N-acetylcysteine leads to greater ovarian protection than enoxaparin sodium in a rat ovarian torsion model.

This study evaluated the effects of N-acetylcysteine (NAC) and enoxaparin on ovarian tissue preservation, ovarian reserve and oxidative damage following ovarian torsion/detorsion injury. Rats were divided into four groups (n = 6/group): control; ischaemia/reperfusion (I/R); I/R + NAC; I/R + enoxaparin. Twenty-four hours after detorsion, ovarian tissues were collected for histopathological analysis and measurement of tissue 8-OHdG, GSH, MDA, MPO and SOD concentrations, as well as pre- and post-operative circulating AMH concentrations. Administration of NAC resulted in more pre-antral follicles compared with enoxaparin treatment and haemorrhage and follicle cell degeneration were more pronounced in I/R + enoxaparin group than I/R + NAC group. Both NAC and enoxaparin led to a significant reduction in ovarian tissue 8-OHdG (P = 0.004 and P = 0.01, respectively) and MPO (P = 0.013 and P = 0.023, respectively) concentrations compared with I/R group, indicating a protective effect against I/R oxidative damage. Only NAC-treated animals showed a significant increase in GSH and SOD concentrations and decrease in MDA concentrations compared with I/R group (P = 0.007, P = 0.024 and P = 0.026, respectively). These results indicate that NAC is more effective than enoxaparin in minimizing ovarian damage and preserving ovarian reserve following ovarian torsion.

A case report: angiomatoid fibrous histiocytoma in a 6-year-old male and review of the literature.

Angiomatoid Fibrous Histiocytoma (AFH) is a distinctive tumor in children, adolescent and young adults which is slow growing with metastatic potential. The histogenesis of AFH is uncertain. Here, we present a case of AFH of 6-year-old on the trunk. In addition, the differential diagnosis for this lesion is also discussed.

Is the low-grade squamous intraepithelial lesion/atypical squamous cells cannot exclude high-grade squamous intraepithelial lesion category associated with cervical intraepithelial neoplasia 2?

OBJECTIVE: A number of cervical smears may exhibit unequivocal low-grade squamous intraepithelial lesions (LSIL) in association with atypical cells cytomorphologically suspicious, but not sufficient to be interpreted as high-grade squamous intraepithelial lesions (HSIL). These lesions are presently called LSIL, atypical squamous cells cannot exclude HSIL (LSIL/ASC-H). Previous studies have shown that LSIL/ASC-H and ASC-H are both equivocal for HSIL and have a high risk of underlying HSIL. However, in researching the literature only two studies were found which rendered the results as cervical intraepithelial neoplasia (CIN) 2 and CIN3 separately. The purpose of this study was to compare the distribution of biopsy results for CIN2 and CIN3 in patients with ASC-H, HSIL, and LSIL/ASC-H. STUDY DESIGN: Between January 2005 and December 2011, cervicovaginal smears (98,594) with a diagnosis of ASC-H, LSIL, LSIL/ASC-H, or HSIL were re-evaluated to determine the prevalence of future lesion development. RESULTS: A total of 252 patients who had histologic follow-up within a year were selected. Among these, LSIL/ASC-H (31.7%) had the highest prevalence of CIN2 between LSIL (9.3%), ASC-H (10%), and HSIL (16%). All differences were statistically significant. CONCLUSION: Because of the high predictive value of CIN2, LSIL/ASC-H may have further importance, especially in women of different age groups.

Association of chondroadherin with leiomyosarcoma.

The leiomyosarcoma (LMS) subtype of uterine sarcoma accounts for 1-2 % of uterine neoplasia cases. The present study aimed to demonstrate that the gene and protein chondroadherin (CHAD) levels may serve as novel biomarkers for predicting prognosis and devising novel treatment models for LMS. A total of 12 patients diagnosed with LMS and 13 patients diagnosed with myomas were included in the study. The extent of tumour cell necrosis, cellularity and atypia and the mitotic index of each patient with LMS were determined. CHAD gene expression was significantly increased in cancerous tissues compared with that in fibroid tissues (2.17 ± 0.88 vs 3.19 ± 1.61; P = 0.047). The mean CHAD protein expression in tissues was higher in LMS cases but this was not statistically significant (217.38 ± 93.9 vs 177.13 ± 66.67;P = 0.226). Positive significant correlations were obtained between CHAD gene expression and mitotic index (r = 0.476; P = 0.008), tumour size (r = 0.385; P = 0.029) and necrosis (r = 0.455; P = 0.011). Furthermore, there were significant positive correlations between CHAD protein expression levels and tumour size (r = 0.360; P = 0.039) and necrosis (r = 0.377; P = 0.032). The present study was the first to demonstrate the significance of CHAD in LMS. The results suggested that, due to its association with LMS, CHAD has predictive value in determining the prognosis of patients with LMS.

Expression of periostin according to endometrial cancer grade.

While various molecular profiling methods have been described for the early diagnosis and prognostic process of endometrial cancer, the most common gynaecological cancer, the data obtained remain insufficient. The present study aimed to investigate the protein and gene expression of periostin and its role as a new biomarker in the diagnosis, treatment and prognosis of endometrial cancer. A total of 15 patients diagnosed with endometrial cancer at the Department of Pathology, Zeynep Kamil Training and Research Hospital (Istanbul, Turkey) and 15 patients who were operated on for non-tumour-related reasons, between December 2019 and May 2020, were included in the study. The cases diagnosed with endometrial cancer were divided into three groups: International Federation of Gynaecology and Obstetrics grades I, II and III. Pathology tumour blocks were selected for enzyme-linked immunosorbent assay and PCR studies in which periostin gene expression and protein levels were measured, respectively. A significant increase in periostin gene expression was observed in the endometrial cancer samples compared with that in the controls (3.40±0.66 vs. 2.23±0.47). The protein level of periostin in the tissues was found to be higher in the endometrial cancer samples than that in the control group (1.59±0.31 vs. 0.94±0.22). The levels of periostin protein and gene expression detected in the endometrial cancer samples increased as the grade increased. To the best of our knowledge, the current study is the first to determine the levels of periostin protein and gene expression in endometrial cancer. The results suggested that periostin may be used as a biomarker in the determination of higher histological grade in endometrial cancer.

Prenatally diagnosed fetal thoraco-lumbar spine duplication associated with lipomyelomeningocele: An extremely rare case of split cord malformation.

Spine duplication is considered rare, a more serious form of split cord malformation. Ultrasonographic evaluation of the spine in the second trimester is central to the antenatal diagnosis of spinal malformations. Here, we report a case of thoraco-lumbar spine duplication associated with lipomyelomeningocele diagnosed by ultrasonography at 19 weeks of gestation. To the best of our knowledge, this is the first case report of spine duplication diagnosed by antenatal ultrasonography.

Chondoadherin as a biomarker in patients with endometrial cancer.

Early diagnosis and development of newer and more effective treatments for endometrial cancer, which is observed so frequently, continue to be necessary. In the present study, we aimed to show the relationship between the tumorigenesis of endometrial cancer and chondoadherin and its place as a biomarker. A total of 15 patients diagnosed with endometrioid adenocarcinoma in the pathology unit of the present tertiary hospital and 15 patients operated for non-tumor reasons between 2019 and 2020 were included in the study. Pathology tumor blocks were selected for ELISA and PCR study in which chondoadherin gene expression and protein levels were measured. We found increased expression of the chondoadherin-like (CHADL) gene in endometrial cancer cells compared to endometrial cells without tumor diagnosis (2.85 ± 0.44 vs. 1.94 ± 0.33). When the mean value for the protein level in CHADL tissues was examined, we found a higher rate in endometrial cancer tissues (228.83 ± 22.30 vs. 186.66 ± 21.09). The CHADL protein level and gene expression increased as the grade increased. The present study is the first report presenting chondoadherin level in endometrial cancer. Chondoadherin level in endometrial cancer can be a guiding marker in early diagnosis and treatment process and prognosis. KEY WORDS: Biomarker, Chondoadherin, Endometrial cancer.

Etanercept protects ovarian reserve against ischemia/reperfusion injury in a rat model.

INTRODUCTION: Etanercept has been widely used in autoimmune diseases for blocking tumor necrosis factor α (TNF-α), which is an inflammatory cytokine. The anti-apoptotic and anti-inflammatory effects of etanercept against ischemia/reperfusion (I/R) injury have been shown for several tissues in rat studies, but to the best of our knowledge, there are no reports on its protective effects following similar injury in ovarian tissue. The aim of this study was to investigate whether etanercept has beneficial effects on ovarian I/R injury, as well as on ovarian reserve. MATERIAL AND METHODS: Twenty-four rats were randomly divided into four groups (n = 6/group): sham (laparotomy only); sham + etanercept; I/R; and I/R + etanercept. Ischemia was induced for 3 h by twisting the ovary, and 24 h after detorsion the ovarian tissues were collected to evaluate histopathologic changes, glutathione (GSH), malondialdehyde (MDA), myeloperoxidase (MPO), and superoxide dismutase (SOD) concentrations for oxidative stress, 8-hydroxy-2'-deoxyguanosine (8-OHdG) for DNA damage, caspase-3 activity for apoptosis and ovarian follicle counts. To measure anti-Mullerian hormone (AMH), serum samples were drawn before and after surgery. RESULTS: Tissue GSH and SOD levels were significantly higher, while MDA and MPO levels were significantly lower in the I/R + etanercept group than in the I/R group (p < 0.05, p < 0.01, respectively). Tissue 8-OHdG and caspase-3 activity were significantly lower in the I/R+etanercept group than in the I/R group (p < 0.05, p < 0.01, respectively). Preoperative and postoperative AMH levels were compared and there was a significant reduction in the I/R and I/R + etanercept groups (p < 0.001, p < 0.001). The reduction of AMH in the I/R + etanercept group was significantly lower than in the I/R group. The primordial, preantral and small antral follicle numbers were also significantly higher in the I/R + etanercept group compared to the I/R group (p < 0.001, p < 0.001, p < 0.005, respectively). CONCLUSIONS: Etanercept attenuated inflammation and related oxidative stress and also helped to preserve ovarian reserve following ovarian I/R damage.

The efficacy of laparoscopic presacral neurectomy in dysmenorrhea: is it related to the amount of excised neural tissue?

OBJECTIVE: To assess the correlation between the number of excised neural fibers and degree of pain relief following laparoscopic presacral neurectomy (LPSN). MATERIALS AND METHODS: In this before and after study, 20 patients with severe midline dysmenorrhea [Visual Analogue Scale (VAS) >80 mm] unresponsive to medical therapy were consecutively enrolled. All patients underwent LPSN. The superior hypogastric plexus was excised and sent for histologic confirmation. Two pathologists counted the number of neural fibers in the surgically removed tissue. VAS was used for pain assessment before and 2nd, 3rd, 6th, and 12th months after the operations. RESULTS: Out of the initial 20 patients undergoing LPSN, eight were excluded from the final analysis due to intraoperative diagnosis of endometriosis; therefore, the remaining 12 patients were evaluated. The pain scores significantly decreased at each follow-up visit compared with the preoperative period (p=0.002). The pathologists, who were blinded, reported the median (minimum-maximum) neural fiber count as 46 (20-85) and 47 (18-83). No significant correlation was demonstrated between the number of excised neural fibers and the amount of pain relief following LPSN. CONCLUSION: LPSN is an effective surgical procedure to control primary dysmenorrhea. Our preliminary results revealed that the degree of pain relief in cases of severe midline dysmenorrhea was not related to the amount of excised neural tissue in LPSN.

Cystic Echinococcosis: One Entity, Two Unusual Locations.

We report two cases of cystic echinococcosis at unexpected locations. Patients were a 64-year-old man and 35-year-old woman. A cystic mass was incidentally found between the prostate and seminal vesicles in the male patient, using ultrasonography during a check-up for ischemic coronary disease. The female patient was admitted to the hospital with symptoms of cardiopulmonary disease, but her detailed radiological examination showed a cystic lesion in the interventricular septum of the heart. Both patients were operated, and examinations of the histologic sections revealed cyst walls consistent with echinococcal infection. Attention should be focused on this entity even in endemic areas, and pathologists should be aware of the histologic characteristics of this lesion, to avoid misdiagnosis as a nonspecific cyst.

Sirenomelia: a review of embryogenic theories and discussion of the differences from caudal regression syndrome.

OBJECTIVE: To discuss the pathological features of sirenomelia in the light of our 10 cases and review the current theories. METHODS: We identified 10 patients with sirenomelia from our hospital database. All clinical details and the autopsy features of 10 cases were noted. RESULTS: Of the 10 children with sirenomelia seven had bilateral renal agenesis, three had bladder agenesis and one had a renal hypoplasia. Single umbilical artery was found in 60% of children with sirenomelia. External genitalia was ambiguous in seven of 10 patients. CONCLUSIONS: Even though the etiology of caudal regression syndrome (CRS) and sirenomelia remains unknown we tend to believe that sirenomelia and CRS might be different entities.

Testicular cavernous hemangioma presenting as an ipsilateral lesion in a child with multicystic dysplastic kidney.

Childhood malignant testicle tumors are very rare. In the literature to date, it has been reported that there are only 24 cavernous hemangioma cases existing in English literature. In this study, we discuss a testicular mass case which was diagnosed as cavernous hemangioma. The patient, who followed for left multicystic dysplastic kidney since his birth, was admitted to our clinic with complaints of left testicular mass and pain at 1-year of age. Histopathological investigation revealed cavernous hemagioma. Even if it has its characteristic ultrasonographic findings, radiology is too far beyond to eliminate the malignancy, final diagnosis can only be made after orchiectomy.

The role of transvaginal power Doppler ultrasound in the differential diagnosis of benign intrauterine focal lesions.

PURPOSE: The purpose of this prospective study was to assess the role of power Doppler imaging in the differential diagnosis of benign intrauterine focal lesions such as endometrial polyps and submucous myomas using the characteristics of power Doppler flow mapping. METHODS: A total of 480 premenopausal patients with abnormal uterine bleeding were evaluated by transvaginal ultrasonography (TVS) searching for intrauterine pathology. Sixty-four patients with a suspicious focal endometrial lesion received saline infusion sonography (SIS) after TVS. Fifty-eight patients with focal endometrial lesions underwent power Doppler ultrasound (PDUS). Three different vascular flow patterns were defined: Single vessel pattern, multiple vessel pattern, and circular flow pattern. Finally, hysteroscopic resection was performed in all cases, and Doppler flow characteristics were then compared with the final histopathological findings. RESULTS: Histopathological results were as follows: endometrial polyp: 40 (69 %), submucous myoma: 18 (31 %). Of the cases with endometrial polyps, 80 % demonstrated a single vessel pattern, 7.5 % a multiple vessel pattern, and 0 % a circular pattern. Vascularization was not observed in 12.5 % of patients with polyps. Of the cases with submucousal myomas, 72.2 % demonstrated a circular flow pattern, 27.8 % a multiple vessel pattern, and none of them showed a single vessel pattern. The sensitivity, specificity, and positive and negative predictive values of the single vessel pattern in diagnosing endometrial polyps were 80, 100, 100, and 69.2 %, respectively; and for the circular pattern in diagnosing submucous myoma, these were 72.2, 100, 100, and 88.9 %, respectively. CONCLUSION: Power Doppler blood flow mapping is a useful, practical, and noninvasive diagnostic method for the differential diagnosis of benign intrauterine focal lesions. Especially in cases of recurrent abnormal uterine bleeding, recurrent abortion, and infertility, PDUS can be preferred as a first-line diagnostic method.

Primary carcinoma of the fallopian tubes: Analysis of sixteen patients.

OBJECTIVE: The aim of this study was to review patients with tubal carcinoma who underwent surgery in our clinic due to primary carcinoma of the fallopian tubes, a very rare gynecologic malignancy. MATERIALS AND METHODS: Sixteen patients who were diagnosed as having primary carcinoma of the fallopian tubes and underwent surgery in Zeynep Kamil Research and Training Hospital between January 2007 and December 2014 were included in the study. Demographic data such as age, gravidity, parity, menopausal condition, symptoms, adjuvant therapy, recurrence of tumor, as well as time and type of operation were extracted from patient epicrisis reports and oncology files. Patient information was extracted from the patients' current files and phone calls were made with patients and their relatives. RESULTS: The mean age of patients was 59.6 (range, 43-78) years. Seventy-five percent of the women were menopausal at admission; the mean menopause duration was 10 years (range, 1-20 years). None of the patients were nulliparous and mean parity was 4.3 (2-8). The most common presenting symptom was abdominopelvic pain, followed by abnormal uterine bleeding. The most common histopathologic type was high-grade serous carcinoma. The mean follow-up duration was 23.7 months (range, 2-53 months). During follow-up, recurrence was seen in 4 (25%) patients. One patient left the study during follow-up. The mean disease-free survival was 48 months. No relation was found between disease-free survival, age, stage, grade, and histologic type in univariate logistic regression analysis. CONCLUSION: Primary carcinoma of the fallopian tubes is a rare gynecologic tumor that is seen in older patients, has no specific signs, and usually cannot be diagnosed before surgery. Therefore, we think that large-series, multi-centered studies with long-term follow-up duration are needed to define its etiopathogenesis and treatment strategies for the disease.

Clinico-pathological significance of extra-nodal spread in special types of breast cancer.

OBJECTIVE: To investigate the significance of extra-nodal spread in special histological sub-types of breast cancer and the relationship of such spread with prognostic parameters. METHODS: A total of 303 breast cancer cases were classified according to tumor type, and each tumor group was subdivided according to age, tumor diameter, lymph node metastasis, extra-nodal spread, vein invasion in the adjacent soft tissue, distant metastasis, and immunohistochemical characteristics [estrogen receptor (ER), progesterone receptor (PR) existence, p53, c-erbB-2, and proliferative rate (Ki-67)]. The 122 cases with extra-nodal spread were clinically followed up. RESULTS: An extra-nodal spread was observed in 40% (122 cases) of the 303 breast cancer cases. The spread most frequently presented in micro papillary carcinoma histological sub-type (40 cases, 75%), but least frequently presents in mucinous carcinoma (2 cases, 8%). Patients with extra-nodal spread had a high average number of metastatic lymph nodes (8.3) and a high distant metastasis rate (38 cases, 31%) compared with patients without extra-nodal spread. CONCLUSION: The existence of extra-nodal spread in the examined breast cancer sub-types has predictive value in forecasting the number of metastatic lymph nodes and the disease prognosis.

Sclerosing stromal tumour in young women: clinicopathologic and immunohistochemical spectrum.

AIM: Sclerosing stromal tumor is a benign tumor of ovary. We aimed to review the clinical findings and immunohistochemical results of SSTs through the 7 diagnosed cases in our hospital. MATERIAL AND METHODS: As immunohistochemical, blocks were applied with estrogen receptor , progesterone receptor, inhibin, calretinin, melan-A, CD10, smooth muscle actin, desmine, vimentin, CD34, S-100, C-kit, cytokeratin , cytokeratin7. RESULTS: Macroscopically, while 5 tumors had solid appearance, 2 tumors were composed of solid and cystic areas. All the tumors were in shape of ovarian masses with good limits. Microscopically, two types of cells were observed as fusiform fibroblast-like cells and theca-like cells with vacuolised cytoplasm. Immunohistochemical results: vimentin, smooth muscle actin, desmine, progesterone receptor, calretinin, inhibin were positive in all the cases; S-100, cytokeratin, cytokeratin7, estrogen receptor were negative in all the cases; CD-10 was positive in 2 cases; C-kit was positive in 5 cases; melan-A was positive in 4 cases. CONCLUSIONS: The significance of these tumors is that it is necessary to distinguish the histopathology in the frozen section in order to protect the other adnexa because of the characteristics to be observed at early ages (2(nd) and 3(rd) decades). Our findings support the conclusion that sclerosing stromal tumors are benign-character tumors that stem from over stroma and are hormonally active tumors because of the detected clinical and immunohistochemical results, although no hormonal effect that could be supported with laboratory tests was observed.

LSIL/ASC-H (LSIL-H) in cervicovaginal smear: histopathological outcomes and clinical significance.

OBJECTIVE: Conventional Pap smears exhibiting unequivocal features of 'low grade squamous intraepithelial lesion' (LSIL) are occasionally mixed with some cells suspicious for, but not diagnostic of 'high grade squamous intraepithelial lesion' (HSIL) on daily routine. The 2001 Bethesda System does not address the significance of such cytological entities. We have referred to these changes in our laboratory as'LSIL, atypical squamous cells cannot exclude HSIL' (LSIL/ASC-H). In this study, we aimed to compare the cytology and biopsy results of LSIL/ ASC-H to LSIL, ASC-H and HSIL. MATERIAL AND METHOD: Out of 37884 cases which were evaluated between 2005-2009 in our laboratory, cases interpreted as LSIL, LSIL/ ASC-H, HSIL and ASC-H were reevaluated and 153 cases for which biopsy materials were available were selected. RESULTS: The rate of histological CIN2 or worse associated with LSIL/ ASC-H (45%) was between the rates of LSIL (10%) and HSIL (65%), but not significantly different from ASC-H (50%). However, LSIL/ ASC-H was more frequently associated with a definitive histological diagnosis of any CIN2 than ASC-H (30% vs. 8%). CONCLUSION: Based on our results, we recommend LSIL/ASC-H to be added to Bethesda System, and Pap test cases of LSIL/ASC-H may need to be clinically followed-up in a manner similar to ASC-H, i.e., with colposcopy for all patients.

GLUT-1 expression in pancreatic neoplasia: implications in pathogenesis, diagnosis, and prognosis.

OBJECTIVES: GLUT-1 has been found to have an important role in the upregulation of various cellular pathways and implicated in neoplastic transformation correlating with biological behavior in malignancies. However, literature regarding the significance of GLUT-1 expression in pancreatic neoplasia has been limited and controversial. METHODS: Immunohistochemical expression of GLUT-1 was tested in a variety of pancreatic neoplasia including ductal adenocarcinomas (DAs), pancreatic intraepithelial neoplasms (PanINs), intraductal papillary mucinous neoplasms (IPMNs), and serous cystadenomas. RESULTS: There was a progressive increase in the expression of GLUT-1 from low- to higher-grade dysplastic lesions: All higher-grade PanINs/IPMNs (the ones with moderate/high-grade dysplasia) revealed noticeable GLUT-1 expression. Among the 94 DAs analyzed, there were minimal/moderate expression in 46 and significant expression in 24 DAs. However, all 4 clear-cell variants of DAs revealed significant GLUT-1 immunolabeling, as did areas of clear-cell change seen in other DAs. Moreover, all 12 serous cystadenomas expressed significant GLUT-1. GLUT-1 expression was also directly correlated with DA histological grade (P = 0.016) and tumor size (P = 0.03). CONCLUSIONS: GLUT-1 may give rise to the distinctive clear-cell appearance of these tumors by inducing the accumulation of glycogen in the cytoplasm. Additionally, because GLUT-1 expression was related to histological grade and tumor size of DA, further studies are warranted to investigate the association of GLUT-1 with prognosis and tumor progression.