A case report of fulminant hepatitis due to ribociclib with confirmed by liver biopsy in breast cancer.

INTRODUCTION: Breast cancer is the most frequently diagnosed cancer in women worldwide. Ribociclib is now frequently used in the treatment of metastatic hormone-positive and human epidermal growth factor receptor 2 (HER 2)-negative breast cancer. CASE REPORT: A 54-year-old woman with breast cancer presented at a clinic in November 2017 with multiple lung and bone metastases. After receiving multiple lines of treatment due to disease progression, ribociclib and fulvestrant were initiated. Grade 4 toxicity was observed due to ribociclib during follow-up, and ribociclib was discontinued permanently.Management & Outcome: Given that liver transaminases and bilirubin elevation persisted despite discontinuation of the treatment, other reasons for liver toxicity were investigated. Abdominal MRI showed no liver metastases, although there was acute hepatitis. A liver biopsy was performed to determine the etiology. The pathology result was compatible with drug-induced acute fulminant toxic hepatitis. After liver biopsy, prednisolone treatment was initiated, after which the laboratory findings normalized. DISCUSSION: Although there are reported cases showing improvement in liver enzymes after ribociclib discontinuation, in our case, no recovery from hepatotoxicity was noticed. The treatment was changed to another hormonal pathway therapy option, exemestane. To the best of our knowledge, this is the first case in the literature reporting this rare side effect of ribociclib, which is a liver biopsy-proven fulminant hepatitis.

The role of miRNAs as a predictor of multicentricity in breast cancer.

Expression profiles of miRNAs are shown to be different in various cancers to regulate expression of mRNA or to have a role in inhibition of translation, thus it shows the possible effect in progression, invasion and metastasis of breast cancer cells. The effect of breast conserving treatment in local recurrence and survival rates for the patients who have multicentric breast cancer is still controversial. In our study, we intended to evaluate the foresight of 84 miRNAs which are identified in breast cancer for having differentiated expressions. Thirty-one patients with unifocal and 26 patients with multicentric breast cancer were included in this study. These tissue samples of both malignant and normal breast tissues were kept in RNA later solution at - 80 °C. Eighty-four miRNAs were studied with miScript miRNA PCR Array Human Breast Cancer kit. Fold change, cut off value was accepted as four. In unifocal group, there were 13 upregulated and five downregulated miRNAs and in multicentric group, there were three upregulated and seven downregulated miRNAs. To reach better results for breast cancer diagnosis and treatment, it is important to enlighten tumor biology, and pay attention to target and individual therapy. Thus, miRNAs have potential role in identifying tumor characteristics in supporting diagnosis and resulting with better evaluated disease for better treatment results with individual strategies.

Prospective multi-center study of surgeon's assessment of the gallbladder compared to histopathological examination to detect incidental malignancy.

PURPOSE: Routine histopathological examination after cholecystectomy for gallstones is performed despite the low rates of incidental findings of malignancy. The aim of this study was to assess predictive values of macroscopic examination of cholecystectomy specimens by surgeons in gallstone disease. METHODS: A prospective multi-center diagnostic study was carried out between December 2015 and March 2017 at four different centers. All patients undergoing cholecystectomy for gallstone disease were consecutively screened for eligibility. Patients whose ages are 18 to 80 years, and preoperative imaging findings without any pathology except cholelithiasis were included. The gallbladder was first evaluated macroscopically ex situ by two operating surgeons and rated as macroscopically benign (group S1), suspicious for a benign diagnosis (group S2), and suspicious for malignancy (group S3). Thereafter, a pathologist made a final histopathological examination whose results are grouped as chronic cholecystitis (group P1), benign or precancerous lesions in which only cholecystectomy is the adequate treatment modality (group P2), and carcinoma (group P3). Diagnostic accuracy of the surgeon's assessment to the histopathological examination was evaluated using sensitivity, specificity, positive and negative predictive values, and accuracy, and correlated by a kappa agreement coefficient. RESULTS: A total of 1112 patients were included in this trial. The specificity rates were 96.5%, 100%, and 98.7% for group S1-group S2, group S1-group S3, and group S2-group S3, respectively. Accuracy rates to detect malignancy were 100% and 95. 2% for group S1 and group S2, respectively. Kappa coefficient values were 1.0 and 0.64 for group S1-group S3 and group S2-group S3, respectively (p < 0.001 for both). CONCLUSION: Assessment of the gallbladder specimen and selective histopathological examination may be adequate after cholecystectomy for gallstone diseases. Such a procedure would have the potential to reduce costs and prevent unnecessary loss of labor productivity without affecting patients' safety. However, higher number of patients in more centers is needed to confirm this hypothesis.

Intraoperative palpation of sentinel lymph nodes can accurately predict axilla in early breast cancer.

Recent randomized trials have shown that completion axillary lymph node dissection (ALND) is not required in all patients with a positive sentinel lymph node (SLN) who will receive radiation therapy. Although routine intraoperative pathologic assessment (IPA) becomes unnecessary and less indicated by breast surgeons in the United States and some European countries, it is still widely used all around the world. In this prospective study, the feasibility of intraoperative nodal palpation (INP) as opposed to IPA of the SLN has been analyzed. Between March 2014 and June 2015, 305 patients with clinical T1-2/N0 breast cancer from two different breast clinics (cohort A; [n = 225] and cohort B; [n = 80]) who underwent any breast surgery with sentinel lymph node biopsy (SLNB) were included in this study. Surgeons evaluated the SLNs by manual palpation before sending for IPA, and findings compared with the final pathology. The positive predictive values (PPV) of INP and IPA were 81.8% and 97.9%, respectively, whereas the negative predictive values (NPV) of INP and IPA were 83% and 92.4%. The accuracies of INP and IPA were 82.6% and 94.1%, respectively. If patients with SLNB including micrometastasis were also considered in the final pathologic assessment (FPA) (-) group that would not require a further axillary dissection, the revised NPV of INP and FPA were found to be 92.6% and 98.1%, respectively. The revised accuracy of INP also found to be increase to 86.9%. Our study, which is the only prospective one about palpation of dissected SLNs in the literature, suggests that INP can help to identify patients who do not need ALND, which encourages omitting IPA in cT1-2 N0 breast cancer.

Contribution of diffusion-weighted imaging to dynamic contrast-enhanced MRI in the characterization of papillary breast lesions.

Papillary lesions have a broad spectrum of appearances on magnetic resonance imaging (MRI). The purpose of this study was to evaluate whether apparent diffusion coefficient (ADC) values of papillary lesions can be used to characterize lesion as benign or malignant. This retrospective study included 29 papillary lesions. Diagnostic values of dynamic contrast-enhanced MRI (DCE-MRI), DWI-ADC, and DCE-MRI plus DWI-ADC were separately calculated. The malignant papillary lesions (0.744×10-3  mm2 /s) exhibited significantly lower mean ADC values than the benign lesions (1.339×10-3  mm2 /s). Addition of DWI to standard DCE-MRI provided 100% sensitivity. We hypothesized that this combination may prevent unnecessary excisional biopsies.

Primary breast carcinomas with neuroendocrine features: Clinicopathological features and analysis of tumor growth patterns in 36 cases.

Primary breast carcinoma with neuroendocrine features (NEBC) is an uncommon tumor. In the classification of WHO 2012, these tumors were categorized as: 1- neuroendocrine tumor, well-differentiated; 2- neuroendocrine carcinoma, poorly differentiated/small cell carcinoma; and 3- invasive breast carcinoma with neuroendocrine differentiation. In this study, we reviewed NEBC except poorly differentiated/small cell carcinoma variant in order to define the morphological growth patterns and cytonuclear details of these tumors. All breast surgical excision materials between 2007 and 2016 were re-evaluated in terms of neuroendocrine differentiation. Thirty-six cases showing positive staining for synaptophysin and/or chromogranin A in ≥50% of tumor cells were included in the study. All cases were female with a mean age of 67.4. Mean tumor diameter was 26 mm. Multifocality was noted in 5 cases. Grossly, they were mostly infiltrative mass lesions. T stages, identified in 34 cases, were as follows: 13 cases with pT1; 19 pT2 and 2 pT3. We described schematically 4 types of patterns depending on predominant growth pattern, except one case: 1) Large-sized solid cohesive groups (6 cases), 2) Small- to medium-sized solid cohesive groups with trabeculae/ribbons and glandular structures (6 cases), 3) Mixed growth patterns (20 cases), 4) Invasive tumor with prominent extracellular and/or intracellular mucin (3 cases). The tumor cells were mostly polygonal-oval with eosinophilic/eosinophilic-granular cytoplasm. The nuclei of tumor cells were mostly round to oval with evenly distributed chromatin. Only 5 cases showed high grade nuclear and histological features. Molecular subtypes of the cases were as follows: 33 luminal A, 2 luminal B, and 1 triple negative. NEBC should come to mind when a tumor display one of the morphological patterns described above, composed of monotonous cells with mild to moderate nuclear pleomorphism and abundant eosinophilic/eosinophilic granular or clear cytoplasm, especially in elderly patients.

Helicobacter pylori is undetectable in intraductal papillary mucinous neoplasm.

BACKGROUND: About half of the world population is infected with Helicobacter pylori (H. pylori), a bacterium associated with gastric cancer and considered to be a risk factor for pancreatic ductal adenocarcinoma. Whether the bacterium is associated with intraductal papillary mucinous neoplasm, believed to be a precursor of pancreatic ductal adenocarcinoma, is unknown. The aim of this study was to investigate the presence of H. pylori DNA in tissue sections of intraductal papillary mucinous neoplasm. METHODS: The presence of H. pylori DNA was tested in a retrospective controlled study of formalin-fixed, paraffin-embedded pancreatic tissues from 24 patients who underwent surgery for intraductal papillary mucinous neoplasm. Histologically normal tissues surrounding neoplasms were used as control. H. pylori DNA was evaluated after deparaffinization, DNA extraction, and purification, and results were evaluated statistically. RESULTS: Samples were collected from 13 males and 11 females with mean age 59 years (range 44-77), and consisted of 19 cases of main-duct and three cases of branched-duct intraductal papillary mucinous neoplasm. Two patients were diagnosed with pancreatic cancer and main-duct intraductal papillary mucinous neoplasm. H. pylori DNA was not detected either in intraductal papillary mucinous neoplasm tissue, or in surrounding normal tissue. CONCLUSIONS: Although H. pylori has been implicated in pancreatic ductal adenocarcinoma, it may not play a key role in the development of intraductal papillary mucinous neoplasm.

p53 expression and relationship with MDM2 amplification in breast carcinomas.

Carcinoma of the breast, like other malignancies, is a genetic disease with multiple genetic events leading to the malignant phenotype. p53 mutations are the most common genetic events in human cancer. Inactivation of p53 can be a result of mutation in gene sequence. One of the main structures that regulate p53 stabilization is MDM2. It suppresses p53 transcriptional activation by recognizing transactivation domain of p53. The loss of MDM2 function on p53 regulation results in deprivation of p53 tumor suppressor ability. Single nucleotide polymorphisms (SNP309 T->G exchange) or MDM2 amplification has been proposed to play a role in this issue. In the present study, our aim is to analyze p53 and MDM2 status and investigate their interactions in human sporadic breast carcinoma. The study groups were separated according to their molecular classifications. In each group, histologic type of the tumor, conventional prognostic parameters, p53, and MDM2 interactions were compared statistically. Tumors are divided into 4 subtypes due to estrogen and progesterone receptor status, HER-2, and Ki-67 proliferation index results. According to this classification, 23 cases are in the luminal A, 32 cases are in the luminal B, 15 cases are in the HER-2 positive, and 22 cases are in the triple-negative group, with a total of 92 cases. p53 expression is low in luminal breast carcinomas than HER-2 and triple-negative subtypes. MDM2 amplification frequency was found to be 5.4% in total. MDM2 gene amplification does not have a significant role in breast carcinogenesis, but other possible mechanisms may play a role in its inactivation.

Assessment of multifocality and axillary nodal involvement in early-stage breast cancer patients using 18F-FDG PET/CT compared to contrast-enhanced and diffusion-weighted magnetic resonance imaging and sentinel node biopsy.

BACKGROUND: Non-invasive evaluation of the extent of axillary nodal involvement in early-stage breast cancer (ESBC) patients and accurate assessment of multifocality are both challenging. Few reports have explored whether 18F-fluorodeoxyglucose (FDG) positron emission tomography/computed tomography (PET/CT) might be more useful than other diagnostic methods in these contexts. PURPOSE: To prospectively evaluate the diagnostic utility of FDG PET/CT, contrast-enhanced, and diffusion-weighted magnetic resonance imaging (DCE-MRI and DWI), and sentinel lymph node biopsy (SNB), in detection of axillary metastatic lymph nodes in ESBC patients; and to explore the utilities of FDG PET/CT and DCE-MRI for identification of multifocality. MATERIAL AND METHODS: Twenty-four female patients (mean age, 47 ± 9.9 years; range, 24-68 years) with ESBC underwent whole-body FDG PET/CT and breast MRI prior to operation. SNB and axillary lymph node dissection (ALND) were performed on all patients, as was mastectomy or wide local tumor excision. Histopathological findings served as the gold standard when evaluating either multifocality or axillary nodal involvement. RESULTS: The sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV), and accuracy, of PET/CT and DCE-MRI, used to detect multifocality, were as follows: 67% versus 78%, 100% versus 53%, 100% versus 50%, 83% versus 80%, and 88% versus 63%. SNB afforded the highest sensitivity (93%) in terms of detection of axillary metastasis. The sensitivity, NPV, and accuracy of PET/CT were 67%, 62%, and 75% respectively, thus higher than the equivalent values of either DCE-MRI or DWI. CONCLUSION: For assessment of multifocality in ESBC patients, highly specific results of PET/CT should be taken into account along with DCE-MRI findings. For evaluation of axillary nodal involvement, PET/CT has higher sensitivity, NPV, and accuracy values than DCE-MRI and DWI and may guide a surgical decision to proceed or not to SNB or ALND.

New thyroid fine needle aspiration biopsy needle. Prospective, randomized, clinical study.

Nodular disease of thyroid in the adult population is common [1]. Estimated prevalence of thyroid nodules on the basis of palpation ranges from 3% to 7% [2]. During the past two decades, according to widespread use of ultrasonography (US) for evaluation of thyroid and nonthyroid neck diseases prevalence of clinically inapparent thyroid nodules is increased, estimated at 20% to 76% in the general population [3,4]. This article is protected by copyright. All rights reserved.

An incidental diagnosis of an unusually located echinococcus alveolaris.

ABSTRACT: Hydatid cyst disease is a zoonotic infection caused by the genus Echinococcus. Hydatid cysts are usually located in the liver or lungs whereas the brain is an unusual location. A 45-year-old male patient was diagnosed with an intracranial mass suggesting a metastasis in the frontal region shown in the cranial computed tomography (CT) scan following a cranial trauma. The histological evaluation revealed an acellular laminated lesion surrounded with reactive changes, compatible with a cuticle. These findings were evaluated in favour of a hydatid cyst caused by Echinococcus multilocularis. Alveolar echinococcosis is a zoonotic disease caused by the genus Echinococcus multilocularis. Hydatid cyst is a common public health issue in the countries where livestock farming is common. Primary or metastatic tumours and abscesses should be considered in the differential diagnosis of hydatid cysts regardless of their location.

Impact of Radiotherapy Volumes on Late-Term Cosmetic Outcomes and Quality of Life in Patients With Unifocal and Multifocal/Multicentric Breast Cancer After Breast-Conserving Surgery.

Objective: Breast-conserving surgery (BCS) followed by radiotherapy (RT) is the standard treatment for early-stage breast cancer. The use of an additional RT dose (boost) to the tumour bed improves local control but may worsen quality of life (QOL) and cosmetic results. Multifocal/multicentric tumours (MMTs) pose a challenge as they require larger boost volumes. This study investigated the impact of RT volumes on late-term cosmetic outcomes and QOL in patients with unifocal and MMTs who underwent adjuvant RT after BCS. Materials and Methods: Retrospective data of 367 patients who underwent BCS between 2012 and 2014 were reviewed. A cohort of 121 patients with at least six months of completed RT were prospectively included in the study. Cosmetic results were evaluated using a modified scoring system, and QOL was assessed using The European Cancer Treatment and Organization Committee tools. Results: The results showed that the inclusion of regional lymphatics in the RT treatment field significantly affected QOL, particularly in terms of role functioning and social functioning. Higher boost volume ratios were associated with increased pain-related symptoms. However, the presence of MMTs did not significantly affect cosmetic outcomes compared to unifocal tumours. Conclusion: The size of the boost and inclusion of regional lymphatics in RT significantly impact QOL in patients undergoing BCS. Tumour foci number does not affect cosmetic outcomes. These findings emphasize the need for careful consideration of RT volumes to minimize long-term adverse effects on QOL. Future prospective studies should evaluate early side effects and baseline QOL scores to provide a comprehensive assessment.

Comparison of the optimized direct spectrophotometric serum prolidase enzyme activity assay method with the currently used spectrophotometric assay methods and liver fibrosis indexes to distinguish the early stages of liver fibrosis in patients with chronic hepatitis B infection.

OBJECTIVE: The aim of this study was to optimize the currently used direct spectrophotometric serum prolidase enzyme activity (SPEA) assay method and compare its diagnostic accuracy with current precipitation and direct spectrophotometric assay methods, AST-to-ALT ratio, age platelet index, AST-to-platelet ratio index, cirrhosis discriminate score, Doha score, FIB-4, FibroQ, fibrosis index, Goteborg University Cirrhosis Index , King's score, and Pohl score for distinguishing Ishak F0 from F1-F3 in patients with chronic hepatitis B (CHB) infection. METHODS: Liver biopsy results from 112 patients were included in this study. RESULTS: The SPEA values were 529 (292-794) U/L, 671 (486-927) U/L, and 1077 (867-1399) U/L with the precipitation, current, and optimized direct spectrophotometric assay methods, respectively. According to multivariate logistic regression analysis optimized direct spectrophotometric SPEA was the only statistically significant parameter to predict the early stages of liver fibrosis. CONCLUSIONS: Optimized direct spectrophotometric SPEA assay method could be used to distinguish early stages of liver fibrosis in patients with CHB infection instead of the currently used spectrophotometric SPEA assay methods and other evaluated liver fibrosis indexes.

Stem cell markers: A guide to neoadjuvant therapy in breast carcinomas.

Aim: This study aims to investigate potential associations between the stem cell population and the degree of tumor regression in breast carcinomas treated with neoadjuvant therapy. Settings and Design: The study included 92 patients with breast carcinoma who received neoadjuvant therapy. Tumor regression was defined based on Miller and Payne grading system. Patients with grade 1 or 2 regression on a 5-point scale were included in group 1 (n = 37), grade 3 regression in group 2 (n = 32), and grade 4 or 5 regression in group 3 (n = 23). Materials and Methods: Immunohistochemical staining was performed on paraffin block sections of every case using CD44, CD24, CD29, CD133, ID4, and ALDH1 antibodies to detect stem cells. Statistical Analysis Used: IBM Statistical Package for the Social Sciences (SPSS), version 23.0 (IBM Corp., Armonk, NY, USA) software was used for statistical analyses, and a P value less than 0.05 was considered statistically significant. Results: Histologically high-grade tumors are more common in the near-complete/complete response group (P = 0.004). HER2-positive tumors were more common in the complete/near-complete response group (P = 0.054). Tumor cells positive for stem cell markers CD44 and CD24 were more common in the poor response group (P = 0.027 and P = 0.001, respectively). CD29 expression was reduced in the posttreatment residual tumor tissue in the near-complete/complete response group. Conclusion: High CD44 and CD24 expression may be a predictor of poor response/nonresponse to neoadjuvant therapy in breast carcinomas. Background: In recent years, stem cells have been defined as the main cell population responsible for resistance to anticancer therapies.

Recurrence of a simultaneous tumor of the parotid gland and scalp skin malignant fibrous histiocytoma.

Malignant fibrous histiocytoma (MFH) is one of the most common soft-tissue sarcomas and generally arises in elderly patients. Most often, MFH occurs in the extremities and the retroperitoneum; MFH of the head and neck region is only reported in 3% of all cases. The distant metastasis appears in one third of all cases, and those cases mainly involve the lung, regional lymph nodes, the liver, or bones. The main treatment of MFH of the head and neck is radical excision of the tumor with modified or radical neck dissection. Recurrences of MFH are commonly seen and identified within the first 2 years of treatment. We report a case of simultaneous MFH tumors of the parotid gland and of the scalp skin in an elderly male patient. The patient underwent a wide surgical excision of the lesion and referred to the oncology department for further treatment. However, 1 month after chemoradiotherapy had commenced, there was a recurrence of the tumor over the skin on the right parotid region.

Expression of transient receptor potential melastatin 4 in differential diagnosis of eosinophilic renal tumors.

Immunohistochemical and molecular studies to differentiate eosinophilic kidney tumors are gradually increasing. The present study investigated the role of transient receptor potential cation channel subfamily M member 4 (TRPM4), a non-selective cation channel associated with migration, proliferation and invasion in cancer cells, in this differentiation. The aim was to investigate the effectiveness of TRPM4 in differentiation of eosinophilic kidney tumors. The study included a total of 112 patients, including 97 eosinophilic kidney tumors with the diagnoses of 33 eosinophilic clear cell renal cell carcinoma (CCRCC), 35 eosinophilic chromophobe renal cell carcinoma (ChRCC), 8 papillary renal cell carcinoma type 2 (P2RCC), 21 renal oncocytoma (RO), as well as 15 papillary renal cell carcinoma type 1 to differentiate from P2RCC. For TRPM4, diffuse staining (>10%) was observed in 2 CCRCC, 15 ChRCC, 20 RO and 4 P2RCC cases. There was a significant difference between eosinophilic CCRCC and other eosinophilic tumors (P<0.05). While basolateral staining was observed in papillary tumors, membrane staining was observed in other stained cases. It was hypothesized that the use of TRPM4 along with morphological findings, cytokeratin 7 and other markers may be useful for the differentiation of eosinophilic kidney tumors.

Mucinous Pancreatic Cysts: Comparison of Cyst Size and Location in Certain Mucinous Cyst Subgroups.

BACKGROUND: There are studies reporting that the location of intraductal papillary mucinous neoplasia (IPMN) predicts malignancy. Therefore, we evaluated the cyst location's relationship with malignancy, and the possibility of using cyst size and location to distinguish between non-main duct (non-MD)-IPMNs, mucinous cystic neoplasia (MCN), and cystic pancreatic ductal adenocarcinoma (PDAC). METHODS: We performed a retrospective analysis of data from 122 patients with a definite cyto-histological diagnosis of non-MDIPMNs, LR-MCNs, and cystic PDACs via endoscopic ultrasound fine-needle aspiration between October 2011 and October 2020. We grouped the cyst locations as head, uncinate, neck (HUN), and corpus or tail (CT). On histology, low-grade dysplasia and intermediategrade dysplasia were considered low risk (LR), whereas high-grade dysplasia and invasive carcinoma were considered high risk (HR). RESULTS: Of the 122 patients (61 (50%) women, median age 61.5 years (range 19-85), there were 34 (27.9%) LR-non-MD-IPMNs, 33 (27%) HR-non-MD-IPMNs, 19 (15.6%) LR-MCNs, and 36 (29.5%) cystic PDACs. We found no significant difference between LRand HR-non-MD-IPMN locations (P = .803). Low-risk non-MD-IPMNs were significantly smaller than HR-non-MD-IPMNs (P < .001), LR-MCNs (P = .002), and cystic PDACs (P < .001). The area under the receiver operating characteristic curve (AUROC) was 0.819 (95% CI: 0.716-0.902; P < .0001), and demonstrated a cyst size cut-off <2.2 cm to differentiate LR cysts, while cysts <1.6 cm had a negative predictive value (NPV) of 100% in non-MD-IPMNs. CONCLUSION: Cyst location is not predictive of malignancy in non-MD-IPMNs. Low-risk non-MD-IPMNs were smaller than HR-non MDIPMNs, LR-MCNs, and cystic PDACs. The cyst size cut-off was 2.2 cm; however, <1.6 cm had a 100% NPV differentiating LR- from HR-non-MD-IPMNs.

Protective and therapeutic effects of pyrrolidine dithiocarbamate in a rat tongue cancer model created experimentally using 4-nitroquinoline 1-oxide.

BACKGROUND: Tongue tumors, which are oropharyngeal tumors, are increasing in frequency. Pyrrolidine dithiocarbamate (PDTC) is a powerful antioxidant and antitumoral agent. OBJECTIVES: To evaluate the protective and therapeutic effects of PDTC in a tongue cancer model induced with 4-nitroquinoline 1-oxide (4-NQO). MATERIAL AND METHODS: We included 40 rats in the trial and assigned them randomly to 5 groups. Group 1 (cancer, n = 7): 4-NQO (0-12 weeks); group 2 (protection, n = 8): 4-NQO (0-12 weeks) + PDTC (300 mg/kg/day, 0-12 weeks); group 3 (therapy-high dose, n = 10): 4-NQO (0-12 weeks) + PDTC (600 mg/kg/day, weeks 12-30); group 4 (therapy-low dose, n = 10): 4-NQO (0-12 weeks) + PDTC (300 mg/kg/day, weeks 12-30); and group 5 (control). Cardiac blood samples were taken to analyze oxidative stress parameters (total antioxidant status (TAS), total oxidant status (TOS) and oxidative stress index (OSI)). Histopathological assessment was performed under a light microscope. RESULTS: The results of the histopathological assessment showed that the model we used in group 1 was successful, which was consistent with the literature. The PDTC dose administered in group 2 could not prevent tumor formation. Group 3 demonstrated that PDTC in high doses is effective as a therapeutic agent. Group 4 indicated that PDTC in low doses has no therapeutic effect. The results of the biochemical assessment showed that in group 3, TOS and OSI values were significantly lower than in groups 1, 2 and 4. No significant difference was found in the TOS and OSI values between groups 5 and 3. CONCLUSIONS: Our study demonstrated histopathologically that in an experimentally generated tongue cancer model, application of 600 mg/kg/day of PDTC led to a significant reduction in the size of the tumor. This was supported by the biochemical parameters.

The Contribution of Additional Sampling in Cholecystectomy Materials: A Multicenter Prospective Study.

OBJECTIVE: Cholecystectomy materials are frequently encountered in routine practice. The aim of this study was to determine the true frequency of gallbladder lesions, the diagnostic consistency, and standardization of reports after macroscopic sampling and microscopic evaluation based on previously defined criteria. MATERIAL AND METHOD: 14 institutions participated in the study within the Hepato-Pancreato-Biliary Pathology Study Group. Routinely examined cholecystectomies within the last year were included in the study in these institutions. Additional sampling was performed according to the indications and criteria. The number of blocks and samples taken in the first macroscopic examination and the number of blocks and samples taken in the additional sampling were determined and the rate of diagnostic contribution of the additional examination was determined. RESULTS: A total of 5,244 cholecystectomy materials from 14 institutions were included in the study. Additional sampling was found to be necessary in 576 cases (10.98%) from all institutions. In the first macroscopic sampling, the mean of the numbers of samples was approximately 4 and the number of blocks was 2. The mean of the numbers of additional samples and blocks was approximately 8 and 4, respectively. The diagnosis was changed in 144 of the 576 new sampled cases while the remaining 432 stayed unaltered. CONCLUSION: In this study, it was observed that new sampling after the first microscopic examination of cholecystectomy materials contributed to the diagnosis. It was also shown that the necessity of having standard criteria for macroscopic and microscopic examination plays an important role in making the correct diagnosis.

Unusual Histopathological Findings in Appendectomy Specimens: A Retrospective Analysis of 2047 Cases.

BACKGROUND: In this study, we retrospectively evaluated cases of patients who had undergone appendectomy in our hospital and aimed to present the efficiency of diagnostic tests and demographic data of cases. Pathological reports were analyzed for the following parameters: age, gender, and pathological diagnosis. In addition, the demographic and clinicopathologic characteristics of patients with unusual histopathologic findings were evaluated in detail, and reanalysis of archived resected appendix specimens was carried out. METHODS: Files of 2047 patients (1329 males, 718 females, sex ratio: 1.85, age range: 1-87 years, mean age: 26, 50 years), who had been operated with a diagnosis of acute appendicitis in the emergency department of Bezmialem Vakif University Medical Faculty from November 2011 to June 2014, were retrospectively evaluated. RESULTS: Cases were separated into 2 groups. Cases with histopathologic examination reported as acute appendicitis constituted group 1 (n = 2013, 98.34%), and cases with pathologic findings other than acute appendicitis constituted group 2 (n = 34, 1.66%). The second group consisted of 8 low-grade mucinous neoplasms, 7 mucoceles, 6 carcinoid, 5 granulomatous inflammation, 4 intraluminal Enterobius vermicularis, 1 endometriosis externa, 1 adenocarcinoma infiltrated to serosa, 1 mesenteric cyst, and 1 low-grade adenocarcinoma formed in mucinous cystic neoplasm background. CONCLUSION: Acute appendicitis is the most common emergency surgical condition. Although most of the resected appendectomy specimens showed typical histopathologic findings, some (1.66%) showed unusual histopathologic findings. Even if the macroscopic appearance of the specimen is normal or acute appendicitis, we suggest routine histopathological examination.