Clinicopathological evaluation of cutaneous leishmaniasis in the mediterranean region of Turkey.

OBJECTIVE: Cutaneus leishmaniasis, a chronic self-limited disease of the skin, is usually caused by Leishmania Tropica. It is endemic in Southeastern Anatolia. The definitive diagnosis depends on demonstration of the parasites by smear and culture or its identification in tissue section. This study aimed to evaluate clinical and histopathological skin lesions in cutaneous leishmaniasis cases in Antalya, Turkey. MATERIAL AND METHOD: Our study included 28 patients diagnosed with cutaneous leishmaniasis at the Pathology Department of Akdeniz University Medical Faculty. Histopathological sections were stained with Haematoxylin-Eosin, Giemsa or Leishman for visual examination of cellular components by two dermatopathologists. The epidermal (acanthosis, hyper-parakeratosis, atrophy, lymphocytic exocytosis) and dermal changes that may indicate lymphohistiocytic infiltration and granuloma formation were investigated. The parasitic load was classified according to the modified Ridley's parasitic index. RESULTS: Out of 28 cases, 11 had hyperparakeratosis, 17 had orthokeratosis, 20 had acanthosis, 4 had epidermal atrophy, and 7 had exocytosis. Typical epithelioid cell granulomas with giant cells and a rim of lymphocytes were present in 16 cases. Leishman-Donovan bodies were extremely rare in typical granulomatous lesions. The other 12 cases showed lymphohistiositic infiltration, giant cells and prominent plasma cells. There were numerous Leishman-Donovan bodies in these lesions. CONCLUSION: We investigated the epidermal and dermal changes that would facilitate the histopathological diagnosis of cutaneous leishmaniasis in this study. We found that atrophy, acanthosis, and orthokeratosis were early stage indicators, while exocytosis, hyperparakeratosis, and atrophy were indicative of late stage disease.

The divergent roles of growth differentiation factor-15 (GDF-15) in benign and malignant skin pathologies.

GDF-15 (Growth Differentiation Factor-15) is a member of the transforming growth factor ß (TGF-ß) superfamily. GDF-15 is not only involved in cancer development, progression, angiogenesis and metastasis, but also controls stress responses, bone formation, hematopoietic development, adipose tissue function and cardiovascular diseases. GDF-15, which is regulated by p53, has shown antitumorigenic and proapoptotic activities in vivo and in vitro. Also, GDF-15 is involved in skin biology and histamine-induced melanogenesis; it is overexpressed in melanoma cells and is associated with depth of tumor invasion and metastasis. GDF-15 level is increased in patients with systemic sclerosis and is related with the degree of skin sclerosis and intensity of pulmonary fibrosis. In the future, GDF-15 may be a potential target for therapy in benign disorders with skin fibrosis and malignant lesions of the skin.

Comparing the effects of pedicle torsion on axial or perforator flaps; improving the perforator flap resistance to pedicle torsion with delay phenomenon.

BACKGROUND: The torsion of the flap's pedicle is one of the most common conditions causing vascular compromise. We aimed to compare the resistance to torsion of axial flap pedicle and perforator pedicle patterns. In the second part of the study, we investigated whether the delay phenomenon is an effective method for improving perforator flap resistance to pedicle torsion. METHODS: In the first phase, 90 male Wistar rats were randomly divided into two groups: perforator and axial. Bilateral groin flaps were elevated in the axial group and bilateral posterior thigh perforator-based flaps were elevated in the perforator group. Viable flap areas were compared at 90, 180, 270, 360, and 720 degrees of pedicle rotation. Microangiographic and histopathological studies were performed. RESULT: As a result, necrosis was seen following earlier rotation in the perforator group and viable flap areas were also lower. In the second phase, after delay procedure, the perforator flaps were exposed to 270, 360, and 720 degrees of pedicle rotation. With the delay procedure, no significant difference in viable flap areas was observed. CONCLUSION: In conclusion, the resistance to torsion of the axial flap pedicle pattern was greater than that of the perforator pedicle pattern, and the delay procedure was not an effective method for improving flap resistance to torsion.

Evidence of surfactant protein A and D expression decrement and their localizations in human prostate adenocarcinomas.

AIM: Surfactant proteins (SP-A and SP-D) were originally described in the lung; however, they are also present in the prostate. Purpose of this study, therefore, was to determine how surfactant proteins are altered in prostate adenocarcinomas (PCa) and find out any connection exists between their expressions and their staining patterns, prostate-specific antigen (PSA) values, Gleason score, age, tumor volume and tumor, node, metastases (TNM) clinical stage. METHODS: Thirty-five tissue samples were obtained during radical prostatectomy. All specimens were classified to three groups based on the Gleason score <7, 7 and Gleason score >7. Surfactant proteins' expressions were tested by immunohistochemical and Western blotting methods. RESULTS: Immunoreactivity was detected in the cytoplasm from both basal cells and secretory epithelial cells in malignant and non-malignant areas. About 80% of the malignant basal cells were characterized as either weak or strong while non-malignant epithelial cells demonstrated strong immunoreactivity for SP-A. Also malignant (81.8%) and non-malignant cells (90.6%) were characterized as either weak or strong for SP-D. Decrement of SP-A and SP-D immunostaining tended to associate with an increasing Gleason score (p > 0.05, p < 0.05), tumor volume (p < 0.05, p > 0.05) and age (p > 0.05, p > 0.05). There was a strong positive correlation between Gleason score and tumor volume (p < 0.01). Also, either none or weak SP-A and SP-D immunoreactivity was observed specimens with Gleason score 7 or higher. SP-A and SP-D reacted with 34 kDa (SP-A) and 43 kDa (SP-D) immunoreactive single bands were decreased in tumor tissues. CONCLUSIONS: The development of prostate cancer may be related to decreased level of surfactant protein A and D.

Laparoscopic radical prostatectomy. Impact of the learning curve on positive surgical margins.

OBJECTIVES: The study was conducted to assess the incidence of positive surgical margins (PSMs ) in our series of laparoscopic radical prostatectomy (LRP ) performed by a fellowship trained surgeon in independent practice. METHODS: In this series, 300 patients underwent LRP by the same surgeon at our institution. The prospectively created records of all consecutive LRPs were reviewed. The patients were divided into three groups based on the time of surgery: group I included the first 100 cases;group II included the second 100 cases; and group III the last 100 cases. We compared the incidence rate and the location of PSMs among the groups. As additional variables, prostate-specific antigen (PSA ) level, biopsy/specimen Gleason score, clinical/pathological stage and pathologic tumor volume were also evaluated. RESULTS: Patient demographics and preoperative staging variables were comparable among the three groups, with no statistically significant differences among them. The PSM rates were 27%, 22% and 27% for groups I, II and III, respectively. The difference in overall PSM rates in the three groups was statistically insignificant (p: 0.966 ) . PSM rates decreased specifically at the posterolateral region and in pT3b stage with non/significant difference when comparing the first 100 patients to the last 100 patients. CONCLUSION: Pathologic surgical margin safety can be achieved with laparoscopic fellowship/training (LFT ) from the initial cases in independent practice.

The effect of erythropoietin on anastomotic healing of irradiated rats.

AIM: The aim of the present study is to evaluate the possible protective effects of erythropoietin (EPO) on anastomotic wound healing after preoperative radiotherapy according to its pleiotropic mechanism of action. METHODS: Thirty-two male Wistar albino rats were randomized into four groups containing eight rats each: ANAS group, standard resection plus anastomosis; RT+ANAS group, radiation plus standard resection plus anastomosis; ANAS+EPO group, standard resection plus anastomosis plus EPO; RT+ANAS+EPO, radiation plus standard resection plus anastomosis plus EPO. All animals were sacrificed by cardiac puncture, and anastomotic healing was measured by bursting pressure, hydroxyproline (OHP) levels, myeloperoxidase (MPO) activity and histopathological evaluations. Malondialdehyde (MDA), tumor necrosis factor-alpha (TNF-α), and matrix metalloproteinase-9 (MMP-9) were also measured in serum specimens. RESULTS: OHP levels in the RT+ANAS + EPO group were significantly increased compared with other groups (p < .05). In contrast, MPO activity in the RT+ANAS+EPO group was significantly decreased compared with other groups (p < .05). Serum MDA levels were found to be decreased in the ANAS+EPO and RT+ANAS+EPO groups (p < .05). Group comparisons demonstrated that bursting pressure was significantly higher in EPO treated rats (p < .05). The histopathology results revealed that EPO treatment improves anastomotic wound healing though decreased necrosis and inflammatory cell infiltration and increased fibroblast activity. CONCLUSION: The findings of the present study indicate that EPO contributes to wound healing and the strength of colon anastomosis following radiation due to its antioxidant and anti-inflammatory effects, but further studies are needed to explore the significance of these effects.

Importance of TNF-related apoptosis-inducing ligand in pathogenesis of interstitial cystitis.

INTRODUCTION: Although interstitial cystitis is an inflammatory disease, its etiopathogenesis is not clearly understood. The objective of the present study is to investigate the distribution of TNF-related apoptosis-inducing ligand (TRAIL) and its receptors in bladder biopsy samples of patients diagnosed with interstitial cystitis and the role of TRAIL in the pathogenesis of interstitial cystitis. MATERIALS AND METHODS: TRAIL and its receptors were stained immunohistochemically in bladder biopsy samples of 27 patients diagnosed with interstitial cystitis, and the samples were evaluated independently by two pathologists and were scored in terms of expression intensity and distribution. RESULTS: An evaluation of the results of the statistical analysis showed that the TRAIL-R4 receptor was immunohistochemically stained with a higher score than TRAIL-R1, TRAIL-R2, TRAIL-R3 receptors and TRAIL, with a statistically significant difference (P < 0.05). CONCLUSION: These findings indicate that TRAIL-R4 is the predominant receptor in the interstitial cystitis inflammation.

Surfactant proteins in inflammatory skin diseases: controlled study.

Surfactant proteins (SP) have recently been reported to be expressed in human skin tissue. SP is thought to play an essential role in the firstline defense of skin. In this study, we aimed to investigate if the SP may play a role in inflammatory skin diseases. Seven volunteers with psoriasis (n = 3), atopic dermatitis (n = 2), lichen planus (n = 1) and Behcet's disease (n = 1) participated in the study. Biopsies from each lesion and adjacent (approximately 2 cm distant) normal-appearing skin in patients were performed. Expression and localization of the SP-A, -B, -C, and -D in fresh tissues were studied by an immunohistochemical technique. In all patients, there was a weak cytoplasmic staining with SP-A and SP-D and nuclear staining with SP-B and SP-C in the epidermis of normal-appearing skin samples. However, epidermal staining with SP was observed to be stronger in all lesional samples. In addition, there was a prominent staining in inflammatory cells infiltrating dermis. This expression represents a previously unknown immunologic response in the inflammatory skin diseases and may represent an important step in the pathogenesis of these disorders.

Prognostic value of Ki-67, CD31 and epidermal growth factor receptor expression in basal cell carcinoma.

Recurrence of basal cell carcinoma following treatment is common, and the majority of recurrences appear in the first 3 years. We examined the original tumors of 26 basal cell carcinoma cases, 14 of whom had a recurrence after an average of 3.7 years, and 12 of whom had no recurrence during an average of 4.4 years follow-up. Using immunohistochemistry, we tested for Ki-67, CD31 and epidermal growth factor receptor expressions in the tumor tissue. The percentages of expression for Ki-67, CD31 and epidermal growth factor receptor were significantly higher in the recurrent tumors than in the non-recurrent ones. Expression of Ki-67 and CD31 was 271.57 +/- 17.91 and 58.1 +/- 9.37 for the recurrent group and 187.08 +/- 21.48 and 23.9 +/- 5.45 for non-recurrent group respectively (p<0.0001; p<0.0001). Expression of epidermal growth factor receptor was positive in all basal cell carcinoma cells. The staining intensity was strong in 57% of recurrent and 8.3% of non-recurrent tumors (p=0.014). These results show that Ki-67, CD31 and epidermal growth factor receptor expression differ between basal cell carcinomas which later recur and those that do not recur.

A 13-year-old girl with recessive dystrophic epidermolysis bullosa presenting with squamous cell carcinoma.

Recessive dystrophic epidermolysis bullosa (RDEB) is an uncommon and severely disabling genetic disorder characterized by trauma-induced blisters, intractable skin ulcers, scarring, milia, and nail dystrophy. Patients with RDEB have an increased tendency for fast-growing and early metastasizing squamous cell carcinoma (SCC). We report here a 13-year-old girl with RDEB who developed a large SCC on the left knee. At 6 months of evolution it was resected and covered with an autologous skin graft. To our knowledge, this is the youngest patient with RDEB complicated by SCC to be reported, and therefore may serve to emphasize the importance of vigilance in surveying RDEB patients for SCC.

Netherton syndrome associated with idiopathic congenital hemihypertrophy.

Netherton syndrome is a rare genodermatosis comprised of anichthyosiform dermatitis, hair shaft defects, and atopic features. Other problems associated with Netherton syndrome are delayed growth and development, immune abnormalities, recurrent infections, and intermittent aminoaciduria. We describe an 18-month-old girl with Netherton syndrome who had idiopathic congenital hemihypertrophy on her right side with contralateral benign nephromegaly in addition to the characteristic clinical signs of the syndrome. To our knowledge, this is the first case of Netherton syndrome associated with idiopathic congenital hemihypertrophy to be reported.