Diagnostic and Treatment Reproducibility of Cervical Intraepithelial Neoplasia / Squamous Intraepithelial Lesion and Factors Affecting the Diagnosis.

OBJECTIVE: Inter-observer differences in the diagnosis of HPV related cervical lesions are problematic and response of gynecologists to these diagnostic entities is non-standardized. This study evaluated the diagnostic reproducibility of "cervical intraepithelial neoplasia" (CIN) and "squamous intraepithelial lesion" (SIL) diagnoses. MATERIAL AND METHOD: 19 pathologists evaluated 66 cases once using H&E slides and once with immunohistochemical studies (p16, Ki-67 and Pro-ExC). Management response to diagnoses was evaluated amongst 12 gynecologists. Pathologists and gynecologists were also given a questionnaire about how additional information like smear results and age modify diagnosis and management. RESULTS: We show moderate interobserver diagnostic reproducibility amongst pathologists. The overall kappa value was 0.50 and 0.59 using the CIN and SIL classifications respectively. Impact of immunohistochemical evaluation on interpretation of cases differed and there was lack of statistically significant improvement of interobserver diagnostic reproducibility with the addition of immunohistochemistry. We saw that choice of treatment methods amongst gynecologists varied and overall concordance was only fair to moderate. The CIN2 diagnostic category was seen to have the lowest percentage agreement amongst both pathologists and gynecologists. We showed that pathologists had diagnostic "styles" and gynecologists had management "styles". CONCLUSION: In summary each pathologist had different diagnostic tendencies which were affected not only by histopathology and marker studies, but also by the patient management tendencies of the gynecologist that the pathologist worked with. The two-tiered modified Bethesda system improved diagnostic agreement. We concluded that immunohistochemistry should be used only to resolve problems in select cases and not for every case.

Evaluation of Local CYP17A1 and CYP19A1 Expression Levels as Prognostic Factors in Postmenopausal Invasive Ductal Breast Cancer Cases.

There is growing attention focused on local estrogen production in the breast tissue and its possible role in breast cancer initiation and progression. Understanding the underlying mechanisms for estrogen synthesis and the microenvironment consisting of tumor and its surrounding adipose tissue might open new avenues in breast cancer prevention, prognosis and treatment. In order to obtain insight, we compared peritumoral and tumor tissue expressions of CYP17A1 and CYP19A1 genes, which play an important role in estrogen biosynthesis. The paired tissue samples of 20 postmenopausal ER+/PR+ patients diagnosed with invasive ductal breast cancer were studied. In addition, 12 breast tissue samples obtained from premenopausal women without a history of breast cancer were also investigated as representative of normal conditions. Peritumoral adipose tissues expressed CYP19A1 approximately threefold higher than tumor itself (p = 0.001). A nonsignificant trend toward low expression of CYP17A1 was observed in peritumoral compared to tumor tissue (p = 0.687). Clinicopathological parameters and patient characteristics which are accepted as risk factors for breast cancer were also associated with individual and combined expressions of CYP17A1 and CYP19A1. This study offers that evaluation of CYP17A1 and CYP19A1 local expression levels might be useful for deciding on personalized treatment approaches and more accurate diagnosis, when evaluated together with several clinicopathological and disease risk factors. Considering the key role of these CYPs in estrogen synthesis, determining their expression levels may be useful as a postdiagnostic marker and for choosing the right treatment method in addition to the conventional approach.

Vacuum-assisted stereotactic breast biopsy in the diagnosis and management of suspicious microcalcifications.

PURPOSE: We aimed to present our biopsy method and retrospectively evaluate the results, upgrade rate, and follow-up findings of stereotactic vacuum-assisted breast biopsy (VABB) procedures performed in our clinic. METHODS: Two hundred thirty-four patients with mammographically detected nonpalpable breast lesions underwent VABB using a 9 gauge biopsy probe and prone biopsy table. A total of 195 patients (median age 53 years, range 32-80 years) with 198 microcalcification-only lesions with a follow-up of at least one year were included in the study. The location of the lesion relative to the needle was determined from the postfire images, and unlike the conventional technique, tissue retrieval was predominantly performed from that location, followed by a complete 360° rotation, if needed. RESULTS: The median core number was 8.5. Biopsy results revealed 135 benign, 24 atypical, and 39 malignant lesions. The total upgrade rate at surgery was 7.7% (6.1% for ductal carcinomas in situ and 10.5% for atypical lesions). Patients with benign lesions were followed up for a median period of 27.5 months, with no interval change. At the follow-up, scar formation was seen in 23 patients (17%); three of the scars were remarkable for resembling a malignancy. CONCLUSION: Our biposy method is fast and practical, and it is easily tolerated by patients without compromising accuracy. Patients with a diagnosis of atypia still need to undergo a diagnostic surgical procedure and those with a malignancy need to undergo curative surgery, even if the lesion is totally excised at biopsy. VABB may leave a scar in the breast tissue, which may resemble a malignancy, albeit rarely.

Expression of PTEN and ß-Catenin and Their Relationship With Clinicopathological and Prognostic Factors in Endometrioid Type Endometrial Cancer.

OBJECTIVE: The aim of this study was to investigate rates of expression of PTEN (phosphatase and tensin homolog deleted on chromosome 10) and ß-catenin and their relationship with clinicopathological and prognostic factors in endometrioid type endometrial cancer (EC). METHODS AND MATERIALS: PTEN and ß-catenin expressions of 59 operated patients with EC between January 2000 and December 2008 and followed-up until December 2014 in Cerrahpasa School of Medicine, Gynecologic Oncology Division, were evaluated retrospectively. Clinical data were obtained from patient files, and pathological data were obtained from pathology records. Each patient had 4 paraffin sections of tumoral tissue. These sections were stained by immunohistochemical methods. Clinical features and postoperative histopathologic findings were analyzed using Fisher exact test or the χ(2) test as appropriate. The Kaplan-Meier method was used to generate the survival curves. RESULTS: During median follow-up of 102 months, tumor recurrence and disease-related mortality were observed in 10 (16.9%) and 7 (11.9%) cases, respectively. Immunohistochemical staining of PTEN and ß-catenin were positive in 61% and 69.5% of all cases, respectively. Positive staining of PTEN was positively correlated with myometrial invasion (P= 0.02). There was no correlation between ß-catenin and clinicopathological factors. PTEN or ß-catenin positivity were not significant prognostic factors for 5-year overall survival (P = 0.37, P = 0.62, respectively) and 5-year disease-free survival (P = 0.28, P = 0.58, respectively). CONCLUSIONS: PTEN and ß-catenin expressions cannot be used to determine prognosis in patients with EC as PTEN and ß-catenin staining status were found to have no significant effect on 5-year overall survival and disease-free survival. Positive staining of PTEN may be associated with increased myometrial invasion. Meta-analyses and broader studies are needed to evaluate the prognostic value of PTEN and ß-catenin in EC.

Preliminary Study: Prominent miRNAs of Breast Malignant Tissues Compared to Normal Tissues in Turkish Patients with Breast Cancer.

miRNA involvement has been observed in almost every type of cancer, including breast cancer. The etiology of abnormal expression of miRNAs in cancer is still not clearly understood. In order to obtain insight into miRNA de-regulation in breast cancer, we analyzed expression levels of five breast cancer-related miRNAs, miRNA21, miRNA155, miRNA19a, miRNA17-5p and let7a miRNA, in both malignant and neighboring non-tumoral paraffin-embedded tissues of 47 patients with invasive ductal breast cancer. The targeted miRNAs, and a reference snRNA, U6, were analyzed by real-time polymerase chain reaction. let7a Levels were significantly lower in patients with lymphatic invasion than in those without (p=0.047). miR21 was down-regulated in 93.3% of patients with necrosis [p=0.017 (Fisher's exact test (FE))], while at least one oncogenic miRNA was up-regulated in 87.3% of the patients with invasive ductal carcinoma [p=0.009 (FE)]. In addition, tumor-suppressor miRNA was down-regulated or unaltered in 65.8% of the patients with tumor grade 2 or 3 and in all with grade 1 [p=0.047 (FE)]. Based on this preliminary study, we suggest that these miRNAs, especially let7a and miRNA21, might be useful markers in follow-up of breast cancer and in prognosis.

In situ hybridization analysis of invasive breast carcinomas with immunohistochemically negative Her-2 status (a national multicenter study).

OBJECTIVE: The aim of this study was to determine the rate of Her-2 gene amplification in breast cancer cases with a previous negative Her-2 result as determined by immunohistochemistry (score 0 or 1). MATERIAL AND METHOD: 552 cases of invasive breast carcinoma were assessed with the contribution of 9 centers. Previous immunohistochemistry score was either 0 or 1+ in all cases. These cases were re-tested by Her-2 silver in situ hybridization in the central laboratory. Her-2 gene amplification was defined as Her-2/CEP 17 ratio of more than 2.2. Cases with a ratio between 1.8 and 2.0 were defined as equivocal and cases with a ratio of less than 1.8 were defined as negative. RESULTS: Re-testing of the 552 cases with silver in situ hybridization showed a total of 22 cases with Her-2 gene amplification, of which 11 (3.2%) were found to be score 0, and 11 were found to be score 1+ (5.3%) by immunohistochemistry previously. Her-2 gene amplification rate of cases (score 0 and 1+) ranged from 0% to 10.48% among the centers. Polysomy was found in 28 (8.1%) of the score 0 cases and 25 (12.1%) among the score 1+ cases. Five (9.4%) of the cases with polysomy were found to be amplified, and 48 (90.6%) were not. CONCLUSION: The results of the study show that a group of cases (3.98%) with a potential to benefit from anti-Her-2 therapy may be missed with the immunohistochemical method. This indicates the importance of quality assurance, especially in central laboratories with many breast cancer cases in daily practice.

Correlation between First and Second Trimester Uterine Artery Doppler Velocimetry and Placental Bed Histopathology.

Aim. To evaluate the relationship between uterine artery Doppler indices and placental bed histopathology independent of clinical outcome. Materials and Methods. Uterine artery measurements were performed to 510 pregnant women who had come for routine antenatal care in 11-14th and 20-24th weeks. Placental bed biopsies from 141 cases were taken during cesarean section. Physiological changes and abnormal placental histology findings were investigated and compared with Doppler findings. Results. 116 biopsies were accepted as adequate biopsy and included in the study. Physiological changes were seen in 100 biopsies. Statistically significant higher PI and RI values in second trimester and higher notch rate in both trimesters were detected in the abnormal placental histology group (P < 0,001). Conclusion. Strong relationship between uterine artery Doppler indices and preeclampsia or intrauterine growth retardation has been shown in previous studies. In our study, we concluded that there is significant relationship between Doppler findings and placental bed histopathology independent of clinical course.

Management of idiopathic granulomatous mastitis diagnosed by core biopsy: a retrospective multicenter study.

Idiopathic granulomatous mastitis (IGM) is a rare, benign, chronic inflammatory condition of the breast, which usually mimics breast carcinoma. The aim of this study was to analyze the clinical features of IGM by identifying a more reliable diagnostic protocol, and evaluating the treatment methods and patient outcomes on follow-up. We performed a retrospective analysis of 46 patients diagnosed with IGM and managed by the same surgical team between 1999 and 2011, at three high-volume hospitals. The median age of the patients was 33 years. The most common symptom was painful breast mass (n = 39), followed by abscess (n = 11). All patients underwent ultrasonography (USG). Mammography (MG) and magnetic resonance imaging (MRI) were also performed in 20 patients (43%) and 17 patients (37%), respectively. The mean size of the lesions was 32.8 ± 8.8 mm and ranged from 15 to 50 mm. Preoperative diagnosis of IGM was established by core needle biopsy (CNB) under USG guidance. Eighteen patients (39%) underwent complete excision of the lesion and 25 (54%) were treated with steroids. Three patients treated with steroids subsequently underwent local excision. The mean follow-up period was 35.4 ± 30.9 months. Eight patients (17%) developed disease recurrence; three of these were successfully treated with steroids, one with surgery, and four with both steroids and surgery. CNB in conjunction with high diagnostic accuracy has a significant role in distinctive diagnosis of IGM and hence, is useful for treatment planning. Treatment can be designated according to the extent and the severity of the disease, and the patient's general health and treatment preferences. Patients with IGM must be closely followed up due to the frequency of disease recurrence.

Stamp2 controls macrophage inflammation through nicotinamide adenine dinucleotide phosphate homeostasis and protects against atherosclerosis.

The six-transmembrane protein Stamp2 plays an important role in metabolically triggered inflammation and insulin action. We report that Stamp2 is expressed in human and mouse macrophages, is regulated upon differentiation or activation, acts as an anti-inflammatory protein, and regulates foam cell formation. Absence of Stamp2 results in significant increases in cellular NADPH levels, and both NADPH homeostasis and the exaggerated inflammatory response of Stamp2(-/-) macrophages are rescued by exogenous wild-type but not by a reductase-deficient Stamp2 molecule. Chemical and genetic suppression of NADPH production in Stamp2(-/-) macrophages reverts the heightened inflammatory response. Stamp2 is detected in mouse and human atherosclerotic plaques, and its deficiency promotes atherosclerosis in mice. Furthermore, bone marrow transplantation experiments demonstrated that Stamp2 in myeloid cells is sufficient to protect against atherosclerosis. Our data reveal a role of Stamp2 in controlling intermediary metabolites to regulate inflammatory responses in macrophages and in progression of atherosclerosis.

Female genital system tuberculosis: a retrospective clinicopathological study of 1,548 cases in Turkish women.

PURPOSE: The incidence of tuberculosis (TB) has increased worldwide in the past decade and it still remains an important global public health problem. METHOD: A retrospective clinicopathological study of 1,548 cases of female genital tuberculosis between 1940 and 2011 was conducted. RESULTS: The mean age of the cases was 29.49 years. Involvement of the endometrium was noted in 1,073, fallopian tubes in 164, cervix in 157, and 154 had multiple organ involvement. Clinically, 115 cases (7.4%) were diagnosed as having primary infertility and 12 cases (0.8%) as having secondary infertility. There was a coexistent carcinoma in 1.5% of the cases. Peritoneal tuberculosis in 21 cases and tuberculous lymphadenitis in 7 cases were seen as well. CONCLUSION: The clinicopathological criteria of female genital tuberculosis in the different organs are described, and special attention is paid to infertility associated with tuberculous lesion, and awareness of the fact that the disease is still with us is thus particularly important.

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.

Reproducibility of endometrial intraepithelial neoplasia diagnosis is good, but influenced by the diagnostic style of pathologists.

Endometrial intraepithelial neoplasia (EIN) applies specific diagnostic criteria to designate a monoclonal endometrial preinvasive glandular proliferation known from previous studies to confer a 45-fold increased risk for endometrial cancer. In this international study we estimate accuracy and precision of EIN diagnosis among 20 reviewing pathologists in different practice environments, and with differing levels of experience and training. Sixty-two endometrial biopsies diagnosed as benign, EIN, or adenocarcinoma by consensus of two expert subspecialty pathologists were used as a reference comparison to assess diagnostic accuracy of 20 reviewing pathologists. Interobserver reproducibility among the 20 reviewers provided a measure of diagnostic precision. Before evaluating cases, observers were self-trained by reviewing published textbook and/or online EIN diagnostic guidelines. Demographics of the reviewing pathologists, and their impressions regarding implementation of EIN terminology were recorded. Seventy-nine percent of the 20 reviewing pathologists' diagnoses were exactly concordant with the expert consensus (accuracy). The interobserver weighted κ values of 3-class EIN scheme (benign, EIN, carcinoma) diagnoses between expert consensus and each of reviewing pathologists averaged 0.72 (reproducibility, or precision). Reviewing pathologists demonstrated one of three diagnostic styles, which varied in the repertoire of diagnoses commonly used, and their nonrandom response to potentially confounding diagnostic features such as endometrial polyp, altered differentiation, background hormonal effects, and technically poor preparations. EIN diagnostic strategies can be learned and implemented from standard teaching materials with a high degree of reproducibility, but is impacted by the personal diagnostic style of each pathologist in responding to potential diagnostic confounders.

Combined effect of CYP1B1 codon 432 polymorphism and N-acetyltransferase 2 slow acetylator phenotypes in relation to breast cancer in the Turkish population.

BACKGROUND: Breast cancer (BC), is more prevalent in subjects who have had prolonged exposure to heterocyclic amines, aromatic amines and high levels of oestradiol. Cytochrome P450 1B1 (CYP1B1) and N-acetyltransferase2 (NAT2) have complementary role in metabolism of xenobiotics such as arylamines and heterocyclic amines, CYP1B1 also hyroxylates 17-beta oestradiol. CYP1B1*3 polymorphism and seven missense and four silent polymorphisms of NAT2 were investigated. PATIENTS AND METHODS: Sixty Turkish female BC patients and 103 healthy controls were phenotyped by polymerase chain reaction (PCR) based restriction fragment length polymorphism (RFLP). RESULTS AND CONCLUSION: The distribution of NAT2 activity in the healthy control group was found to be correlated with that of healthy caucasians. Patients had slow acetylator phenotypes of NAT2, 1.8 times higher than controls but no statistical differences were found (p=0.07). In addition, the NAT2*5 alelle was more statistically correlated with breast cancer patients rather than the controls (p=0.02). Moreover, NAT2*5B was the most frequent haplotype of the NAT2*5 family (p=0.000). Breast cancer patients were detected to posses more CYP1B1*3 mutant alleles than the controls (p=0.043). The combined effect of CYP1B1*3 polymorphism and NAT2 slow acetylator genotype contributed to an increased risk for breast cancer in patients in this study (p=0.004).

The incidence of placental abnormalities, maternal and cord plasma malondialdehyde and vascular endothelial growth factor levels in women with gestational diabetes mellitus and nondiabetic controls.

BACKGROUND/AIMS: To evaluate the incidence of placental abnormalities, cord plasma erythropoietin (EPO) levels and nucleated red blood cell (NRBC) counts, maternal and cord plasma malondialdehyde (MDA) and vascular endothelial growth factor (VEGF) levels in women with gestational diabetes mellitus (GDM) and nondiabetic controls. METHODS: Twenty-two women with GDM, diagnosed according to the current criteria of the American Diabetes Association, were compared with 22 controls. Maternal and cord blood and placental samples were obtained from all pregnant women. Cord plasma EPO levels and NRBC counts, maternal and cord plasma MDA and VEGF levels were determined. Placental tissues were examined histologically. RESULTS: Maternal and cord plasma levels of MDA and cord plasma EPO levels and NRBC counts were significantly higher in GDM pregnancies (p < 0.01). The presence of villous immaturity, chorangiosis and ischemia were significantly increased in the placentas of women with GDM (p < 0.05). The maternal and cord plasma levels of MDA increased (p = 0.007 and p = 0.001, respectively), whereas VEGF decreased (p = 0.046 and p = 0.001, respectively) with the presence of villous immaturity. CONCLUSION: The complex process of villous development and maturity might be influenced by the maternal and fetal oxidative and angiogenetic milieu. The placenta that shows abnormalities in angiogenesis and maturation may lead to fetal hypoxia and compromise.

Mammary pseudoangiomatous stromal hyperplasia composed of predominantly giant cells: an unusual variant.

Pseudoangiomatous stromal hyperplasia (PASH) is a benign proliferative lesion of mammarian stroma that presents as a localized mass. We describe the clinical, radiologic, cytologic, and histopathologic features of a case of PASH with giant cells that presented as a rapidly growing localized mass in the breast in a 32-year-old woman. An unusual feature of our case was the presence of multinucleated giant cells lining pseudovascular spaces and dispersing in collagenous stroma. To the best of our knowledge, this is the second case in the English literature and PASH with predominance of multinucleated giant cells has never been described previously in a female patient.

Müllerian adenosarcoma with sarcomatous overgrowth of the cervix: unusual large polypoid mass.

Müllerian adenosarcoma (MS) is a rare neoplasm of uterine cervix composed of benign epithelial and malignant stromal components. An aggressive variant of adenosarcoma, müllerian adenosarcoma with sarcomatous overgrowth (MASO) is extremely rare. The difference between MS and MASO is the pure high grade sarcoma features in MASO. In this report we present a MASO case, derived from uterine cervix of a 60 year-old-female patient presenting as a cervical polypoid mass, to our knowledge the second case of the English literature. In spite of sarcomatous overgrowth, high mitotic activity and huge tumor size of 12,5 cms, it displayed no myometrial invasion, vascular invasion and heterologous elements. The patient has been clinically free of disease for 14 months of follow up after total abdominal hysterectomy and bilateralsalpingo-oopherectomy. The difficulties in diagnosis and treatment of this entity will be evaluated in this report.

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.

Difference in alpha(v)beta3 integrin expression in endometrial stromal cell in subgroups of women with unexplained infertility.

OBJECTIVE: The aim of the study was to evaluate the endometrial receptivity by using alpha(v)beta3 expression in the midsecretory phase in different endometrial compartments in women with unexplained infertility. STUDY DESIGN: A prospective controlled clinical trial in a setting of a university teaching hospital was performed. Thirty-three fertile and 33 infertile women were included in the study. Midluteal endometrial biopsies of the endometrium were carried out during the implantation window. Immunohistochemical staining was performed for the expression of alpha(v)beta3 in endometrial samples. Alpha(v)beta3 expression was measured using the HSCORE scoring system in the endometrial glandular and luminal epithelium and in the endometrial stroma. Serum levels of estradiol, progesterone, follicle-stimulating hormone, luteinizing hormone, thyroid-stimulating hormone, prolactin, total testosterone and dehydroepiandrosterone sulphate were measured in the early follicular phase and in the midluteal phase. RESULTS: The average alpha(v)beta3 integrin expression at different sites of the endometrium was not different in the infertile and fertile controls. However, the stromal alpha(v)beta3 integrin was found to be expressed significantly less in a subgroup of women with lower than average alpha(v)beta3 integrin expression in luminal epithelium than in fertile controls and significantly more in a subgroup of women with higher than average alpha(v)beta3 integrin expression in luminal epithelium. There was no difference in stromal alpha(v)beta3 integrin expression in the lower or higher glandular alpha(v)beta3 integrin expression subgroups. CONCLUSIONS: Alpha(v)beta3 integrin expression in endometrial stromal cells may be different in subgroups of women with unexplained infertility.

Brunner's gland adenoma: a rare cause of vomiting.

UNLABELLED: Upper gastrointestinal system adenoma is generally seen amongst elderly patients and quite rarely seen during the childhood. A 14-y-old female patient was referred to our hospital with complaints of vomiting and abdominal pain. She had been followed up for 6 y with the diagnosis of familial intermittent fever and chronic renal failure due to amyloidosis. Endoscopic examination of the upper gastrointestinal system revealed mild hyperaemia in the corpus and antrum, and a polyp of 0.5x0.5 cm with an ulcerated and pedunculated top in the bulbus. Brunner's gland adenoma was diagnosed by the histopathological examination of the lesion following polypectomy. CONCLUSION: Brunner's gland adenoma is usually asymptomatic; however, it may reveal clinical findings such as obstruction, bleeding or intussusception, especially in uraemic patients. Thus, we would like to emphasize that, in patients with chronic renal failure and acute onset vomiting and abdominal pain, Brunner's gland adenoma should be considered in the differential diagnosis.