Reduced gene expression of bikunin as a prognostic marker for renal cell carcinoma.

AIM: Experimental and clinical studies showed that bikunin, a Kunitz-type protease inhibitor, found in urine and amniotic fluid has a role in spread of tumor cells by providing a significant reduction in the levels of urokinase-type plasminogen activator (uPA) and its specific receptor urokinase-type plasminogen activator receptor (uPAR). The aim of this study was to investigate expression of bikunin at the mRNA level and screen for mutations in exon sequence in renal cell carcinoma (RCC) tissues. MATERIALS AND METHODS: Total RNA and DNA were extracted from paired normal and tumor tissues of total 50 RCC (11 papillary, 8 chromophobe, 26 clear cell, and 5 other types) patients (23 females, mean age: 53.55 ± 14.17; 27 males mean age: 62.1 ± 7.92). Bikunin mRNA levels were detected using semi-quantitative reverse transcription-polymerase chain reaction (RT-PCR). Mutational screening was performed by using single strand conformation polymorphism (SSCP) method and nucleotide sequence analysis. RESULTS: There was a statistically significant decrease in the 25 (50%) of tumor tissues comparing to normal tissues in terms of mRNA levels of bikunin (Wilcoxon signed rank test, p = 0.0337). According to the classification based on subtypes of RCC; clear cell RCC samples displayed a reduced gene expression (p = 0.0148). Additionally, the patients with the age above 50 had low bikunin expression. The SNP rs80057939 spanning 4(th) exon of bikunin was detected in 13 tumor tissues. However, it was not statistically significant (p > 0.05). CONCLUSION: Decreased bikunin mRNA level in renal cells might be associated with poor prognosis of renal carcinoma. Therefore, gene constructs or exogenous administration of bikunin might be a potential adjuvant therapy for RCC treatment.

Adaptation process of the skin graft to vaginal mucosa after McIndoe vaginoplasty.

OBJECTIVE: There are many methods of treatment of vaginal agenesis. METHODS: In this study, patients who underwent McIndoe vaginoplasty were evaluated for development of vaginal mucosa. Vaginal pH measurements, smears, and punch biopsies were obtained from seven patients postoperatively at 3, 6, and 12 months after having McIndoe vaginoplasty. RESULTS: Neovaginal smears indicated no specific data for mucosal development at the 3rd and 6th month after the operation. However, Doderlein bacilli were determined at the 12th month. Histopathological examination of punch biopsies revealed dermal and subdermal thickening at the 3rd month, partial adaptation to mucosa at 6th month, and full adaptation to mucosa at 12th month. Also normal vaginal pH levels were recorded at the 12th month. CONCLUSION: As a result of the adaptation process, the split thickness skin graft acquired both histological and physiological characteristics of normal vaginal mucosa. Also, neovaginal epithelium was evaluated to be macroscopically similar to normal vaginal mucosa, 12 months after the operation.

Immunohistochemical analysis of PCNA, Ki67 and p53 in nasal polyposis and sinonasal inverted papillomas.

Immunoreactivity of proliferating cell nuclear antigen (PCNA), Ki67 and p53 in inflammatory nasal polyp and inverted papilloma tissues was investigated. Immunohistochemistry was performed using a standard avidin-biotin-peroxidase method, and the immunoreactivity of PCNA, Ki67 and p53 was quantified by counting immunostained nuclei in at least 1000 epithelial cells. The mean labelling index (percentage of immunostained cells) for PCNA was 40.68 in the inverted papilloma group and 14.73 in the nasal polyp group, and for Ki67 was 15.43 in the inverted papilloma group and 2.64 in the nasal polyp group. Both of these differences between the inverted papilloma and nasal polyp groups were significant. Immunoreactivity for p53 was detected in five (35.7%) inverted papilloma patients and two (9.5%) nasal polyp patients. The increase in epithelial cell proliferation seemed to be greater in inverted papillomas than in inflammatory nasal polyps. Increased epithelial cell proliferation may be involved in the development of inverted papillomas.

The effects of anastrozole on neonatal rat skin.

BACKGROUND: Anastrozole is a third-generation nonsteroidal aromatase inhibitor which is used in the treatment of breast cancers. Anastrozole has also been used in the treatment of dermatomyositis skin eruptions but its direct effects on skin have not been well documented. OBJECTIVE: To study the effects of anastrozole administration on neonatal rat skin. METHODS: Forty Sprague-Dawley female newborn rats were separated into two control groups and two experimental groups (n = 10). One day after birth the control group of newborn rats were given daily 0.02 ml saline subcutaneously for a period of 15 days. The first experimental group of rats were treated with 0.05 mg/100g/day anastrozole subcutaneously for 15 days whereas the second experimental group of rats were given 0.25 mg/100g/day anastrozole subcutaneously for 15 days. Histopathological assessments were made and compared with the control groups. RESULTS: Increased keratinization, strippling, hypertrophic epidermal cells and disorganization of the epidermal cells were observed in the first experimental group. In the second experimental group in addition to these pathologic findings acantholysis was observed. CONCLUSION: The administration of anastrazole in newborn rats showed considerable harmful effects.

The relationship between expression of p53/bcl-2 and clinicopathological criteria in cervix squamous cell carcinomas.

OBJECTIVE: Thirty cases with squamous carcinomas of cervix who underwent total abdominal hysterectomy and bilateral salphingo-oopherectomy were reviewed histopathologically. MATERIALS AND METHODS: The tissues were stained immunohistologically with p53 and bcl-2. Ten cases were selected as well differentiated (large cell keratinizing) carcinoma, ten cases moderately differentiated (large cell non keratinizing) carcinoma and ten cases poorly differentiated carcinoma (includes small cell squamous cell carcinoma). RESULTS: We observed 11 cases (36.6%) with bcl-2 and 13 cases (43.3%) with p53 positivity. P53 expression showed the opposite correlation to bcl-2 staining. CONCLUSION: A decrease in bcl-2 reactivity and an increase in p53 positive staining was noted as the histological differentiation worsened.

Paget's disease of the esophagus.

We describe the case of a 72-year-old male patient who was suffering from Pagetoid spread to the esophageal mucosa from adenocarcinoma located in the distal esophagus and proximal stomach. Esophageal Paget's disease is rare. The histogenesis of extramammary Paget's disease has remained controversial. In the majority of cases, it originates from a primary esophageal tumor. In this report, we describe a patient who was suffering from esophageal adenocarcinoma and discuss the origin of extramammary Paget's disease in the light of the literature.

Paraurethral cyst: is conservative management always appropriate?

Paraurethral cyst, arising from cystic dilatation of a paraurethral gland in a girl, is rarely reported in infancy. Although the lesion has a reported incidence of between 1 in 2000 and 1 in 7000 live female births, only 41 examples have been reported previously in the English literature. The management of this lesion is controversial. Surgical excision has been advocated, but spontaneous rupture has also been reported. The latter has prompted some authors to recommend non-operative treatment. We report a female infant whose paraurethral cyst failed to resolve despite a 6-month observation period. She eventually required surgery. The management of our case and the experience in the literature is discussed.

Ruptured heterotopic pregnancy: a report of unusual acute abdominal syndrome in two cases.

A heterotopic pregnancy is in effect a multiple pregnancy with one or more intrauterine pregnancies coexisting with an ectopic pregnancy. Prompt diagnosis, rapid fluid and blood resuscitation, heart-sparing anesthesia and gentle, expeditious surgery collectively contribute to a favorable outcome for the mother and fetus in patients with a ruptured tubal pregnancy. In this report we present two cases of heterotopic pregnancies with ruptured tubal components; one spontaneous and the other one after clomiphene citrate treatment. Explorative laparotomy and salpingectomy were performed in both patients. After surgery, the intrauterine pregnancies were not damaged, and were still healthy on progression.

Early diagnosed intramural ectopic pregnancy associated with adenomyosis: report of an unusual case.

Intramural pregnancy is the rarest type of ectopic pregnancy and almost always is diagnosed intraoperatively. It constitutes less than 1% of ectopic pregnancies and the world literature contains only 33 cases. We present an additional case of an uncomplicated intramural pregnancy in a patient with extensive adenomyosis, which is the earliest preoperatively diagnosed (sixth week of gestation) case in the literature.

Cycline-dependent kinase inhibitor, p27 (KIP1), is associated with cholesteatoma.

OBJECTIVE: Cyclin-dependent kinases (CDKis) can arrest the cell cycle, which in turn inhibits the cell proliferation. P27 (KIP1) is a CDKi and acts as a tumor suppressor gene. In this study, we aimed to investigate the role of p27 CDKi in cholesteatoma, a disease characterized by the presence of hyperproliferative squamous epithelium. STUDY DESIGN: Immunohistochemical staining of 15 cholesteatoma and 18 control ear canal skin samples, which were taken intraoperatively, was performed for p27 positivity. METHODS: The monoclonal antibodies to p27 were used for immunohistochemical staining of the sections. The streptavidin-biotin horseradish method was used. The number of cells staining positive for p27 was calculated, and the intensity of p27 positivity was graded. RESULTS: P27 positivity was obtained in 9 (50%) of 18 skin tissues. In the cholesteatoma tissues, p27 positivity was found only in 2 (13.3%) tissue samples. The difference between the groups were statistically significant (P =.03). The mean numbers of p27 positivity were 11.8 +/- 15.5 and 1.4 +/- 3.8 (mean +/- standard deviation) in the skin and cholesteatoma samples, respectively. This difference was also statistically significant (P =.02). The p27 results of primary and secondary cholesteatoma samples were not significantly different (P =.3). The results of p27 were not related to the gender of the patients (P =.8). CONCLUSION: P27 is involved directly or indirectly in the occurrence of cholesteatoma. Alterations of p27 levels in keratinocytes can influence the proliferative state of the keratinocytes. Altered p27 levels in cholesteatoma may suggest a molecular pathology in cholesteatoma. The search for significance of CDKis seems promising to better understand the pathogenesis of cholesteatoma.

The relationship between expression of p53/Bcl-2 and histopathological criteria in breast invasive ductal carcinomas.

Seventy-five cases of invasive ductal carcinoma (IDC) on whom axillary lymph node dissection and mastectomy were performed between 1996 and 2000 were reviewed histopathologically. The slides were stained immunohistologically with p53 and Bcl-2. In 40 cases we observed 53% Bcl-2 and 69% p53 positivity. There were correlations between p53 and tumour grade, and also between p53 and Bcl-2. We did not observe any connection between the main histopathological prognostic factors--lymph node metastasis, tumour size, tubule formation, pleomorphism--and p53/Bcl-2. In our study, IDC with a high mitotic index and poor differentiation showed mutant p53 positive staining. Expression of Bcl-2 is associated with low nuclear grade and absence of mutant p53. This study was designed to reveal the correlation between histopathological findings and the expression of p53/Bcl-2 on prognosis.

Adenoid cystic carcinoma of the vulva: conservative surgery using a de-epithelized rhomboid flap.

Adenoid cystic carcinoma of the vulva is a very rare entity manifested by an indolent clinical course, late recurrence and a propensity for perineural and local invasion. A 41-year-old women underwent radical local excision and ipsilateral superficial lymph-node dissection using a de-epithelized rhomboid flap for adenoid cystic carcinoma of the left vulva. On follow-up after two years the patient is alive and well with no evidence of disease. In this report we present the first case of adenoid cystic carcinoma of the vulva using a de-epithelized rhomboid flap.

Effect of intra-articular administration of hyaluronan and cortisone on secondary osteoarthritis of the infected rabbit's knee.

Hyaluronan is known to play an important role in the healing of degenerative osteoarthritis. But there is no clear consensus how it effects on osteoarthritis compare to cortisone. The purpose of the research was to determine the comparative effects of hyaluronan and cortisone on the healing of degenerative osteoarthritis. A rabbit model used in which a degenerative osteoarthritis were created in the articular cartilage by the inoculation of Staphylococcus Aureus (S. Aureus). The rabbits divided into two groups namely injected with hyaluronan (group A) and cortisone (group B) at days 20, 23 and 26. After hyaluronan and cortisone injections for treatment of osteoarthritis at day of 25 and 35 six rabbits (each of three injected with hyaluronan and cortisone) and at day 50 (six of injected with hyaluronan and five of cortisone) were sacrified. In biopsies obtained from these knees both articular cartilage degeneration and inflammation around the joint were examined by light microscopy. It was seen that the histopathologic findings were consistent with active chronic inflammation at day 10, followed by chronic inflammation. At day 5 of treatment the degeneration decreased (60%) in group A, and clinical findings disappeared after day 9 of treatment. At day 15 of hyaluronan treatment the degeneration degree regressed and at day 30 absolutely healed (all except one). In group B, at day 5 of treatment, the clinical findings disappeared and the healing rate was 72%. At day 15 of cortisone treatment, the degeneration slightly increased and at day 30 the degeneration degree increased more than that day of 15. The results showed that cortisone is effective in the treatment of cartilage degeneration and inflammation early in the course of the septic arthritis whereas the therapeutic effect of hyaluronan is higher late in the course of the disease. Further studies are required in order to understand the effectiveness of the combined or consecutive use of these drugs in degenerative osteoarthritis.

AgNOR/P53 expression compared with different grades in bladder carcinoma.

OBJECTIVE: The aim of this study is to assess the relation between silver-strained nucleolar organizer regions (AgNOR)/P53 expression and urothelial neoplasm of the bladder which graded according to the WHO/ISUP tumor grading system. METHODS: Transurethral resection materials (TUR) and cystectomy specimens from 52 patients with bladder urothelial carcinomas were stained by AgNORs and analyzed immunohistochemically using an avidinbiotin peroxidase method for p53 staining and also silver for AgNORs. RESULTS: Nuclear p53 accumulation was determined in two of 5 LMP cases (%40), in 10 of 22 LGC (%45.4), and in 8 of 25 HGC (%32). Positivity of p53 accumulation was observed in 20 (%57.7) of all cases. There was no statistically significant relationship between AgNOR score of p53(+) and p53(-) cases. There was no correlation between LGC and LMP, also between LGC and HGC (p > 0.05), but a meaningful relationship was found between LMP and HGC (p = 0.03). Association between P53 and grade, AgNOR value and grade, p53 and AgNOR was found statistically insignificant. CONCLUSIONS: Although we found a statistically significant correlation between AgNOR count of LMP and HGC, this study did not show a satisfying correlation between AgNOR, p53 and any grade of urothelial carcinoma.

Immunohistochemical study on histogenesis of congenital epulis and review of the literature.

Congenital epulis is a very rare lesion found only in newborn infants. This tumor is multiple in about 10% of reported cases, rarely with the simultaneous involvement of the maxilla and mandibula, as in this article. In the presented case, light microscopy demonstrated large eosinophilic granular cells arranged in solid nests that are separated by thin fibrovascular areas. The tumors in the maxilla and mandibula were investigated with a panel of polyclonal and monoclonal antibodies, and using immunoperoxidase methods on formalin-fixed, paraffin-embedded sections. Immunohistochemical studies revealed strong and diffuse cytoplasmic staining for neuron specific enolase and vimentin. However, all other reactions were negative. These results suggest that the congenital epulis may be derived from uncommitted nerve-related mesenchymal cells.

Hydatid disease in a thyroglossal cyst.

The location of hydatid disease in organs other than the liver and lung is unusual and occasionally producing difficulties in diagnosis. Thyroglossal cyst itself is not so common, so that more careful search of thyroglossal cyst for the presence of scolex and/or laminated membrane may result in increase in frequency of such a condition in the area where hydatid disease is prevailed. Since we were unable to find a case of hydatid disease involving thyroglossal cyst, as in our present case, we feel justified in reporting this case, considering it would be the first publication in world literature.