programmed death ligand 1 (PD-L1) in laryngeal squamous cell carcinomas (SCCs). MATERIALS AND METHODS: The study includes 52 laryngeal SCC cases that underwent surgical resection. Immunohistochemical staining of PD-L1 (Clone 22C3) was applied to the sections obtained from paraffin blocks. Combined Positive Score (CPS) was evaluated as described in manuals. Tumor Proportion Score (TPS) was assessed by the percentage of positive tumor cells which were designated as positive if ⩾1% of the tumor cells showed membranous staining. RESULTS: There were 35 cases (67.3%) having CPS < 1 and 17 cases (32.7%) having CPS ⩾ 1. There was no relationship between CPS, TPS, and the clinicopathological data. CONCLUSION: Further studies with a large number of advanced-stage cases are needed.

Association between human leukocyte antigen gene polymorphisms and multiple EPIYA-C repeats in gastrointestinal disorders.

BACKGROUND: Polymorphisms of human leukocyte antigen (HLA) genes are suggested to increase the risk of gastric cancer (GC). AIM: To investigate the HLA allele frequencies of patients with GC relative to a control group in terms of CagA+ multiple (≥ 2) EPIYA-C repeats. METHODS: The patient group comprised 94 patients [44 GC and 50 duodenal ulcer (DU) patients], and the control group comprised 86 individuals [(50 non-ulcer dyspepsia patients and 36 people with asymptomatic Helicobacter pylori (H. pylori)]. Polymerase chain reaction was performed for the amplification of the H. pylori cagA gene and typing of EPIYA motifs. HLA sequence-specific oligonucleotide (SSO) typing was performed using Lifecodes SSO typing kits (HLA-A, HLA-B HLA-C, HLA-DRB1, and HLA-DQA1-B1 kits). RESULTS: The comparison of GC cases in terms of CagA+ multiple (≥ 2) EPIYA-C repeats showed that only the HLA-DQB1*06 allele [odds ratio (OR): 0.37, P = 0.036] was significantly lower, but significance was lost after correction (Pc = 0.1845). The HLA-DQA1*01 allele had a high ratio in GC cases with multiple EPIYA-C repeats, but this was not significant in the univariate analysis. We compared allele frequencies in the DU cases alone and in GC and DU cases together using the same criterion, and none of the HLA alleles were significantly associated with GC or DU. Also, none of the alleles were detected as independent risk factors after the multivariate analysis. On the other hand, in a multivariate logistic regression with no discriminative criterion, HLA-DQA1*01 (OR = 1.848), HLA-DQB1*06 (OR = 1.821) and HLA-A*02 (OR = 1.579) alleles were detected as independent risk factors for GC and DU. CONCLUSION: None of the HLA alleles were detected as independent risk factors in terms of CagA+ multiple EPIYA-C repeats. However, HLA-DQA1*01, HLA-DQB1*0601, and HLA-A*2 were independent risk factors with no criterion in the multivariate analysis. We suggest that the association of these alleles with gastric malignancies is not specifically related to cagA and multiple EPIYA C repeats.

Enterobius vermicularis Infestation Mimicking Rectal Malignancy

Enterobius vermicularis is a common intestinal nematode of humans that can be considered relatively harmless. A polypoid lesion mimicking malignancy was detected in the rectum of a 66-year-old female patient who had been operated for sigmoid colon adenocarcinoma in the past. Histopathological examination of the lesion revealed no malignancy but there was adult E. vermicularis nematodes and eggs. In this case report, we aimed to present an enterobiasis infestation that produces non-necrotizing granuloma tissue in the rectum.

Cutaneous Metastasis of Signet Cell Gastric Carcinoma.

Gastric cancer is the fourth most commonly diagnosed cancer and the second most common cause of cancer-related death worldwide. Cutaneous metastases of signet-ring cell gastric carcinoma are uncommon. Here, we report a metastatic gastric adenocarcinoma, which manifested itself as an asymptomatic scar-like lesion on the epigastric area and histopathological features of the cutaneous lesion showing signet-ring cell.

Association between polymorphisms in HLA-A, HLA-B, HLA-DR, and DQ genes from gastric cancer and duodenal ulcer patients and cagL among cagA-positive Helicobacter pylori strains: The first study in a Turkish population.

Colonization of the human gastric mucosa by H. pylori may cause peptic and duodenal ulcers (DUs), gastric lymphomas, and gastric cancers. The cagL gene is a component of cag T4SS and is involved in cagA translocation into host. An association between the risk of gastric cancer and the type of HLA class II (DR and/or DQ) was suggested in different populations. The aim of this study was to investigate, the clinical association of the cagL gene with host HLA alleles in H. pylori strains that were isolated from patients with gastric cancer, DU, and non-ulcer dyspepsia (NUD) and to determine the HLA allele that confers susceptibility or resistance for the risk of gastric cancer and DU development in Turkish patients. A total of 94 patients (44 gastric cancer and 50 DU patients; 58 male, 36 female; mean age, 49.6 years), and 86 individuals (50 NUD patients and 36 persons with normal gastrointestinal system [NGIS]; 30 male, 56 female; mean age, 47.3 years) were included as the patient and the control groups, respectively. CagA and cagL were determined by PCR method. DNA from peripheral blood samples was obtained by EZ-DNA extraction kit. For HLA SSO typing, LIFECODES SSO Typing kits (HLA-A, HLA-B HLA-C, HLA-DRB1 and HLA-DQA1/B1 kits) were used. The CagL/CagA positivity distribution in the groups were as follows: 42 (95.4%) gastric cancer, 46 (92%) DU and, 34 (68%) NUD and no NGIS cases. The HLA-DQA1*01 (OR: 3.82) allele was significantly different, suggesting that these individuals with H. pylori strains harbouring the CagL/CagA positivity are susceptible to the risk of gastric cancer and DU, and the HLA-DQA1*05 (OR, 0.318) allele was suggested as a protective allele for the risk of gastric cancer and DU using univariate analyses. HLA-DQA1*01 (OR, 2.21), HLA-DQB1*06 (OR, 2.67), sex (male, OR, 2.27), and CagL/CagA/(<2) EPIYA C repeats (OR, 5.72) were detected independent risk factors that increased the risk of gastric cancer and DU using multivariate analyses. However, the HLA-DRB1*04 (OR, 0.28) allele was shown to be a protective allele, which decreased the risk of gastric cancer and DU. Gastric pathologies result from an interaction between bacterial virulence factors, host epigenetic and environmental factors, and H. pylori strain heterogeneity, such as genotypic variation among strains and variations in H. pylori populations within an individual host.