Is There Any Difference Between Seminomas and Nonseminomatous Germ Cell Tumors on Shear Wave Elastography? A Preliminary Study.

OBJECTIVES: The purpose of this study was to evaluate the ability of shear wave elastography (SWE) to differentiate seminomas from nonseminomatous germ cell tumors. METHODS: Approval for this retrospective study was obtained from the local Ethics Committee of Istanbul University Cerrahpasa Medical School. Fifteen patients with malignant testicular lesions were examined by grayscale sonography, color or power Doppler sonography, and SWE between February 2011 and October 2015. The size of each lesion, Doppler signal parameters, echogenicity, presence of microlithiasis, unifocality or multifocality, and histopathologic findings were the main factors evaluated. RESULTS: The mean age of the patients was 33 years (range, 25-55 years). There were no differences between seminomas and nonseminomatous germ cell tumors in terms of Doppler signals, echogenicity, microlithiasis, or focality. Only the homogeneous and heterogeneous echogenicity patterns differed significantly. However, a significant difference was evident in SWE-derived quantitative data. CONCLUSIONS: Seminomas and nonseminomatous germ cell tumors do not differ significantly on grayscale or Doppler sonography, except in terms of homogeneity. However, SWE seems to differentiate seminomas from nonseminomatous germ cell tumors.

Core length in prostate biopsy: size matters.

PURPOSE: The diagnostic yield of prostate biopsy is limited. Increasing the number of cores enhances the cancer detection rate by sampling additional sites and obtaining more tissue. An alternative way to inspect more tissue would be to obtain longer cores. However, the impact of biopsy core length on cancer detection rate is an undervalued topic. We assessed the role of biopsy core length in prostate biopsy and determined the minimal tissue length to serve as quality assurance. MATERIALS AND METHODS: We retrospectively analyzed the records of 331 patients who underwent transrectal ultrasound guided initial prostate biopsy with 12 to 18 cores. The biopsy procedure and pathological evaluation were standardized. Core length was compared in patients with vs without cancer. Statistical analysis was done to determine a minimally acceptable cutoff for biopsy length. RESULTS: We analyzed data on 245 patients. The overall cancer detection rate was 30.2%. Mean core length in patients with vs without cancer was 12.3±2.6 vs 11.4±2.4 mm (p=0.015). Thus, core length was significantly longer in patients with cancer. Core length greater than 11.9 mm was associated with an increased prostate cancer detection rate (OR 2.57, 95% 1.46-4.52). The cancer detection rate for cores less vs greater than 11.9 mm was 23% vs 39%. CONCLUSIONS: Needle core length is an important morphometric parameter of transrectal prostate biopsy that directly influences the cancer detection rate. Results suggest a core length of greater than 11.9 mm as a cutoff for quality assurance.

Mixed Epithelial and Stromal Tumor Family of Kidney (Adult Cystic Nephroma, Mixed Epithelial and Stromal Tumor): Retrospective Clinicopathological Evaluation.

OBJECTIVE: Tumors belonging to the mixed epithelial stromal tumor family (MESTF) are rare; thus clinicopathological experience about them are limited. Each epithelial and stromal component shows different patterns in these tumors. MATERIAL AND METHOD: Clinicopathological features of 11 MESTF cases that were diagnosed between 2000 and 2021 at a single center were evaluated. RESULTS: Ten of the 11 patients were female (F:M = 10:1). The mean age of the females was 47 (31-63) years; the male patient was 45 years old. The mean tumor diameter was 6.7 (3.5-19) cm. All tumors had varying proportions of cystic and solid components. Eight cases were well circumscribed, and the others had distinct but irregular borders. Two of the tumors with irregular borders were bulging into the renal sinus. The epithelial component was dominant in most cases. In the epithelial component, macrocyst, microcyst, and tubules were the most common patterns and the most common types of lining epithelium were flat, cuboidal and hobnail. The stromal component was variable in most cases and included hypocellular (mostly collagenous) and cellular areas. In most cases, the cellular stroma had an ovarian-like appearance. Among the other features observed, hyalinization and dystrophic calcification were common. The positivity for estrogen and progesterone receptor in the stromal component was observed in almost all female cases. CONCLUSION: MESTF, which has distinctive features, should be considered in the differential diagnosis of cystic kidney tumors.

Suboptimal Prediction of Clinically Significant Prostate Cancer in Radical Prostatectomy Specimens by mpMRI-Targeted Biopsy.

OBJECTIVE: To investigate the correlation of multiparametric magnetic resonance imaging targeted (TBx) and/or systematic prostate biopsy (SBx) in predicting the presence of clinically significant (cs) prostate cancer (PCa) in radical prostatectomy (RP) specimens. Concordance of mpMRI and RP specimen lesions was also investigated in terms of tumor localization and histopathological features. METHODS: A total of 70 male patients with PCa and treated with robot-assisted RP were included in this study between January 2016 and December 2019. All patients underwent mpMRI-TBx and concomitant SBx. Suspicious lesions on mpMRI were scored according to Prostate Imaging-Reporting and Data System version 2 (PI-RADS) criteria. TBx was performed for all suspicious lesions with a PI-RADS score ≥3. RESULTS: The median age was 67 (43-77) years. Presence of csPCa in prostatectomy specimens was missed by TBx and SBx specimens in 25.4% and 19.4% of the cases, respectively (P<.001, for each). Combination of both biopsy (CBx) results improved detection by missing only 4.5% of csPCa (P = .250). International Society of Urologic Pathology grade group concordance with RP specimens were 50%, 54.3% and 67.1% for SBx, TBx, and CBx, respectively. There was a statistically significant correlation in terms of tumor localization and histopathological features between prostatectomy specimens and the first 3 lesions, particularly for the index lesions. CONCLUSIONS: CBx improved detection rate of csPCa. We propose TBx of 3 lesions with highest PI-RADS score(s) and a combination with SBx for the highest correlation with prostatectomy histopathology.

Specificity and sensitivity of differentiation antigens in superficial soft tissue tumors: comparison of SMA, calponin, H-caldesmon, C-kit, PLAP and HPL.

We examined the expression pattern of smooth muscle actin (SMA), h-caldesmon (HCD), calponin (CALP), placental alkaline phosphatase (PLAP) and human placental lactogen (HPL) in benign and malignant spindle cell superficial soft tissue tumors in order to determine the role of these markers in differential diagnosis. Archival tissue from 38 patients with superficial smooth muscle cell and so-called fibrohistiocytic tumors (8 benign fibrous histiocytomas (BFHs), 6 dermatofibrosarcoma protuberans (DFPT), 9 malignant fibrous histiocytomas (MFHs), 9 leiomyomas (LMs) and 6 leiomyosarcomas (LMSs)) were immunostained with antibodies against SMA, HCD, CALP, PLAP and HPL. smooth muscle cell (SMC) tumors showed significantly high immunopositivity for HCD than that of so-called fibrohistiocytic tumors (p is less than or equal to 0.05) but 1/3 of DFPT and MFH cases and half of BFH cases also showed HCD immunopositivity; thus, this difference is debatable and not highly discriminative as expected. All tumor groups showed 100% immunopositivity for CALP. SMC tumors displayed significantly stronger and more widespread immunostaining pattern for PLAP than so-called fibrohistiocytic tumors (p < 0.05). Superficial soft tissue tumors did not express c-kit. In conclusion, HCD and PLAP can be used as ancillary immunomarkers in differential diagnosis of SMC tumors (Tab. 2, Fig. 7, Ref. 37).

Neuronal nitric oxide synthase expression in glial tumors: correlation with malignancy and tumor proliferation.

INTRODUCTION: Increased vascular permeability, vasodilatation, neovascularization and free radical injury in malignant tumors and adjacent normal tissues are believed to be mediated by nitric oxide (NO). High levels of neuronal nitric oxide synthase (nNOS) have been demonstrated in cultured and intracerebral cells. Our aim was to investigate nNOS expression in human glial tumors and to assess its correlation with the histologic grade and proliferative potential. METHODS: Tissue specimens were obtained from 29 patients with supratentorial astrocytomas [15 glioblastoma multiforme (GBM), six anaplastic astrocytomas (AA) and eight low grade astrocytomas (LGA)] diagnosed and classified according to the current WHO classification of nervous system tumors. Immunohistochemical staining was performed in paraffin embedded specimens with polyclonal anti-nNOS antibody, and the levels of nNOS expression was evaluated as slight, moderate or dense on the basis of intensity and the extent of distribution of nNOS immunoreactivity. Proliferative potential was evaluated with immunostaining for Ki-67. RESULTS: There was a significant positive correlation between the histologic grade and nNOS expression in terms of intensity and the extent of distribution of nNOS immunoreactivity (p<0.05). Greater values of Ki-67 indices were demonstrated in tumors with higher nNOS expression, indicating a positive correlation between proliferative potentials and expression of nNOS immunoreactivity. CONCLUSION: Our study suggests that nNOS expression is increased in glial tumors, which was significantly correlated with histologic grade and proliferative potential. NO overproduction due to overexpression of nNOS activity, seems to have significant correlation with malignancy in glial tumors, and may provide another target for anti-proliferative therapy in the future.

Expression of cyclooxygenase-2, c-kit, progesterone and estrogen receptors in uterine smooth muscle tumors: differential diagnosis.

We examined the expression pattern of cyclooxygenase-2 (COX-2) and c-kit in uterine smooth muscle neoplasms and tried to determine the role of these markers in differential diagnosis. Archival tissue from 64 patients with uterine smooth muscle neoplasms (20 leiomyomas (LMs), 22 atypical leiomyomas (ALMs), and 22 leiomyosarcomas (LMSs)) was immunostained with antibodies against estrogen (ER) and progesterone receptors (PR), COX-2 and c-kit. 7 of 20 LM cases and 5 of 22 ALM cases were immunopositive for COX-2, whereas none of the LMS cases stained immunopositive (p< or =0.05). 4 of 20 LM cases and 5 of 22 ALM cases were immunopositive for c-kit, whereas 15 of 22 LMS cases showed c-kit immunopositivity (p< or =0.05). In conclusion, very few LMs and ALMs show COX-2 immunopositivity. LMSs usually do not express COX-2. COX-2 expression in smooth muscle tumors is not a prominent feature. Therefore, COX-2 inhibitors may not be useful in LMS therapy. C-kit was significantly expressed in uterine LMSs.

Fluoro-18 fluorodeoxyglucose positron emission tomography/computerized tomography scans in a patient with penile cancer for appropriate therapeutic strategy.

In patients with penile cancer, positron emission tomography (PET) is important for identifying metastatic lesions and for therapeutic strategy planning. By using PET/computerised tomography -CT scanning, more precise localization and attenuation correction is provided by CT as an additional advantage for diagnosis. A 78-year-old man with squamous cell cancer of the glans penis diagnosed after histopathological examination was referred to our Nuclear Medicine Department PET/CT unit by the Urology Department of our Hospital, for investigation of metastases and for therapeutic strategy planning. There was significantly increased focal fluoro-18 fluorodeoxyglucose (18F-FDG) activity (SUV: 18.2) in the glans penile area and slightly increased activity in the right inguinal region which was described as inflammation by the histopathological examination. There was no other increased abnormal 18F-FDG activity. 18F-FDG PET or PET/CT may be used in squamous cell cancer of the penis for the detection of metastases and for therapeutic strategy planning. Finally, invasive procedures such as total bilateral inguinal lymphadenectomy, having a high morbidity, may be avoided.

[Isolated tuberculous tenosynovitis of the Achilles tendon: a report of two cases]. / Asil tendonunda izole tüberküloz tenosinovit: Iki olgu sunumu.

Tuberculous tenosynovitis involving the tendons of the feet is very rare. Isolated primary tuberculous tenosynovitis of the Achilles tendon was detected in two women aged 19 and 53 years, respectively. The younger patient had a swollen and painful Achilles tendon in the left foot. Complete excision of the lesion followed by antituberculous chemotherapy for six months resulted in complete improvement. Magnetic resonance imaging showed normal findings at the end of six months and no recurrence after 27 months of follow-up. The older patient had diabetes and was on cytostatic treatment for rheumatoid arthritis. She had difficulty in squatting and climbing stairs due to swelling and pain in the right ankle. She underwent abscess drainage and excision of the cystic mass. Despite disappearance of symptoms in the affected ankle in the course of antituberculous chemotherapy, she died due to miliary tuberculosis in the sixth month. Tuberculous tenosynovitis should be considered in the differential diagnosis of patients suffering from persistent swelling and pain in the hind foot.

A Translocation Renal Cell Carcinoma with Skeletal Muscle Metastasis in a Child.

Renal cell carcinoma is a tumor that is well known for a high rate of metastasis to several locations like the lung, liver and bones. Skeletal muscle is a rare location for dissemination of the disease. Herein, we describe a 7-year-old boy who presented with flank pain. On physical examination, an abdominal mass located on the left kidney as well as a solid palpable lesion on the left upper arm were detected. Total nephrectomy with subsequent excision of the arm mass was performed. Pathology examination revealed presence of translocation renal cell carcinoma. The patient received α-interferon followed by multikinase inhibitor (Sorafenib) treatment but was lost due to progressive disease. This is the first description of a pediatric patient with skeletal muscle metastases of translocation renal cell carcinoma in the literature.

A Rare Presentation of Immunoglobulin A Nephropathy: Acute Kidney Injury.

BACKGROUND: Acute kidney injury (AKI) is known as an uncommon presentation in immunoglobulin A nephropathy (IgAN). The aim of our study was to analyze the clinical data and biopsy findings in IgAN patients presenting with AKI. METHODS: We performed a retrospective analysis of all subjects who had biopsy-proven IgAN and presented with AKI during June 2002 September 2015. The following data were obtained from medical records. RESULTS: A total of 15 patients of 123 patients (12.2%) with primary IgAN admitted with AKI. Patients were generally male (73.3%), with a median age of 38 (interquartile range; IQR, 2,944) years. The serum creatinine at admission was above the normal range (median 2.3 [IQR, 2.14.7] mg/dL]). On histology, cellular/fibrocellular crescents were present in 6 patients. In most cases (53.3%), pathologic abnormalities associated with acute tubular injury/necrosis were defined. Red blood cell casts in tubules were present in 6 cases (40%). In all cases, interstitial mixed inflammatory cell infiltration was observed. In 4 cases, admixed eosinophils were also found. In 3 patients, biopsy specimens showed acute thrombotic microangiopathy lesions (20%). Median follow-up time was 13 (IQR, 346) months. Six patients (40%) progressed to end-stage renal disease (ESRD). Among patients diagnosed with primary IgAN and presenting without AKI, only 4 patients progressed to ESRD. The proportion of patients who progressed to ESRD presenting with AKI was significantly higher than the patients presenting without AKI (p = 0.000). CONCLUSIONS: In conclusion, AKI complicates IgAN more often.

Adult paratesticular myxofibrosarcoma: report of a rare entity and review of the literature.

A case of 70 years old man with a slowly enlarging painful scrotal mass is herein reported. Computed tomography scan of the scrotum showed a homogenous and encapsulated mass, associated with the tunica albuginea. There was no evidence of any metastatic lesion(s). Orchidectomy was performed with high ligation of the spermatic cord. Histopathologic examination revealed a rare case of paratesticular myxofibrosarcoma. Complete surgical resection is the only curative treatment modality in the treatment of these low grade tumors. Adjuvant chemotherapy or radiotherapy are not recommended for paratesticular myxofibrosarcomas.

Small cell carcinoma of the bladder: a case report and review of the literature.

Primary pure small cell neuroendocrine carcinoma of the bladder is a rare condition. It is an aggressive tumor with an average five-year survival rate of less than 10% as cited by multiple case reports. We report a 48 year-old male patient with primary small cell neuroendocrine carcinoma of the bladder who was treated with TUR-T, adjuvant carboplatin-based chemotherapy and radiotherapy. The patient is free of disease at the end of 30 months with a normally functioning bladder.

Alkaptonuria and renal failure: a case report.

In alkaptonuria, the absence of homogentisic acid oxidase (HGO) results in the accumulation of homogentisic acid (HGA) in the body. Associated renal failure is rare and usually occurs in the later stages of the disease. We report a 33-year-old male who presented, initially, with renal failure, but no past history of illness. He had pigmentation of sclerae and ear helices, intervertebral disk calcifications and mild mitral insufficiency. His disease was confirmed by HGA detection in the urine. As size and thickness of renal parenchyma seen on ultrasonography were normal, renal biopsy was performed and it showed glomerular sclerosis, diffuse tubular atrophy and interstitial fibrosis with inflammation. Wall thickening of small arteries and pigment deposits were identified in some kidney tissue elements. He progressed to end-stage renal disease despite supportive therapy.

Fine needle aspiration biopsy of the parotid gland. Diagnostic problems and 2 uncommon cases.

OBJECTIVE: To describe the diagnostic problems and present our findings in 2 uncommon tumors, malignant myoepithelioma and small cell undifferentiated carcinoma, by examining fine needle aspiration (FNA) biopsies of parotid gland masses. STUDY DESIGN: The study group consisted of 34 females and 41 males 12-80 years old, with an average of 44. Excluding inflammatory results, all adequate aspirates were confirmed histologically to determine the correlation. RESULTS: Sensitivity of FNA cytology was 91%, with specificity of 98%. We encountered some difficulties, and therefore misdiagnoses, in evaluating specific neoplasms, such as adenoid cystic carcinoma and Warthin's tumor, which have well-established cytologic diagnostic criteria. Two cases of uncommon neoplasms of salivary glands, small cell undifferentiated carcinoma and malignant myoepithelioma, were cytologically found to be malignant but not further classified. In addition, tuberculous parotitis, with its well-defined features, should to be referred since unnecessary surgery can be avoided by using FNA cytology. CONCLUSION: FNA is a sensitive and specific diagnostic tool for parotid gland masses. However, specific classification of neoplasms may sometimes be difficult. Pathologists should be aware of specific entities, such as malignant myoepithelioma, when evaluating high grade neoplasms.

Spindle cell rhabdomyosarcoma displaying CD34 positivity: a potential diagnostic pitfall; report of two pediatric cases.

Spindle cell rhabdomyosarcoma is a rare subtype of rhabdomyosarcoma mainly seen in children. Occasional aberrant staining with a variety of immunohistochemical markers has been noted. The aberrantly expressed markers include alpha-smooth muscle actin, cytokeratin, S100, neurofilaments, CD20, immunoglobins, and CD117. We report herein two pediatric cases displaying strong CD34 positivity and one with additional focal CD117 positivity, causing considerable difficulty in distinction from solitary fibrous tumor and extra-gastrointestinal stromal tumor. To our knowledge, CD34 staining has been merely reported in rhabdomyosarcoma. Spindle cell rhabdomyosarcoma has to be considered in the differential diagnosis of childhood spindle cell tumors. Post-chemotherapy specimens should be evaluated in caution, since chemotherapy can cause considerable changes in tumor antigen expression. Since CD117 and CD34 are stem cell markers, their positivity in pediatric tumors should be interpreted with caution. Even if the morphology is not supportive, a wide immunohistochemical panel should be applied in childhood malignant solid tumors.

Expression of MMP-1, MMP-9 and TIMP-2 in prostate carcinoma and their influence on prognosis and survival.

PURPOSE: Matrix metalloproteinases (MMPs) and tissue inhibitors of metalloproteinases (TIMPs) participate in tumorigenesis, and their association with disease outcome is highly controversial. The present study investigates the influence of MMP-1, MMP-9 and TIMP-2 on different clinicopathologic variables and disease-free survival (DFS) of patients with prostate carcinoma. METHODS: Hundred and forty-five cases are included in the study, and levels of MMP/TIMP expressions are assessed in three tissue compartments (i.e., tumor, stroma and normal glands) with immunohistochemistry. RESULTS: Matrix metalloproteinase-1 expression in tumor cells was associated with lower Gleason scores, pretreatment prostate-specific antigen levels and lower incidence of vascular, perineural and extracapsular invasions. Moreover, MMP-9 positivity and TIMP-2 expression in normal glands were correlated with lower Gleason patterns and early stage at presentation. Expression of MMP in tumor cells and the presence of TIMP-2 in normal glands were associated with better DFS. CONCLUSION: Variability of MMP/TIMP expressions from case to case makes it difficult to evaluate their impact on clinical outcome. However, these proteins might be new and promising targets for prostate cancer therapy in the future.

Association of Pb, Cd, and Se concentrations and oxidative damage-related markers in different grades of prostate carcinoma.

Prostate cancer is known to be affected by the heavy metal levels and oxidative damage of the body, yet there are very few studies which look into the way it occurs. The aim of this study was to determine whether blood and tissue lead (Pb), cadmium (Cd), and selenium (Se) levels are associated with oxidative damage in the context of prostate cancer progression and development. Seventy-nine patients comprising 25 patients with benign prostatic hypertrophy (BPH), 23 patients with malignant prostatic carcinoma (malign Ca), 16 patients with low-grade prostatic intraepithelial neoplasia (LGPIN), and 15 patients with high-grade prostatic intraepithelial neoplasia (HGPIN) diagnosed on the basis of their clinical profile, transrectal ultrasonography, and histopathology were included in this study. Cd and Pb levels in whole blood were found to be increased in patients with HGPIN compared with the BPH group; also, the levels of Cd in whole blood and tissue were found to be increasing in patients with malign Ca, unlike BPH patients. Moreover, the levels of malondialdehyde (MDA) in plasma and tissue were significantly increased in malign Ca, LGPIN, and HGPIN than those in BPH. However, the levels of tissue Pb were found to be decreasing in BPH, unlike the malign Ca and HGPIN patients, and the levels of tissue protein carbonyls in malign Ca were significantly lower than those in HGPIN. The levels of tissue reduced glutathione (GSH) in malign Ca were significantly lower than those in BPH. Additionally, the levels of Se in serum and tissue in LGPIN were significantly lower than those in BPH. The serum Se levels in HGPIN were also significantly lower than those in BPH and malign Ca groups. Furthermore, the concentrations of serum Se in LGPIN were significantly lower than those in malign Ca. From the Pearson correlation analysis, there were significant positive correlations between tissue Cd and MDA levels in malign Ca, LGPIN, and HGPIN and between the tissue Pb and tissue MDA and protein carbonyl levels in malign Ca. Blood Pb and tissue Pb were also significantly positively correlated with plasma MDA and protein carbonyl levels in malign Ca. In addition, blood Pb was significantly positively correlated with tissue MDA and protein carbonyl levels in malign Ca, and a significant positive correlation was also found between blood Cd and plasma protein carbonyls and tissue MDA in LGPIN. We observed that altered prooxidant-antioxidant balance and heavy metal levels may lead to an increase in oxidative damage and may consequently play an important role in prostate carcinogenesis. These findings indicate that changes in the levels of Pb, Cd, Se, MDA, protein carbonyls, and GSH in the blood and/or tissue are related to the prostatic carcinoma development and progression, although triggering one of the mentioned changes is unknown; therefore, further study is required to determine the exact steps of the process and clarify the roles of different substances in order to obtain a more detailed explanation of the phenomenon.

C-Erb-b2 oncogene expression in intraductal proliferative lesions of the breast.

The ductal intraepithelial neoplasia (DIN) classification which proposes new approaches to the diagnosis, terminology and differential diagnosis of intraductal proliferative lesions of the breast was applied to a series of female patients comprising C-erbB2 oncogene expression which may serve as an adjunct to the morphology by immunohistochemistry. The study was performed using the data of 94 patients. There was no difficulty encountered in the diagnosis of intraductal hyperplasia (IDH). In patients with Atypical Ductal Hyperplasia (AIDH), the diagnosis could be made by using the 2-mm rule of the DIN classification in patients who exhibited cytologic and structural characteristics of Ductal Carcinoma in Situ (DCIS) alone or in conjunction with classical IDH patterns. However, in lesions that mimicked classical IDH patterns despite displaying cytological features of in situ carcinomas, the experience and view point of the pathologist played a more prominent role. When the DIN classification criteria were applied to grade DCIS lesions, although the system was found to be practical, it did not provide adequate differentiation in intermediate grade (grade II-DIN 2) patients and further improvement was considered desirable. Fourty-five cases (47.8%) IDH, 19 (20.2%) AIDH, and 30 (31.9%) were DCIS. There were statistically significant differences in the levels of c-erbB2 oncogene expression between IDH, AIDH and DCIS lesions (p<0.001). In DCISs, grade, cell size, pleomorphic nuclear atypia showed statistically significant associations with c-erbB2 oncogene expression. These results suggest that c-erbB2 oncogene expression is a valuable marker in the differential diagnosis and prognostic evaluation of patients with intraductal proliferative lesions.