Tonsillar Plasmacytoma: clues on magnetic resonance imaging.

BACKGROUND: Malignant plasma cell proliferation may present as a disseminated disease (multiple myeloma), a solitary plasmacytoma of bone, or an extramedullary plasmacytoma of soft tissue. The latter plasmacytomas represent approximately 3% of all plasma cell proliferations, and 80% develop in the head-and-neck region. The unexpected clinical presentation of such masses may be present. CASE PRESENTATION: Here, we report a rare case of primary tonsillar plasmacytoma in a 42-year-old female. The patient presented with asymmetric tonsillar hypertrophy that was resistant to antibiotherapy. Upon further workup, we found no evidence of multiple myeloma or light-chain disease. The patient underwent surgery and, at the last follow-up, exhibited no evidence of such disease. CONCLUSIONS: In adults presenting with asymptomatic tonsillar enlargement, the possibility of submucosal masses should be considered, thus encouraging the radiologist to evaluate crypts within the palatine tonsil on a postcontrast MRI, besides enlargement and signal change.

Analysis of the Differences between Bethesda Groups according to Conventional Smear and Liquid-Based Cytology Methods in Cervicovaginal Cytology: A Single-Center Experience with 165,915 Cases.

INTRODUCTION: Liquid-based cytology (LBC) has replaced conventional smear (CS) in the world. In this study, through a series with a large number of cases, we aimed to make a comparison and general evaluation in all groups, primarily epithelial abnormalities, according to LBC and CS methods. This study was carried out in a private pathology laboratory located in a metropolitan city, where cytological materials sent from many clinics were examined. MATERIAL AND METHODS: There were 165,915 cases whose smears were examined between 2012 and 2020, most of them conventional (131,224 CS, 34,691 LBC). Cases were evaluated on the basis of the Bethesda 2014 classification and divided into sub-diagnostic categories after they were divided into two main groups as "with epithelial abnormalities" and "without." χ2 and Fischer's precision statistical tests were conducted using SPSS 23.0 package. In the CS process, cervical samples were obtained using an endocervical brush and a spatula. Cells were directly spread onto the slides and promptly fixed in 95% ethanol, followed by staining with the standard Papanicolaou stain. For LBC ThinPrep, cervical specimens were gathered using a cervix brush. The brush was washed in a vial and discarded. Finally, cells were isolated through vacuum filtration and transferred to the slide using air pressure. RESULTS: Squamous cell abnormalities (atypical squamous cells of undetermined significance [ASC-US], atypical squamous cells - cannot exclude high-grade squamous intraepithelial lesion [ASC-H], low-grade squamous intraepithelial lesion [LSIL], high-grade squamous intraepithelial lesion [HSIL], squamous cell carcinoma, atypical glandular cells of undetermined significance) were reported in 5,696 (3.43%) cases. ASC (ASC-US + ASC-H)/SIL ratio (1.36/2.04) was found to be 0.67 (recommended Bethesda ratio is <3). ASC-US (p < 0.001), ASC-H (p < 0.001), and HSIL(p < 0.001) detection rate of LBC was found to be significantly higher than CS. ASC-US (1.8/1.2), ASC-H (0.08/0.008), and HSIL (0.6/0.3) case ratios of LBC/CS were found to be significantly higher in LBC. LSIL (1.72/1.66) rate was similar. CONCLUSION: LBC is superior to CS in detecting epithelial lesions. In addition to being used as a screening method, it is clear that it makes a great contribution to reducing cervical carcinomas due to HPV typing. Definitive comments regarding comparison of methods on reactive changes and microorganism detection are challenging. Preanalytical factors might account for these situations.

Human Papilloma Virus Frequency and Genotypes; Evaluation of the 4879 Screenings Made with Polymerase Chain Reaction and Chip Array Between 2001 and 2019 in Istanbul.

OBJECTIVES: The aim of this study is the documentation of human papilloma virus (HPV) frequency and types seen in the city of Istanbul, Turkey, as well as evaluation of the relationship between these subtypes and cytological and pathological diagnoses. METHODS: 4879 cases were studied in our molecular pathology department between 2001 and 2019 in Istanbul. Between 2001 and 2010, 1692 cases were screened for HPV 6, 11, 16, 18, 31, and 33 by conventional hybridization and polymerase chain reaction (PCR). Since 2011, up to 49 HPV typing has been performed for 3187 cases with chip array. The cases were referred to the pathology center and the hospital pathology department by clinicians for screening before HPV vaccination and on the observation of precancerous changes and koilocyts in cytological-histopathological evaluations. RESULTS: In this study, the frequency of HPV was found to be 10.8% (527 HPV-positive cases). Among these, 348 cases were high-risk groups, whether or not they were previously associated with a low-risk group. When we look at the distribution of the cases according to the high-risk HPV types, HPV 16 is the most common type. The frequencies of occurrence of other HPV types are as following: HPV-16: 41.7%, HPV-31: 11.7%, HPV-52: 7.9%, HPV-51: 7.1%, HPV-33: 6.9%, HPV-45: 6.5%, HPV-18: 6.3%, HPV-39: 6.1%, and HPV-58: 5.8%. It was further found that multiple infections were 28% of high grade squamous intraepithelial lesion cases. HPV frequency was 38% and 72%, respectively, in cases with cytologically or histopathological precancerous, low-grade squamous intraepithelial lesion, and HSIL changes. As a final note, HPV was detected in 9 of 10 cases with cervical cancer (90%). Only 1 adenocarcinoma case detected in the series was a double infection with HPV types 18 and 45. CONCLUSION: HPV 16 was the most common type found in this study. It is followed by types 31, 52, 51, 33, 45, 18, 39, and 58, respectively. The most common association observed in double infections was between HPV 16 and 58. It was also observed that the incidence of HPV in the city of Istanbul, Turkey, was similar to other developed countries. As a final note, in addition to screening tests, PCR and chip array studies should be conducted and the community should be informed about preventive medicine and the importance of condom use.

Diagnosis in childhood abdominal Burkitt's lymphoma.

BACKGROUND: The role of surgery has changed substantially over the years in abdominal Burkitt's lymphoma. Laparotomy without total excision of the tumor does not have a positive effect on survival, might cause complications, and delays initiation of chemotherapy. Here we present our diagnostic management of patients with abdominal Burkitt's lymphoma. MATERIALS AND METHODS: The diagnostic methods of abdominal Burkitt's lymphoma cases treated between January 1999 and December 2009 were evaluated retrospectively. RESULTS: Of the 48 abdominal Burkitt's lymphoma patients, 13 also had extra-abdominal site involvement. Diagnosis was made with ultrasound-guided tru-cut needle biopsy of the abdominal mass (n = 11), fluid cytology (n = 7), extra-abdominal site biopsy (n = 4), bone marrow aspiration (n = 2), gastroscopy (n = 1), and laparotomy (n = 23). In patients diagnosed with laparotomy, chemotherapy was started in 4-22 days (median 7) compared with patients diagnosed with other diagnostic interventions in 2-4 days (median 2) (P < .001). CONCLUSION: Although the most frequently used technique is laparotomy and open biopsy in our series, other methods provided quicker initiation of chemotherapy and less surgical morbidity. Especially in patients with high stages, cytological evaluation and tru-cut needle biopsy with radiological guidance is a better alternative of laparotomy.

Covering the colon anastomoses with amniotic membrane prevents the negative effects of early intraperitoneal 5-FU administration on anastomotic healing.

PURPOSE: This study investigated whether covering the colonic anastomoses with amniotic membrane (AM) protects the anastomotic healing from the adverse effects of immediate 5-fluorouracil (5-FU) administration. METHODS: One hundred twenty wistar albino rats were randomized to one of four groups (I-IV, 30 rats in each) and underwent a standardized left colon resection and anastomoses. The anastomoses of the rats in groups II (AM) and IV (5-FU + AM) were covered with AM. Saline solution (2 ml/day; groups I (control) and II) or 5-FU (20 mg/kg/day; groups III (5-FU) and IV) was administered to the rats intraperitoneally once daily from the day of operation until sacrificed. Half of each group was sacrificed on the postoperative day 4 (IA, IIA, IIIA, and IVA) and other half on the postoperative day 8 (IB, IIB, IIIB, and IVB), and their anastomoses were evaluated when sacrificed. RESULTS: The dehiscence rate of anastomotic dehiscence and adhesion formation were significantly higher in groups IIIA and IIIB compared with groups IVA and IVB, respectively. Bursting pressure was significantly higher in the 5-FU + AM groups than in the 5-FU groups. The inflammatory cell infiltration was significantly lower in groups IIIA and IVA compared with group IA, in groups IIIB and IVB compared with group IB, and in group IVA compared with group IIIA. Neoangiogenesis, fibroblast activity, collagen deposition, and hydroxyproline levels were significantly higher in the 5FU + AM groups compared with control and 5-FU groups. Malondialdehyde levels were significantly higher in the 5-FU groups than in the 5-FU + AM groups. CONCLUSION: Covering colon anastomoses with AM protects them, preventing leakage and reversing the negative effects of 5-FU administration.

Effects of the amniotic membrane on healing of colonic anastomoses in experimental left-sided colonic obstruction.

PURPOSE: We investigated the effects of the amniotic membrane on experimental primary colonic anastomoses of colonic obstruction in rats. METHODS: Fifty female Sprague-Dawley rats were used in this study. All rats were submitted to a 2-0 silk ligature obstruction of the left colon 4 cm above the peritoneal reflexion and were reoperated upon 24 h later. Ten animals served as controls for measurement of bursting pressure, while the other 40 animals underwent colonic resection followed by primary anastomosis and were divided into two groups, the anastomosis (O) and amniotic membrane (OA). The latter group had anastomoses covered by amniotic membranes. Fifty percent of both OA and O groups were killed on postoperative day 3 (OA3, O3), and the other 50% were killed on postoperative day 7 (OA7, O7). RESULTS: Bursting pressures were significantly higher in groups OA3 and OA7 compared to those in O3 (p < 0.5) and O7 (p < 0.01), respectively. Inflammatory cell infiltration and adhesion scores were significantly lower in groups OA3 and OA7 compared to those in O3 (p = 0.001 and p < 0.01, respectively) and O7 (p = 0.001 and p < 0.05, respectively). Neoangiogenesis, fibroblast activity, collagen deposition, and hydroxyproline concentrations were significantly higher in groups with amniotic membrane than in groups without amniotic membrane (p < 0.05, for all comparisons). CONCLUSIONS: Covering colonic anastomoses with amniotic membranes has a positive effect on both the early and late phases of anastomotic healing on left-sided large bowel obstruction and provides a safer and stronger alternative than suturing one.

Effects of amniotic membrane on the healing of primary colonic anastomoses in the cecal ligation and puncture model of secondary peritonitis in rats.

PURPOSE: We aimed to investigate the effects of amniotic membrane on primary colonic anastomoses in a rat peritonitis model. MATERIALS AND METHODS: Fifty female Sprague Dawley rats were used in the study. Bacterial peritonitis was induced in all rats by performing a cecal ligation and puncture. Ten rats served as controls for the bursting pressure measurement, while the other 40 animals were divided into two groups (the anastomosis group (P) or the amniotic membrane group (PA)), and all of them underwent colonic anastomosis. The latter group had amniotic membrane covering their anastomoses. Half of the PA and P groups were sacrificed on the third postoperative day (PA3, P3), and the other half on the seventh postoperative day (PA7, P7). RESULTS: The bursting pressures were significantly higher in groups PA3 and PA7 compared with P3 (p < 0.01) and P7 (p < 0.05), respectively. Inflammatory cell infiltration and adhesion scores were significantly lower in groups PA3 and PA7 compared with groups P3 (p < 0.001, p < 0.01, respectively) and P7 (p < 0.001, p < 0.05, respectively). Neoangiogenesis, fibroblast activity, collagen deposition, and hydroxyproline concentrations were significantly higher in groups with amniotic membrane than in groups without amniotic membrane (p < 0.05, for all comparisons). CONCLUSION: This study showed that the covering of colonic anastomoses with amniotic membrane significantly prevented the delaying effect of intraperitoneal sepsis and provided a safer and stronger anastomosis than suture and that this was the case for both the early and late phases of anastomotic healing in the colon.

Effects of amniotic membrane on the healing of normal and high-risk colonic anastomoses in rats.

BACKGROUND: This study was aimed at examining whether or not the addition of amniotic membrane to a sutured colonic anastomosis improves its healing. MATERIAL AND METHODS: Ninety female Sprague Dawley rats were used in the study. Ten served as controls for bursting pressure measurement, while the other 80 animals were divided into four groups: Anastomosis group (NA), high-risk anastomosis group (HRA), anastomosis plus amniotic membrane group (NA-AM), and high-risk anastomosis plus amniotic membrane group (HRA-AM). The last two groups had amniotic membrane covering their anastomoses. Anastomotic evaluation was carried out on the third (NA3, HRA3, NA-AM3, and HRA-AM3, respectively) and seventh (NA7, HRA7, NA-AM7, and HRA-AM7, respectively) postoperative days. The main outcome measures were gross anastomotic healing, adhesion formation, mechanical strength, hydroxyproine content, and parameters of histopathological healing. RESULTS: Anastomotic dehiscence rate was 66.7%, 40%, 20%, and 10% in group HRA7, HRA3, NA7, and NA3, respectively. However, there was no significant difference between groups regarding the dehiscence rate. The adhesion scores were significantly higher in groups NA3 and HRA3 compared with groups NA-AM3 and HRA-AM3, respectively (p < 0.05, p < 0.001). Bursting pressure was significantly higher in groups with amniotic membrane compared without amniotic membrane (p < 0.05, for all comparison). Inflammatory cell infiltration was significantly lower in groups with amniotic membrane compared with groups without amniotic membrane (p < 0.05, for all both comparisons). Neoangiogenesis was significantly higher in the NA-AM3 and HRA-AM3 groups compared with the NA3 (p < 0.01) and HRA3 (p < 0.05) groups, respectively. Fibroblast activity was significantly higher in groups NA-AM3 and NA-AM7 compared with groups NA3 (p < 0.05) and NA7 (p < 0.05), respectively. Collagen deposition and hydroxyproline concentrations were significantly higher in groups with amniotic membrane compared with groups without amniotic membrane (p < 0.05, for all both comparisons). CONCLUSION: The covering of both normal and high-risk colonic anastomoses with amniotic membrane provides a beneficial effect over conventional suturing of healing.

Solid-pseudopapillary neoplasm of the pancreas: Clinicopathologic and immunohistochemical analysis of nine cases.

BACKGROUND: Solid-pseudopapillary neoplasm (SPPN) of the pancreas is a distinctive tumor of low malignant potential with a predilection for female patients in the second and third decades of life. We studied nine cases of SPPN of the pancreas and reviewed the literature concerning these uncommon tumors. MATERIALS AND METHODS: A total of 7 cases of SPPN located in the tail of the pancreas and two located in the head of the pancreas were presented. Distal pancreatectomy in three patients and distal pancreatectomy with splenectomy in two patients Whipple's operation in four patients were performed. Histological diagnosis was made by performing hematoxylin-eosin and periodic acid-Schiff staining, immunohistochemical staining. Follow-up of the patients was between 2 months and 12 years. RESULTS: Computed tomography and magnetic resonance imaging were found as equivocal for diagnosis. Mass containing cystic and solid areas were not characteristic but raised suspicion of SPPN. Pathologic examination showed SPPN in all patients. No metastasis or recurrence was detected during follow-up. CONCLUSIONS: Solid-pseudopapillary neoplasm is a relatively rare tumor, and patients tend to survive for a long period. Preoperative imaging is not characteristic. Pathologic examination is the mainstay in the diagnosis. Complete surgical removal is the best choice of treatment.

Effects of chitosan on healing and strength of colonic anastomosis in rats.

PURPOSE: To investigate whether chitosan application over colonic anastomosis line, provide reinforcement, and subsequently improve anastomotic healing. METHODS: Forty eight Wistar albino female rats were used and were randomly divided into four groups, 12 rats in each: The control groups (1 and 3) received no further treatment. The experimental groups (2 and 4) received chitosan application over the colonic anastomosis. After sacrifying rats at the end of the experiment (either on day three or on day seven, depending on the group), colonic bursting pressure, a hihydroxyproline level and histopathologic characteristics of the perianastomotic tissue were examined. RESULTS: At three days, chitosan and control groups had similar values for histopathologically. On day seven, chitosan group had significantly higher mean score of collagenization (p=0.007) and a significantly higher bursting pressure (p=0.038). CONCLUSION: Our study emphasizes the positive effect of chitosan in the process of collagenation in colonic anastomosis healing.

Mesothelial/monocytic incidental cardiac excrescence in a patient with antiphospholipid syndrome.

Mesothelial/monocytic incidental cardiac excrescence (MICE) is a rare benign lesion composed of a mixture of histiocytes, mesothelial cells, fibrin, adipocytes and scattered inflammatory cells without a vascular network or supporting stroma. Its pathogenesis is controversial with some authors favoring an artifactual theory while others consider a reactive phenomenon. To date, only 41 cases of MICE have been reported in the literature. We describe an additional case of MICE in a 24-year-old female with antiphospholipid syndrome. A mobile hyperechogenic mass attached to the left ventricular surface of the aortic valve was documented by transthoracic echocardiography (TTE). The patient did have cardiac catheterization one month before the cardiac surgery. Histopathologic and immunohistochemical examination showed a lesion composed of histiocytes and mesothelial cells together with fibrin and scattered inflammatory cells. To our knowledge, this is the first case of MICE detected in a patient with antiphospholipid syndrome.

Micronodular T-cell/histiocyte-rich B-cell lymphoma of the spleen in a case of small lymphocytic lymphoma: a Richter's transformation.

Abstract A case of micronodular T-cell/histiocyte-rich B-cell lymphoma of the spleen who had a prior diagnosis of small lymphocytic lymphoma is presented. Micronodular T-cell/histiocyte-rich B-cell lymphoma of the spleen was first described in 2003, and very few cases have been reported since then. This is the first reported case supervening in a patient with pre-existing chronic lymphocytic lymphoma. We review its clinical, pathologic, and immunohistochemical features and the difficulties we encountered during diagnosis.

Endometriosis of the appendix presenting as acute appendicitis.

As with other types of endometriosis in the intestinal tract, endometriosis of the appendix is generally asymptomatic and is usually discovered incidentally during laparotomy in patients with pelvic endometriosis. When it presents with symptoms they are difficult to differentiate from acute appendicitis. Appendiceal endometriosis may not only cause symptoms of acute appendicitis, but may also present as cyclic and chronic right lower quadrant pain, melena, lower intestinal haemorrhage and caecal intussusception. We report a case of appendiceal endometriosis clinically presenting as acute appendicitis, where the definitive diagnosis was established by histopathological examination of the appendix.

Giant true cyst of the spleen with elevated serum markers, carbohydrate antigen 19-9 and cancer antigen 125.

A 19-year-old woman presented with a left upper abdominal mass. Computed tomography of the abdomen showed a solitary cystic lesion in the splenic hilum, approximately 20×16 cm in size, demonstrating almost total displacement of the remaining splenic parenchyma. She had high serum concentrations of carbohydrate antigen 19-9 and cancer antigen 125. A splenectomy was performed. Immunohistochemical study confirmed the existence of an epithelial cyst. Following surgery, the serum concentrations of the tumour markers decreased gradually. True splenic cysts are rare and their origin is controversial. In splenic cysts with high serum concentrations of tumour markers, such as occurred in our patient, cystectomy or splenectomy were preferred to remove tumour marker-producing epithelium and to prevent recurrence after treatment. If the epithelial lining of the cyst cannot be detected under light microscopy, immunohistochemical study should be performed.

Prevention of peritoneal adhesions by intraperitoneal administration of vitamin E and human amniotic membrane.

BACKGROUND: Our objective was to evaluate the comparative effectiveness of intraperitoneally administered vitamin E and human amniotic membrane in preventing postoperative intraperitoneal adhesion formation. MATERIAL AND METHODS: 75 Wistar-albino rats were separated into 5 groups: Group 1 (control), Group 2 (intraperitoneal olive oil, the diluent of vitamin E), Group 3 (Intraperitoneal vitamin E diluted in olive oil), Group 4 (Amniotic membrane group) and Group 5 (Amniotic membrane and Intraperitoneal vitamin E diluted in olive oil). The same experimental method, consisting of cecal abrasion and ligature of the adjacent parietal peritoneum, was used in all rats to produce adhesions. Relaparotomy was performed on the 15th postoperative day. intra-abdominal adhesions were scored according to macromorphological characteristics and adhesion-carrying tissues underwent standard histologic examination. Inflammation, vascularization and fibrosis in granulation sites were graded in all samples. The results were analyzed using a Mann-Whitney-U test. RESULTS: In terms of inflammation, neovascularization and fibrosis scores obtained by histology and macromorphologic adhesion scores. There were no significant differences between Groups 1 and 2 (p=0.176). The results of Groups 3, 4 and 5 showed a significant difference when compared with both Group 1 and 2 (p=0.001). The difference between Groups 3, 4 and 5 were not significant with respect to these 4 parameters. CONCLUSION: Intraperitoneal vitamin E and amniotic membrane treatment were both effective in the prevention of peritoneal adhesions. The combination of these agents did not produce a synergistic effect. Easy applicability of the intraperitoneal administration of vitamin E was its major advantage.

Effects of chitosan on healing and strength of colonic anastomosis in rats / Efeitos de quitosana na cicatrização e resistência de anastomose colônica em ratos

PURPOSE: To investigate whether chitosan application over colonic anastomosis line, provide reinforcement, and subsequently improve anastomotic healing. METHODS: Forty eight Wistar albino female rats were used and were randomly divided into four groups, 12 rats in each: The control groups (1 and 3) received no further treatment. The experimental groups (2 and 4) received chitosan application over the colonic anastomosis. After sacrifying rats at the end of the experiment (either on day three or on day seven, depending on the group), colonic bursting pressure, a hihydroxyproline level and histopathologic characteristics of the perianastomotic tissue were examined. RESULTS: At three days, chitosan and control groups had similar values for histopathologically. On day seven, chitosan group had significantly higher mean score of collagenization (p=0.007) and a significantly higher bursting pressure (p=0.038). CONCLUSION: Our study emphasizes the positive effect of chitosan in the process of collagenation in colonic anastomosis healing.

OBJETIVO: Investigar se a aplicação de quitosana em anastomose colônica promove resistência à tração e consequentemente a melhora na cicatrização. MÉTODOS: Foram utilizados 48 ratos Wistar fêmeas distribuídos em quatro grupos, 12 ratos em cada. Grupos controle (1 e 3) não receberam tratamento. Grupos experimento (2 e 4) receberam aplicação de quitosana na anastomose colônica. Após eutanásia após 3º ou 7º dias foram examinadas a tensão, o nível de hidroxiprolina e aspectos histopatológicos da anastomose. RESULTADOS: Após três dias os grupos controle e quitosana não apresentaram alterações histopatológicas. No sétimo dia o grupo quitosana apresentou significante elevação do escore de colagenização (p=0,007) e da tensão de ruptura (p=0,038). CONCLUSÃO: A quitosana apresentou bons resultados nos processos de colagenização e cicatrização de anastomose colônica.