Do HPV 16 positive/ASC-H cervical cancer screening results predict CIN 2+ better than other high-risk HPV subtypes?

Objective: To determine whether patients with atypical squamous cells, cannot exclude high grade squamous intraepithelial neoplasia (ASC-H) cytology have a correlation between high-risk human papillomavirus (HPV) type and CIN 2+1 lesion in final pathology. Material and Methods: The study was conducted retrospectively, using data from three tertiary gynecologic oncology centers located in various regions of Turkey. Data from 5,271 patients who had colposcopy between January 2003 and January 2021 were analyzed. Results: A total of 163 patients who had ASC-H cervical cytology test results, based on the Bethesda 2014 classification were eligible, and of these 83 (50.9%) who tested positive for HPV were included in the study. There was no correlation between the occurrence of CIN 2+ lesions and age (p=0.053). If there was any HPV 16 positivity (only HPV 16, HPV 16 and 18, HPV 16 and others) the presence of CIN 2+ lesions in the final pathology increased significantly. In HPV 16 positive ASC-H patients, the probability of CIN 2+ lesions in the final pathology were 72.5% while this rate was 48.1% in HPV 16 negative group (p=0.033). Conclusion: The guidelines do not provide a comprehensive definition of the role of the HPV test in managing ASC-H. Positive high-risk HPV types, especially HPV 16, together with an ASC-H smear result should bring to mind the possibility of high-grade dysplasia.

Is fibroblast growth factor 11 (FGF11) a predictive marker for breast cancer?

The prognostic role of fibroblast growth factor 11 (FGF11) has only been reported in cancers such as nasopharyngeal carcinoma and prostate cancer. The role of FGF11 in breast cancer is not fully known. It was aimed to compare FGF11 expression levels in de novo metastatic hormone receptor-positive, human epidermal reseptor-2-negative breast tumor tissue and healthy breast tissue and investigate the effect of the FGF11 expression on survival in breast cancer patients. To determine the FGF11 expression rate, breast tumor tissue of breast cancer patients diagnosed by breast biopsy and healthy breast tissue of healthy individuals who underwent breast biopsy due to benign lesions were used. The study population included 38 breast cancer patients and 24 healthy controls. The number of patients with a FGF11 expression level score of 1 (15.8% vs 12.5%), score of 2 (18.4% vs 12.5%), and score of 3 (31.6% vs 0%) was significantly higher in the patient group compared to the healthy control group. The median overall survival and progression-free survival were numerically better in the group with a FGF11 expression score of 0 to 1 than the group with a FGF11 expression score of 2 and 3, but this difference was not statistically significant. FGF11 may be a predictive marker for breast cancer formation. Additionally, with new FGF11-targeted treatment agents to be developed, endocrine resistance may be reduced, and better survival results may be achieved in hormone receptor-positive, human epidermal reseptor-2-negative breast cancer.

Clinicopathological features of atypical glandular cells, not otherwise specified, on cervicovaginal pap smears.

OBJECTIVE: The Papanicolaou (Pap) smear test is a standard screening test that detects cervical lesions and cancers. In this multicentric study, we performed a retrospective analysis of cytological results associated with atypical glandular cells, not otherwise specified (AGC-NOS). METHODS: We retrospectively reviewed Pap smear tests that resulted as AGC-NOS. A total of 254 women who underwent colposcopy due to a Pap smear result of AGC-NOS were included the study between 2003 and 2021. The ages, Pap smear results, HPV results if any, colposcopic biopsy results, endocervical and endometrial pathology results, and management of these patients were analysed. RESULTS: Two hundred fifty-four patients with AGC-NOS Pap smear results were included in the study. A total of 70 (27.6%) patients had cervical and endometrial premalignant or malignant lesions. Malignancy was observed in 17 (6.7%) patients (endometrium, n = 11 [4.3%]; cervix, n = 6 [2.4%]). Isolated premalignant or malignant lesions of the cervix and endometrium were detected in 57 (22.4%) and 12 (4.7%) patients, respectively. CONCLUSIONS: Patients diagnosed with AGC-NOS should undergo a careful evaluation with all clinicopathological features. Because cancer of the cervix and endometrium is not rare in patients diagnosed with AGC-NOS, colposcopic examination with endocervical sampling should be a priority based on a cervicovaginal smear. Endometrial sampling is also required according to the patient's clinic, age, and examination characteristics.

Idiopathic granulomatous hypophysitis mimicking adenoma.

Hypophysitis is a rare disease of pituitary gland, which, although it is usually a primary lesion, can also occur secondary to systemic conditions. Granulomatous hypophysitis is an inflammatory disease condition which accounts for less than 1% of all cellular lesions and can mimic adenoma. A 32-year-old woman presented with weight gain, galactorrhea and blurred vision. The MRI showed a cystic, nodular lesion in the intermediate lobe of the pituitary gland and the initial diagnosis was adenoma. She underwent surgery and the histopathology revealed granulomas composed of epithelioid histiocytes, multinuclear giant cells and mononuclear inflammatory cells. Inflammatory diseases of the pituitary gland are much less frequent than pituitary adenomas and idiopathic granulomatous hypophysitis is extremely rare. Histopathology and the ruling out of a systemic cause are the gold standards for its diagnosis.

Discrimination of lipoma from atypical lipomatous tumor/well-differentiated liposarcoma using magnetic resonance imaging radiomics combined with machine learning.

PURPOSE: To evaluate the diagnostic capability of radiomics in distinguishing lipoma and Atypic Lipomatous Tumors/Well-Differentiated Liposarcomas (ALT/WDL) with Magnetic Resonance Imaging (MRI). MATERIALS AND METHODS: Patients with a histopathologic diagnosis of lipoma (n = 45) and ALT/WDL (n = 20), who had undergone pre-surgery or pre-biopsy MRI, were enrolled. The MDM2 amplification was accepted as gold-standard test. The T1-weighted turbo spin echo images were used for radiomics analysis. Utility of a predefined standardized imaging protocol and a single type of 1.5 T scanner were sought as inclusion criteria. Radiomics parameters that show a certain level of reproducibility were included in the study and supplied to Support Vector Machine (SVM) as a machine learning method. RESULTS: No significant difference was found in terms of gender, location and age between the lipoma and ALT/WDL groups. Sixty-five parameters were accepted as reproducible. Fifty-seven parameters were able to distinguish the two groups significantly (AUC range 0.564-0.902). Diagnostic performance of the SVM was one of the highest among literature findings: sensitivity = 96.8% (95% CI 94.03-98.39%), specificity = 93.72% (95% CI 86.36-97.73%) and AUC = 0.987 (95% CI 0.972-0.999). CONCLUSION: Although radiomics has been proven to be useful in previous literature regarding discrimination of lipomas and ALT/WDLs, we found that its accuracy could further be improved with utility of standardized hardware, imaging protocols and incorporation of machine learning methods.

Asymtomatic Mass In The Tail Of The Pancreas: Intrapancreatic Accessory Spleen (IPAS).

We present a 48-year-old male patient with a mass in the tail of the pancreas on abdominal ultrasonography. The lesion was suspicious for a well-differentiated pancreatic neuroendocrine tumor and spleen preserved distal pancreatectomy surgery was performed. It was diagnosed as intrapancreatic accessory spleen (IPAS) after pathological examination. Accessory spleen is not an infrequent congenital entity caused by the localization of normal splenic tissue in ectopic regions. As it is known, an accessory spleen is a benign entity and does not require surgical treatment or follow-up when detected. However, it is important to recognize IPAS tissue as it may mimic a pancreatic neoplasia when it is located in the pancreas. In this article, we discuss the differential diagnostic possibilities of the IPAS entity.

Comparison of clinicopathological features and treatments between pre- and postmenopausal female breast cancer patients - a retrospective study.

INTRODUCTION: To find out if there are clinical and biological differences in breast cancer characteristics of premenopausal and postmenopausal women. For this reason, we investigated the differences in terms of the clinicopathological features and treatment methods of premenopausal and postmenopausal breast cancer patients in our study. MATERIAL AND METHODS: In this study, the files of 428 patients who were operated due to breast cancer between 1 January 2007 and 31 December 2017 in Ankara Atatürk Training and Research Hospital were examined retrospectively. The age, tumour size, tumour grade, oestrogen receptor, progesterone receptor, HER2 score, Ki-67 proliferation index, perineural invasion, and lymphovascular invasion were investigated. RESULTS: In patients with premenopausal breast cancer, the tumour diameter was larger (p = 0.047) and the lymph node metastasis was higher (p < 0.001). Oestrogen receptor (OR) expression (p = 0.002), progesterone receptor (PR) expression (p = 0.014), negative human epidermal growth factor receptor 2 (HER2) expression (p = 0.038), and Ki-67 expression (p = 0.017) were higher in the premenopausal group. In the premenopausal group, breast conserving surgery (p = 0.004), chemotherapy (p = 0.007), radiotherapy (p = 0.008), and endocrine therapy (p = 0.025) were higher than in the postmenopausal group. CONCLUSIONS: Premenopausal and postmenopausal female breast cancer patients have significant differences in tumour size, tumour grade, axillary lymph node metastasis, hormone receptor status, HER2 expression, and treatment modalities.

Diagnosing atypia of undetermined significance in thyroid fine needle aspiration samples using nuclear scoring.

BACKGROUND: Atypia of undetermined significance (AUS) is an indeterminate category in the Bethesda system for reporting thyroid cytopathology. Cytological features described as atypia are not always observed in every case, and it is difficult to determine how the small population of cells with enlarged nuclei, a few grooves, and rare elongated nuclei should be classified. Therefore, there is inter-intra observer variability considering these cell types, even though the cytological criteria are well defined. Therefore, this study aimed to establish a nuclear scoring system to help in the differential diagnosis of AUS. METHODS: Fine needle aspiration (FNA) samples that showed AUS and had surgical follow-up were included in this study. The aspirate was scored for the presence of intanuclear cytoplasmic inclusions, nuclear grooves, overlapping, enlargement, and elongation individually. The total nuclear score for each case was calculated. Statistical analysis of the association between each nuclear feature and the presence of papillary thyroid cancer (PTC) in the surgical specimens was performed. Cut-off points from the total score of these nuclear features were also calculated. RESULTS: Nuclear grooves and overlapping were more common in malignant cases (p < 0.001 and p = 0.048, respectively). A cut-off point of ≥5.5 for the total score was sensitive and specific for defining malignancy. CONCLUSION: The risk of PTC was higher in nodules with more prominent nuclear overlapping or nuclear groove in their FNA samples. In order to achieve a more confident AUS diagnosis, our scoring system can be helpful for thyroid FNA samples.

Expression of Immunomodulatory Molecules PD-1, PD-L1, and PD-L2, and their Relationship With Clinicopathologic Characteristics in Endometrial Cancer.

Chemotherapeutic agents are not very effective in treating advanced endometrial cancers (ECs). Recent studies have demonstrated the immune evasion mechanism of tumors and possible remedies. Programmed cell death protein 1 (PD-1), programmed death ligand 1 (PD-L1), and programmed death ligand 2 (PD-L2) are immunomodulator molecules that have been the focus of research in lung cancer, melanoma, and renal cell cancer. However, there are few studies concerning EC. This retrospective study aimed to determine PD-1, PD-L1, and PD-L2 expression immunohistochemically in EC, and to study their correlation with clinicopathologic tumor characteristics. This study comprised 127 patients with EC. Anti PD-1, PD-L1, and PD-L2 antibodies were examined immunohistochemically on sections obtained from tissue microarray paraffin blocks. No staining with PD-1 in tumor cells was seen; however, we found positive staining in tumor cells at 36.2% with PD-L1 and 64.4% with PD-L2, and at 61.6% with PD-1, 36.2% with PD-L1, and 93.2% with PD-L2 in immune cells. When comparing staining and clinicopathologic findings, most of the PD-L1 negative tumors (both in tumor and immune cells) were FIGO Stage I, which was significantly higher than stage II-III-IV tumors (P<0.05). There was a statistically significant association between the FIGO grade and the PD-L1 score in immune cells (P=0.009), and between staining of PD-1, PD-L1, and PD-L2 and age (P=0.004, 0.013, and 0.043, respectively). Interaction between PD-1, PD-L1, and PD-L2 may be a potential target for immunotherapy in elderly and advanced stage EC patients.

Zinc Sulfate and/or Growth Hormone Administration for the Prevention of Radiation-Induced Dermatitis: a Placebo-Controlled Rat Model Study.

Growth hormone (GH) and zinc (Zn) were evaluated for their potential to prevent radiation injury using a rat model of radiation-induced skin injury. Sprague-Dawley rats were divided into five groups: a control group not receiving Zn, GH, or irradiation: a radiation (RT) group receiving a single 30 Gy dose of gamma irradiation to the right hind legs; a radiation + GH group (RT + GH) receiving a single 30 Gy dose of gamma irradiation plus the subcutaneous administration of 0.01 IU kg d-1 GH; a radiation + Zn group (RT + Zn) receiving a single 30 Gy dose plus 5 mg kg d-1 Zn po; and a radiation + GH + Zn group (RT + GH + Zn) group receiving a single 30 Gy dose plus subcutaneous 0.01 IU kg d-1 GH and 5 mg kg d-1 Zn po. Acute skin reactions were assessed every 3 days by two radiation oncologists grouping. Light microscopic findings were assessed blindly by two pathologists. Groups receiving irradiation were associated with dermatitis as compared to the control group (P < 0.05). The severity of radiodermatitis in the RT + GH, RT + Zn, and RT + GH + Zn groups was significantly lower than that in the RT group (P < 0.05). Furthermore, radiodermatitis was observed earlier in the RT group than in the other treatment groups (P < 0.05). GH and Zn effectively prevented epidermal atrophy, dermal degeneration, and hair follicle atrophy. The highest level of protection against radiation dermatitis was observed in the combination group.

Relationship of CD95 and COX-2 in renal cell carcinomas with survival and other prognostic parameters: A tissue microarray study.

OBJECTIVE: To investigate the expression of cyclooxygenase-2 and cluster of differentiation 95 in renal cell carcinomas having different clinico-pathological characteristics. METHODS: The study entailed histopathological diagnoses carried out on paraffin blocks at the Department of Pathology of the Medical Hospital of Duzce University, Turkey, between 2005 and 2011. Immunohistochemical staining for cyclooxygenase-2 and cluster of differentiation 95was performed on tissue microarray using standard procedures. Each patient's age and gender as well as the tumour's grade, stage, diameter, ureteral surgical margins, vascular invasion, capsule invasion and subtype were assessed. In order to determine if the cases were still alive, relatives were telephoned and identity registration records were checked. SPSS 18 was used for statistical analysis. RESULTS: There were 49 paraffin blocks in the study.Significant correlations were found between cyclooxygenase-2 and tumour subtype (p=0.044) as well as between cyclooxygenase-2 and tumour diameter (p=0.026). There was a significant correlation between cluster of differentiation 95and the Fuhrman grade (p=0.050). CONCLUSIONS: Expression of cluster of differentiation 95and cyclooxygenase-2 may be correlated with prognostic parameters in renal cell carcinoma and may also be associated with tumour progression.

Diffractaic acid, a novel proapoptotic agent, induces with olive oil both apoptosis and antioxidative systems in Ti-implanted rabbits.

Usnea longissima Ach., a lichen species, is a traditional herbal medicine with anti-detrimental effects. We evaluated the in vivo effects of a major constituent of U. longissima, diffractaic acid, and the main fatty component of the Mediterranean diet, olive oil, against apoptosis, including various caspase activations and oxidative injury in surrounding tissues after titanium implantation in rabbit femurs. Furthermore, we evaluated the underlying molecular mechanisms. In this study, this lichen metabolite and olive oil activated caspase-dependent cell death with apoptotic morphology, which is distinctly different from necrosis. Both orally and locally administered olive oil and diffractaic acid exerted pro-apoptotic induction in tissues surrounding the implants in titanium-implanted rabbits through the activation of initiator caspases (Cas-2, -8 and -9) and executioner caspase (Cas-3). In addition, they displayed strong myeloperoxidase and inducible nitric oxide synthase activities, providing an alleviating effect. Furthermore, administrations of diffractaic acid and olive oil attenuated the Ti-alloy implantation, and decreased superoxide dismutase activity and total glutathione level in peri-implant tissues. These results demonstrate that diffractaic acid and olive oil are involved in the induction of apoptotic cell death both through caspase-dependent cell death and as an antioxidant. Thus, the data suggest that both diffractaic acid and olive oil could be developed as effective proapoptotic agents in various disorders treatments.

Invasive ductal carcinoma with multiple metastases to facial and cranial bones: a case report.

Female breast cancer is one of the major causes of death among women. Metastatic tumors to the maxillo-facial bones are rare. We present diagnosis and treatment of multiple metastatic invasive ductal carcinoma involving massive and early stage the left half of the mandibular body, the floor of the orbit, maxilla, left parietal bone, the iliac bone and cervical and thoracal vertebras in a 36 years old female one and half years after operated.

Determination of linear x-ray attenuation coefficients of pathological brain tissues and use of filters in tissue contrast enhancement in computed tomography.

OBJECTIVE: X-ray attenuation coefficients are used in common radiological, pathological and spectroscopic examinations and in the determination of the radiation dose distribution in biological tissues. In radiology, these coefficients enable diagnosis by differentiating the abnormal tissues from the normal ones using their morphological structure and contrast differences. In this study, our aim is to precisely determine the linear x-ray attenuation coefficients of pathological brain tissues and to use x-ray beam filters to enhance the tissue contrast in computed tomography. MATERIALS AND METHODS: To directly measure the relative linear attenuation coefficients, an energy dispersive x-ray spectroscopy system (EDXRS-Canberra, Si(Li) with DSA-1000 spectrum analyzer 1998; CT, USA) was used with collimators and a medical-purpose x-ray tube (Siemens, Siremobil, 1985; Erlangen, Germany) in a linear geometry. RESULTS: Using a Mo filter with Computed Tomography CT and photon energies from 15 to 25 keV, EDXRS acquisitions were found to significantly distinguish grades of brain tumors (p<0.05). For the data acquired from CT systems with the decreasing filtered photon mean energy, the x-ray attenuation coefficients (i.e., the Hounsfield units) show that the ratio of EDXRS to CT for water's attenuation coefficient are increased. With our suggested x-ray filters, the tissue contrast has been found to be increased in ex vivo brain tumor slices compared with slices scanned in conventional CT scanners. CONCLUSION: X-ray attenuations measured with the EDXRS are found to be statistically more reliable because of the length of acquisition times in this study.

A rare location of Castleman's disease: parotid region.

Castleman's disease in the parotid gland region is very rare. The most frequent site of involvement is the mediastinum. A 15-year-old female with Castleman's disease in the parotid region is herein reported.

Alveolar echinococcosis of the brain in five patients.

Cerebral alveolar echinococcis is a biologically aggressive infestation that mimics a malignant neoplasm radiologically and macroscopically. This paper describes the clinical and radiological aspects of the disease, with new diagnostic studies, and discusses the surgical treatment of this infestation. The records of five patients with cerebral alveolar echinococcis treated at our center between 2000 and 2004 were reviewed. Three patients underwent radical surgical treatment and received antihelminthic therapy post-operatively, two of whom experienced asymptomatic recurrence. Two patients with multiple lesions were treated with antihelminthic therapy alone. The prognosis was poor for these patients. Radical surgery combined with antihelminthic therapy of sufficient duration are mandatory to prevent the progression of symptoms but the disease continues to be difficult to cure.

Vitamin E and L-carnitine, separately or in combination, in the prevention of radiation-induced brain and retinal damages.

Our aim was to determine the effects of vitamin E and L-carnitine supplementation, individually or in combination, on radiation-induced brain and retinal damages in a rat model. Group 1 received no treatment (control arm). Group 2 received a total dose of 15 Gy external radiotherapy (RT) to whole brain by Cobalt-60 teletherapy machine. Groups 3, 4, and 5 received irradiation plus 40 kg(-1) day(-1) Vitamin E or 200 mg kg(-1)day(-1) L-carnitine alone or in combination. Brain and retinal damages were histopathologically evaluated by two independent pathologists. Antioxidant enzyme levels were also measured. Radiation significantly increased brain and retinal damages. A significant increase in malondialdehyde levels as well as a decrease in superoxide dismutase and catalase enzymes in brain was found in group 2. Separate administration of Vitamin E+RT and L-carnitine+RT significantly reduced the severity of brain and retinal damages and decreased the malondialdehyde levels and increased the activity of superoxide dismutase and catalase enzymes in the brain. The findings of current study support the antioxidant and radioprotective roles of vitamin E and L-carnitine. However, the combined use of Vitamin E and L-carnitine plus irradiation interestingly did not exhibit an additive radioprotective effect.

Epithelioid hemangioendothelioma of the submandibular gland.

Epithelioid hemangioendothelioma (EH) is a seldom tumor of vascular origin, which occurs at sites such as liver, lung or soft tissues, and has a highly unpredictable malignant potential and clinical course. We submitted a case with epithelioid hemangioendothelioma of submandibular gland. The patient was a 44-year-old woman who presented with left submandibular painly mass. Fine needle aspiration showed a mixed lymphoid population. Contrast enhanced Computerize Tomography (CT) scan revealed that to be a well-circumscribed and including microcalcification in centre 2.5 cm x 2.0 cm mass in diameter without evidence of bony invasion. Submandibular gland was excised. The pathological result was interpretated as epithelioid hemangioendothelioma of the submandibular gland. The patient was seen regularly for recurrence.

The effects of silica exposure on upper airways and eyes in denim sandblasters.

OBJECTIVE: Silicosis due to denim (or jean) sandblasters is newly described cause of silicosis. In such cases lungs are severely affected due to heavy exposure to silica without serious protection. We aimed to investigate whether silica had an effect on the upper airways and eyes. METHODS: The study included the patients recently diagnosed with silicosis. For comparisons, a control group was constituted. Firstly, a questionnaire was performed to obtain demographic and exposure characteristics of the cases. Later, routine nasal examination by endoscope and routine eye examination by slit-lamp microscope were performed to investigate presence of rhinitis and/or adenoid vegetation and eye findings associated with dust exposure, respectively, in both patient and control groups. Punch biopsies of the adenoid tissue were obtained using an endoscopic telescope with the patient under local anesthesia and sent for histopathologic examination. In addition, nasal pH and mucociliary clearance were investigated. Both pH and saccharin nasal transport time (SNTT) measurements were performed by two physicians, who reached a final consensus. RESULTS: The study group consisted of 83 male silicotics with an average age of 23 +/- 6 years, and the control group consisted of 84 age and gender matched healthy individuals. Their mean exposure time was 40 +/- 26 months. On routine nasal examination, silicotics had higher rates of rhinitis (28.9% versus 16.7%) mostly ipsilaterally (p = 0.01), adenoid vegetation (32.5% versus 13.3%/, p < 0.05), conjunctival hyperaemia (70% versus 45%, p < 0.001), pingueculae (68% versus 23%, p < 0.01), papillar formation (40% versus 28%), and higher nasal pH values (7.9 +/- 0.7 versus 6.9 +/- 0.6, p < 0.001), higher SNTT values (19.9 +/- 2.9 versus 10.9 +/- 1.9, p < 0.001) compared with the controls. CONCLUSION: The results of our study suggest that upper airways and eyes are considerably affected in the patients with silicosis. Thus, appropriate protection is required to prevent the development of such problems in denim sandblasters.

Mammary tuberculosis -- importance of recognition and differentiation from that of a breast malignancy: report of three cases and review of the literature.

BACKGROUND: While tuberculosis of the breast is an extremely uncommon entity seen in western populations, it accounts for up to 3% of all treatable breast lesions in developing countries. CASE PRESENTATIONS: We reviewed three female cases of mammary tuberculosis that were diagnosed and treated in Turkey during the same calendar year. All three patients presented with a painful breast mass. In all cases, fine needle aspiration was nondiagnostic for mammary tuberculosis. However, the diagnosis of mammary tuberculosis was confirmed by histopathologic evaluation at the time of open surgical biopsy. All three patients were treated with antituberculous therapy for six months. At the end of the treatment period, each patient appeared to be clinically and radiologically without evidence of residual disease. CONCLUSION: The diagnosis of mammary tuberculosis rests on the appropriate clinical suspicion and the histopathologic findings of the breast lesion. Its recognition and differentiation from that of a breast malignancy is absolutely necessary. Antituberculous chemotherapy, initiated immediately upon diagnosis, forms the mainstay of treatment for mammary tuberculosis.