Regression of experimentally induced endometriosis with a new selective cyclooxygenase-2 enzyme inhibitor.

BACKGROUND: Cyclooxygenase-2 (COX-2) levels increase in women with endometriosis. COX-2, via increasing prostaglandin E2, contributes to an increase in vascular endothelial growth factor. In this way, COX-2 may contribute to the progression and continuity of endometriosis. We investigated the effect of dexketoprofen trometamol, a new selective COX-2 enzyme inhibitor, on experimentally induced endometriotic cysts. METHODS: Experimental endometriotic cysts were created in 60 adult female Wistar albino rats. The rats were randomized to 2 equal groups, a control (group Con) and a dexketoprofen (group Dex) group. Six weeks later, cyst volumes were measured as in vivo (volume 1). Following volume 1 measurement, for 4 weeks group Con received 0.1 ml distilled water; group Dex received 0.375 mg dexketoprofen trometamol/0.1 ml distilled water, intramuscularly, twice a day. At the end of administration, the cyst volumes were remeasured (volume 2), and the cysts totally excised and weighed. Glandular (GT) and stromal tissues (ST) and natural killer (NK) cell contents in the cyst wall were scored. RESULTS: NK cell content and volume 1 were not different between the 2 groups. Volume 2, cyst weight, and GT and ST contents in group Dex were significantly lower than those in group Con. CONCLUSION: Dexketoprofen trometamol significantly reduced the development of experimentally induced endometriotic cysts both macroscopically and microscopically.

Primary testicular leiomyosarcoma.

Primary testicular leiomyosarcoma is an extremely rare tumor, and, to the best of our knowledge, only 20 cases in adults have been reported in the literature to date. Herein, we present a case of a 68-year-old man who complained of left scrotal swelling for 2 months. Radiological examination revealed a left testicular tumor with no metastases to other organs. A left inguinal orchiectomy was carried out and histopathologic examination revealed an intratesticular leiomyosarcoma. The patient was treated successfully by orchiectomy and received no adjuvant therapy. During follow up until 12 months after surgery, there has been no recurrence or metastases of the disease.

Primary intestinal-type adenoma of the vagina arising directly from endocervical-type adenosis: a case report.

BACKGROUND: Tubular or villous adenomas are common neoplasms of the gastrointestinal tract. Other locations where these adenomas are found, including the female genital tract, are very rare. A literature review documents that only eight cases of tubular or villous adenomas found within the vagina have been published. CASE: A 25-year-old, Caucasian woman presented with a history of primary infertility and postcoital bleeding. Gynecologic examination revealed a polypoid mass attached to the lateral wall of the vagina, approximately 2 cm above the introitus. The polypectomy specimen was a soft, tan, polypoid mass measuring 2 x 1 x 0.8 cm in size. Microscopically, the lesion was identical to pure tubular adenomas of the large intestine. Positive immunohistochemical staining for cytokeratin (CK) 20, CK 7, CEA and Cdx2 were identified. CONCLUSION: An intestinal-type adenoma should be included in the differential diagnosis of a vaginal polypoid mass lesion in women. Our review of the literature presents the risk of malignant transformation.

Fine-needle aspiration cytology of metastatic oligodendroglioma: case report and literature review.

BACKGROUND: Systemic metastasis of a glial tumor is a rare event. However, metastatic cases are anticipated to increase due to prolongation of survival as a result of the development of new treatment modalities. The possibility of metastasis should be considered in patients with a history of a glial tumor rather than a second primary tumor. Fine-needle aspiration cytology is one of the diagnostic procedures primarily applied for confirmation of metastasis in cases with a known primary focus. Therefore, comprehensive knowledge of diagnostic cytomorphologic findings is required in these cases. CASE REPORT: We report a young woman with oligodendroglioma metastasizing to the cervical lymphatic chain 5 years after initial diagnosis. Fine-needle aspiration cytology revealed a highly cellular smear with dispersed single cells and loosely cohesive cell clusters showing rosette-like features on a clean background. The relatively monotonous tumor cells were small sized and had round nuclei with moderate anisonucleosis and scant cytoplasm without extensions. Diagnostic confirmation was made by excisional biopsy and demonstration of 1p19q codeletion on tissue section by fluorescence in situ hybridization. CONCLUSION: A brief review of the literature with an emphasis on the cytologic features of metastatic oligodendroglioma and differential diagnosis with respect to other metastatic small round cell tumors is provided.

Malignant lymphoma associated with Behçet's disease: A report of 2 cases.

Herein we report 2 cases of malignant lymphoma associated with Behçet's disease. Case 1, a 53-yearold man, was diagnosed as Behçet's disease at the age of 26 years, and was treated with cyclophosphamide and prednisolone. At 45 years of age, bilateral enlarged lymph nodes were observed in the patient's neck. Evaluation of a lymph node biopsy specimen showed Hodgkin's disease and chemotherapy was administered. Due to disease recurrence 7 years later, chemotherapy and radiotherapy were administered. Case 2, a 67-year-old male, was diagnosed as Behçet's disease at age 44 years and began colchicine treatment. At 60 years of age a mass in his left tonsillar fossa was noted. Evaluation of a left tonsil biopsy specimen showed malignant lymphoma. Radiotherapy and chemotherapy were subsequently administered. At the time this report was written both patients were disease-free. Malignant lymphoma associated with Behçet's disease is rare-only 17 cases have been published. In addition to the presented cases, the literature regarding malignant lymphoma associated with Behçet's disease is reviewed.

Rhabdomyosarcoma arising in a mature cystic teratoma with contralateral serous carcinoma: case report and review of the literature.

SUMMARY: Malignant transformation of a mature cystic teratoma of the ovary is rare, and occurs in approximately 2% of all cases. The most common malignancy arising in mature cystic teratoma is squamous cell carcinoma. Sarcomas very rarely develop in mature cystic teratoma. We describe the case of a 65-year-old patient with mature cystic teratoma, and with rhabdomyosarcomatous transformation and contralateral serous carcinoma. To our knowledge, this is the first case of a pure rhabdomyosarcoma arising in a mature cystic teratoma. The clinicopathologic and immunohistochemical findings of this exceptional case are reported and the literature is reviewed.

Metastasis of adenocarcinoma of the gall bladder to an endometrial polyp detected by endometrial curettage: case report and review of the literature.

SUMMARY: Polyps are the most common benign lesions in the endometrium. Metastasis to the endometrial polyp from a distant primary tumor is rare. Breast carcinoma is the most frequent extragenital cancer that metastasizes to the endometrial polyp. We report the case of a 63-year-old with metastatic gall bladder adenocarcinoma involving endometrial polyps detected by endometrial curetting. It was the first sign of her metastatic disease. After this diagnosis, bone metastases were detected during radiologic screening. Gastrointestinal tumor metastasis to an endometrial polyp is a very rare event, but if a patient with a known primary extragenital tumor has abnormal vaginal bleeding, the possibility of metastasis should be included in the differential diagnosis.

Fascin expression in uterine smooth muscle tumors.

SUMMARY: The diagnosis of malignant, uncertain malignant potential, and benign uterine smooth muscle tumors is derived from histologic criteria such as tumor cell necrosis, mitotic activity, and cytologic atypia. Morphologically, some variants of leiomyoma can be confused with leiomyosarcoma (LMS). In this study, we compared fascin expression in cases of leiomyoma, leiomyoma variants (LVs), uterine smooth muscle tumor of uncertain malignant potential (STUMP), and LMS, and sought to determine the potential role of fascin in differential diagnosis. Fascin expression was investigated through the immunohistochemistry of paraffin-embedded tissue in 79 cases of uterine smooth muscle tumor including 22 usual leiomyoma, 31 LV, 4 STUMP, and 22 LMS cases. The cases were scored on the basis of staining extent (from 0 to 4) and intensity (from 1 to 3), and were assigned a combined score. Fascin expression was present in 20 of 22 (90.9%) LMS, 2 of 4 (50%) STUMP, 1 of 31 (3.2%) LV, and 1 of 22 (4.5%) usual leiomyoma cases. There was a statistically significant difference in fascin extent and intensity between the LMS and benign groups, but no difference between the LMS and STUMP groups. The results of this study indicate that more distinct fascin expression exists in LMS than in the benign groups. Fascin can serve as a reliable immunohistochemical marker in distinguishing uterine LMS from LVs and usual leiomyoma, and it may usefully be used with histologic criteria in diagnosing problematic cases.

Fascin expression in melanocytic lesions of the skin.

Fascin is a globular actin cross-linking protein that is important in carcinogenesis. It shows differential staining in various tumors, dependent on grade and stage. The purpose of this study was to compare fascin expression in benign, dysplastic and malignant (metastatic and non-metastatic) melanocytic lesions of the skin, and also to investigate the potential role of fascin in their differential diagnosis. Fascin expression was investigated through the immunohistochemistry of paraffin-embedded tissue in 73 cases of melanocytic lesions of the skin, including 20 benign nevi, 12 dysplastic nevi, 4 lentigo malignas, 25 malignant melanomas and 12 metastatic melanomas. The cases were scored on the basis of staining extension (from 0 to 4) and intensity (from 1 to 3), and were assigned a combined score. Fascin expression was present in 19/20 (95%) benign nevi, 8/12 (67%) dysplastic nevi, 1/4 (25%) lentigo malignas, 7/25 (28%) malignant melanomas and 3/12 (25%) metastatic melanomas. There was significantly less frequent expression of fascin in malignant melanoma than in benign nevi (p < 0.001) and dysplastic nevi (p = 0.036). The results of this study indicate that differential fascin expression exists between benign nevi and malignant melanomas. Fascin can therefore serve as a reliable immunohistochemical marker in distinguishing malignant melanomas from melanocytic nevi and dysplastic nevi, and it may be used with histological criteria for differential diagnosis.

CD117 expression in normal, neoplastic, inflammatory, and reactive lesions of the thyroid.

The mutations of c-kit gene, which encodes a transmembrane receptor tyrosine kinase (CD117-KIT) or activation of CD117, lead to the activation of signal transduction cascades regulating cell proliferation, apoptosis, chemotaxis, and adhesion. The aim of this study was to investigate the expression of CD117 in normal, inflammatory, neoplastic, and reactive lesions of the thyroid. Using polyclonal anti-CD117 antibody, we performed immunohistochemical staining on tissue blocks from 230 cases obtained from the archives of the Department of Pathology, Ondokuz Mayis University (Samsun, Turkey), collected between 1990 and 2006. Each slide was evaluated for extent and intensity of staining. Staining extent was expressed as the percentage of stained cells. Staining of <10% of the cells was accepted as negative. Staining intensity was evaluated only in positive cases. By addition of the extent and intensity scores, the combined score was calculated. In our study, the combined CD117 staining scores of neoplastic and inflammatory groups were found to be higher than the reactive and normal groups. Within the neoplastic group, papillary carcinomas differed from follicular adenomas significantly, although papillary carcinomas showed no statistically significant difference compared to follicular carcinomas. Immunohistochemical CD117 positivity was detected in a wide range of neoplastic and inflammatory thyroid diseases. The neoplastic group and, within them, the papillary carcinomas showed a higher ratio of CD117 positivity. Although our results need to be confirmed by other molecular and genetic studies, the high rate of positivity in papillary carcinomas was one of the striking findings, which may result in novel diagnostic and therapeutic approaches.

Efficacy of recombinant human interferon alpha-2b on experimental endometriosis.

OBJECTIVE: To investigate the efficacy of recombinant human interferon alpha-2b on endometriosis. STUDY DESIGN: The randomized, placebo-controlled, single-blind, experimental study was performed on 30 Wistar female rats in the Experimental Surgery Laboratory at Ondokuz Mayis University in Turkey. After the peritoneal implantation of endometrial tissue, rats were randomized to two equal intervention groups: (1) the control group and (2) the interferon group. Six weeks later, after implant volume was measured (volume-1) by performing a second laparotomy, interferon alpha-2b (100,000 IU subcutaneously per rat, three times at 48 h intervals) was administered to the interferon group, and saline solution (0.1 ml SC, once per week), to the control group, for 8 weeks. At the end of the treatment, a third laparotomy was performed to remeasure implant volumes (volume-2), and implants were totally excised for histopathologic examination. Volume-1 and volume-2 within the groups, as well as stromal and glandular tissues between the groups were compared. RESULTS: In the interferon group, volume-2 was statistically significantly reduced compared with volume-1, whereas there was no significant volume change in the control group. In the interferon group, when compared with the control group, both stromal and glandular tissues had statistically significantly lessened. CONCLUSIONS: Interferon alpha-2b was seen to regress significantly both the size and the histological structure of endometriotic implants.

Bcl-2 positivity in B and C hepatitis and hepatocellular carcinomas.

BACKGROUND/AIMS: This study aims to investigate the expression of bcl-2 in the chronic hepatitis B, C and hepatocellular carcinoma. METHODOLOGY: In this study, 23 chronic hepatitis C, 17 chronic hepatitis B and 29 hepatocellular carcinoma cases were examined. Liver biopsies have been immunohistochemically stained for the expression of bcl-2. Positive staining was semi-quantitatively graded from + to +++. RESULTS: Two out of 23 hepatitis C cases and 3 out of 17 hepatitis B cases were found to express bcl-2, staining was more intense in areas adjacent to active inflammatory process. Of the 29 hepatocellular carcinoma cases 6 stained positively for bcl-2; 9 biopsies in this group had also non-neoplastic liver tissue, and, of these 6 stained positively for bcl-2. Of the latter 6 bcl-2 positive biopsies 3 also showed tumoral staining while in the remaining 3, neoplastic elements were bcl-2 negative. CONCLUSIONS: As the present study is a cross-sectional study, no causative relation between bcl-2 positivity and hepatocellular carcinoma can be implied, however high incidence of bcl-2 activity in the non-neoplastic liver parenchyma of the HCC cases suggest that bcl-2 activation may be involved in the development of at least some cases of hepatocellular carcinoma. Case control and/or prospective studies are needed to show whether bcl-2 positivity in a chronic hepatitis case has a predictive value for the development of hepatocellular carcinoma.

Sacrococygeal teratoma with sarcomatous differentiation in a child.

Most of the extragonadal teratomas are located in the sacrococygeal region. Teratoma with malignant sarcomatous differentiation is a rare form of germ cell tumor. The authors describe a 5-year-old-girl with sacrococygeal teratoma in which sarcomatous elements were observed. The patient was treated with complete surgical excision and adjuvant chemotherapy according to sarcoma protocols.

Dystrophic calcification of fetal myocardium: a case report.

OBJECTIVE: A diagnosis of myocardial dystrophic calcification, a rare cause of fetal cardiac masses, is presented. METHODS: The fetal echocardiography of a 26-year-old pregnant woman who was referred to the Pediatric Cardiology Department at 20 weeks' gestation revealed an echogenic mass in the post wall of the left ventricle. RESULTS: The pregnancy was terminated. The histopathology of the necropsy material revealed dystrophic calcification. CONCLUSION: The dystrophic calcification of myocardium must be kept in mind in prenatal differential diagnosis of intracardiac masses for patient management and genetic counseling.

Chromophobe renal cell carcinoma with osseous metaplasia containing fatty bone marrow element: a case report.

A 27-year-old woman presenting with epigastric pain and dyspepsia was found to have a calcified mass in the upper-middle right kidney. Gross examination of the nephrectomy specimen revealed a 6.5 x 5 x 4 cm renal tumor with dense calcification and ossification. Histopathological examination of the tumor showed solid, trabecular sheets and nesting of polygonal epithelial cells with abundant cytoplasm and prominent cell border and mature bony tissue enclosing fatty marrow. Renal cell carcinoma is frequently associated with calcification, but ossification is extremely rare. To our knowledge, we report the fourth case of a chromophobe renal cell carcinoma with extensive calcification and ossification.

Radiologic and histological evaluation of otogenic sliced cartilage grafts at the tip of the chin of rabbits: an experimental study.

OBJECTIVES: Cartilage grafts have been commonly used in plastic and reconstructive surgery applications for many different goals, such as auricular reconstruction and rhinoplasty. The use of autologous cartilage is ideal for many reasons. An attempt was made to produce an experimental animal model to test the efficacy of otogenic Surgicel-wrapped sliced cartilage. METHODS: In this experimental study, cartilage grafts were harvested from rabbits' ears. These grafts were cut in pieces of 0.5 mm to 1 mm using a no. 11 blade. This cartilage mass was wrapped in one layer of Surgicel (oxidized regenerated cellulose) and inserted in the chin of the rabbits. MR analyses were made at 1 week and 6 months and histological analyses were made at 6 months. RESULTS: Cartilage grafts maintained approximately 80% of their dimensions in MRI. The proportion of necrosis was between 30% and 50% and the proportion of resorption was approximately 20% in the histological studies.

Glutathione-S transferase-pi expression in non small cell lung cancer in the assessment of response to chemotherapy.

OBJECTIVE: To determine the relation of glutathione-S transferase-pi (GST-pi) expression and cisplatin resistance in non small cell lung cancer (NSCLC). METHODS: This study was carried out on 61 patients who were admitted to Chest Diseases Clinic, Ondokuz Mayis University, Samsun, Turkey, from 1997 to 1999. Twenty-seven NSCLC patients out of 61 lung cancer cases whose biopsy specimens were evaluated for GST-pi, received multiagent chemotherapy including cisplatin. The correlations between GST-pi expression and age, sex, performance score, histology, stage of the disease and response to chemotherapy were investigated. RESULTS: There was a significant correlation between GST-pi expression and the histological type of the disease (p<0.05). However, no significant relation was found with age, sex, performance score or stage of the disease (p>0.05). Glutathione-S transferase-pi staining characteristics of the 27 patients receiving chemotherapy were: less than 10% in 3 patients (11.1%), 10-50% in 9 patients (33.3%) and more than 50% in 15 patients (55.5%). One of the 3 patients (33.3%) with GST-pi staining percentage of less than 10%, 3 of 9 patients (33.3%) with staining percentage of 10-50% and 4 out of 15 patients (26.6%) with staining percentage of more than 50% had an objective response to chemotherapy. No significant correlation was found between GST-pi expression and response to chemotherapy in the 3 groups (p>0.05). CONCLUSION: Glutathione-S transferase-pi expression might not always predict the response to combination chemotherapy regimens containing cisplatin. Several other mechanisms may play a role in cisplatin-resistance.

The prevalence of clubbing in different types of lung cancer.

BACKGROUND: The aim of the study was to determine the relative frequency of digital clubbing in small cell lung cancer (SCLC) and non-small cell lung cancer (NSCLC), and to find out whether there is a gender predominance in the frequency of clubbing. PATIENTS AND METHODS: The study was a single center prospective study conducted at the Pulmonary Medicine Department in a university hospital. Between January 1988 and December 1998, 738 patients with histopathologic diagnoses of SCLC or NSCLC were enrolled. Twenty-six patients with a diagnosis of in differentiated lung cancer were excluded. RESULTS: Clubbing was present in 128 (17.3%) of the 738 patients and was detected in 17.5% of patients with NSCLC vs. 16.7% of patients with SCLC (chi(2) test, P>0.05), and it was more common in males (18.6%) than in females (4.4%, Fisher's exact test, chi(2)=8.74, P<0.01). CONCLUSION: The incidence of clubbing was similar in both SCLC and NSCLC patients, which is inconsistent with classical knowledge in the literature, and digital clubbing was significantly more common in males than in females with lung cancer.

[Clinical features of non-small cell lung cancer cases]. / Küçük hücreli disi akciger kanserli hastalarin klinik özellikleri.

The aim of this study was to evaluate the clinical features of non-small cell lung cancer (NSCLC) cases that were diagnosed in our clinic. The patients who were diagnosed as NSCLC in our clinic between January 1988 and January 1999 were comprised the study group. The files and records of the study group were retrospectively reviewed to identify patients and all the data including demographic characteristics, history, physical examination findings, laboratory values, diagnostic procedures, radiologic findings and staging procedures. The study group included 564 patients (506 male, 58 female). The mean age was 60 years (28-97). 87% of the patients were current smokers or ex-smokers. The most frequent symptoms on admission were cough, sputum, and dyspnea. The most common radiologic finding was a central mass with a diameter of more than 4 cm with an irregular border. The diagnosis was established by histopathologic examination of biopsy specimens obtained by various means, in which bronchoscopy was the sole means of diagnosis in 83% of the patients. Histopathologic examination of the biopsy specimens resulted as follows: 85.8% squamous cell carcinoma, 10.3% adenocarcinoma, 1.4% large cell carcinoma, 0.45% adenosquamous carcinoma, and 2.1% undifferentiated NSCLC. Staging procedures that were done in all patients revealed that 85% of the patients were diagnosed at the stage IIIB and IV. Metastasis was most frequently to the bones followed by brain and liver. In our study squamous cell carcinoma was the most common histopathologic type with a higher percentage than the previous reports in the literature. The percentages of stage IIIB and IV were also higher in our study than previous papers in the literature.

Pilomatrixoma localized in the arm and forearm.

Pilomatrixoma is a rare benign skin tumor arising from hair follicle stem cells which is also known as calcifying epithelioma of Malharbe. It occurs with a rate of 0.1% among skin tumors. The definite diagnosis is made histopathologically. In treatment, it is recommended that the lesion be excised surgically. In this study, we wished to present two patients who presented with swelling and underwent excisional biopsy as a result of magnetic resonance imaging and whose pathological result was reported to be pilomatrixoma in accompaniment with the literature.