Bronchial Carcinoid Tumors with Massive Osseous Metaplasia: A Case Report and Review of the Literature.

Bronchial carcinoid tumors are primary lung neoplasms thought to originate from neuroendocrine cells, i.e. Kulchitsky cells, in the bronchial mucosa, although the type of cellular origin has not been clearly understood. A 61-year-old male patient underwent surgery and microscopic examination of the specimen revealed an anastomosing trabecular bony structure among the nests of tumor cells with round nucleus, granular chromatin, and large eosinophilic cytoplasm. Our case has been deemed worthy of being presented as bronchial carcinoid tumor with exaggerated osseous metaplasia.

Intraoperative pathology consultation for pulmonary lesions: errors and deferrals.

The accuracy rate of frozen section constitutes an important step of quality assessment step in pathology practice. This study aimed to investigate pulmonary lesions that were incorrectly diagnosed or postponed for routine examination by pathologists at frozen section examination; it also aimed to discuss the reasons for difficult diagnoses and the various clues enabling the correct diagnosis to be made when such lesions are encountered. This study retrospectively reviewed the medical data of the thoracic surgery cases that underwent frozen section examination between 2009 and 2014. Frozen section errors and deferrals were identified in 25 cases. Fourteen (56%) lesions were of pulmonary parenchymal origin and 11 (44%) were of pleural origin. The number of cases in which the pathologists postponed the diagnosis without making any approach was 14. Of these, 9 (64%) were benign lesions such as bronchiectasis, fibrosis anthracosis, chronic inflammatory cell infiltration, chronic pleuritis, and mesothelial proliferation. The number of misdiagnosed cases was 11. Of these, 7 (64%) were of pulmonary and 4 (36%) were of pleural origin. Because the examination techniques of each pathology department may differ from one another, the comparative examination of frozen sections and routine sections would aid in becoming familiar with various pathologies and would be beneficial for pathologists in minimizing their diagnostic errors.

Molecular markers for patients with thymic malignancies: not feasible at present?

BACKGROUND: Thymomas and thymic carcinomas are rare malignancies and devising clinically effective molecular targeted therapies is a major clinical challenge. The aim of the study was to analyze BLC2 and vascular endothelial growth factor receptor (VEGFR) expression and KRAS and EGFR mutational status and to correlate them with the clinical characteristics of patients with thymomas and thymic carcinomas. MATERIALS AND METHODS: A total of 62 patients (mean age: 50.4 ± 13.2 years) with thymomas and thymic carcinomas were enrolled. The expression of BLC2 and VEGFR in tumor cells and normal tissues was evaluated by RT-PCR. The mutational status of the KRAS and EGFR genes was investigated by PCR with sequence specific primers. RESULTS: The BLC2 and VEGFR expression levels did not differ significantly between tumor and normal tissues. Moreover, there were no clearly pathogenic mutations in KRAS or EGFR genes in any tumor. None of the molecular markers were significantly related to clinical outcomes. CONCLUSIONS: Changes in levels of expression of BLC2 and VEGFR do not appear to be involved in thymic tumorigenesis. Moreover, our data suggest that KRAS and EGFR mutations do not play a major role in the pathogenesis of thymomas and thymic carcinomas.

Why did the patient die? The relationship between ambulance accidents and death of patients: forensic medical issues.

This article's aim is investigating traumatic consequences of ambulance accident on patients and discussing difficulties to give a decision about the relation between death and accident at these cases. The cases were selected among the forensic medical reports concluded between 1996 and 2005 years. They were documented for age, sex, causes of urgent call, localization and extent of traumatic lesion, properties of events and board decisions. A total of 21 cases were found. 15 cases died on the day of the accident. Skin injuries at head (8 cases) and legs (6 cases) were most common traumatic lesions. Totally 6 deaths were found related with ambulance accident. Death of patient after ambulance accidents may not be associated easily to the accident. Delay due to accident or concomitant contributing medical conditions may also facilitate the death in this type of cases. Reliable medical records were needed for accurate medicolegal evaluation.

Interinstitutional review of slides for forensic pathology: types of inconsistencies.

Because of the specific structure of forensic medicine in Turkey, reexamination of histopathologic specimens is a frequent practice. The aim of the present study is the assessment of microscopic diagnostic consistency in forensic pathology between different laboratories. Reports of the Council of Forensic Medicine between 2001 and 2004 were examined, and 150 cases with second pathologic examination were found. Results of histopathologic reports from peripheral laboratories were compared with those made by the Council pathologists with regard to diagnostic consistency. Consistency was assessed in 3 groups and 1 subgroup. Group 1, consistent and minor inconsistency; includes a major consistency subgroup. Group 2, major inconsistency, is the second diagnosis which is lethal; group 3, major inconsistency, is the first diagnosis which is lethal. The lung was found to be the organ with the highest frequency of diagnostic major inconsistency (group 2 and 3) and major consistency. Bronchopneumonia was the most common diagnosis. The brain had the highest frequency of intercenter diagnostic overall consistency (90.2%, group 1). Myocardial infarction was the diagnosis most frequently rejected on reevaluation (group 3). In conclusion, forensic pathology requires different experience than surgical ones. In cases of discrepancy between the anamnesis of the lethal event and pathologic findings, reevaluation of specimen is mandatory to avoid any diagnostic errors. Quality assurance systems with all include internal and external control mechanisms will improve the diagnostic reliability.

Suicide among children and adolescents in a province of Turkey.

Despite well-documented increases in completed suicides among children, accurate knowledge of the characteristics of these suicides is very limited. The aim of this study was to investigate general characteristics of suicide among children and adolescents in the province of Istanbul and to evaluate obtained results in the light of the literature. Data were collected from autopsy records of the Morgue Department of Institute of Forensic Medicine, Istanbul. General characteristics of completed suicides among children and adolescents between 2001 and 2005 were retrospectively reviewed. The study included 176 suicides aged 9-19 years. The overwhelming majority of the suicides (92%) were aged 15-19 years. More than half of the suicides (60%) were male. The most frequent means of suicide was hanging (55%) followed by firearms (20%) and jump or descent from height (15%).

Pulmonary alveolar microlithiasis in a textile worker.

Pulmonary alveolar microlithiasis is a rare lung disease characterized by small calculi, called calsispheritis, in the alveoli. The disease usually presents at age 20 to 30 years and is mostly diagnosed incidentally or detected on routine pulmonary roentgenograms. The radiologic findings are pathognomonic for the disease. Pulmonary alveolar microlithiasis most frequently appears in Turkey, followed by Italy. We present the case of a 29-year-old female textile worker found to have widespread micronodules after a routine pulmonary roentgenogram.

[Cardiac ruptures following myocardial infarction in medicolegal cases]. / Infarkt sonrasi gelisen kardiyak rüptürler; adli otopsi serisi.

OBJECTIVE: Characteristics of legal autopsy cases with cardiac rupture following myocardial infarction are investigated in this retrospective observational study and the results are compared with a control group consisting of acute myocardial infarction cases without rupture. METHODS: Legal autopsy reports of 50 cases with heart tamponade resulting from heart muscle rupture following myocardial infarction, autopsied at the Morgue Department of the Council of Forensic Medicine between the years 1998-2005 were retrospectively reviewed. Findings were compared to control group consisting of 30 myocardial infarction cases without rupture. RESULTS: The rupture was located in the left ventricle in 48 of 50 cases. At microscopic examination, infarction date was consistent with first three days, 4-7 days and 1-2 weeks for 30, 12 and 8 cases, respectively. The average volume of fluid leading to tamponade was 467 ml in males and 352.3 ml in females. There were no statistical differences between rupture and control groups for existence of hypertrophy and scar tissue in myocardium and advanced atheromatous lesions in coronaries (p>0.05). Considering the manner of death of the cases died due to heart wall rupture and tamponade formation, 28 of the cases were found dead at home, 6 died suddenly by falling to the ground at home or on the street, and 5 were delivered dead to the hospital. CONCLUSION: The rupture was located in the left ventricle in almost all cases. Ruptures in the left ventricle were found most frequently in the anterior wall. There was no relationship between development of rupture and existence of hypertrophy and scar tissue in myocardium, and advanced atheromatous lesions in coronaries.

Expression of cyclooxygenase-2, c-kit, progesterone and estrogen receptors in uterine smooth muscle tumors: differential diagnosis.

We examined the expression pattern of cyclooxygenase-2 (COX-2) and c-kit in uterine smooth muscle neoplasms and tried to determine the role of these markers in differential diagnosis. Archival tissue from 64 patients with uterine smooth muscle neoplasms (20 leiomyomas (LMs), 22 atypical leiomyomas (ALMs), and 22 leiomyosarcomas (LMSs)) was immunostained with antibodies against estrogen (ER) and progesterone receptors (PR), COX-2 and c-kit. 7 of 20 LM cases and 5 of 22 ALM cases were immunopositive for COX-2, whereas none of the LMS cases stained immunopositive (p< or =0.05). 4 of 20 LM cases and 5 of 22 ALM cases were immunopositive for c-kit, whereas 15 of 22 LMS cases showed c-kit immunopositivity (p< or =0.05). In conclusion, very few LMs and ALMs show COX-2 immunopositivity. LMSs usually do not express COX-2. COX-2 expression in smooth muscle tumors is not a prominent feature. Therefore, COX-2 inhibitors may not be useful in LMS therapy. C-kit was significantly expressed in uterine LMSs.

Cardiac myxoma: an unusual cause of sudden death in childhood.

Primary tumors of the heart and pericardium are rare in autopsy series. Considering all age groups, the most common cardiac tumor is the myxoma. They may arise in any of the four chambers or, rarely, on the heart valves. About 90% are located in the atria, with the left-to-right ratio of 4:1. The majority of patients are usually in the age group of 30-60 years. Female predominance has been reported. In this report, we describe a six-year-old boy with right atrial myxoma. A 5x4x3 cm, polypoid, smooth-surfaced, brown-colored tumor was found in the right atrium. It was attached by the stalk to the atrial septum. Microscopically, the tumor had the typical appearance of a myxoma with spindle cells widely spaced by abundant myxoid matrix. The diagnosis was based on histopathological and immunohistochemical findings. Sudden death may occur in patients with atrial myxoma. Death is caused by coronary or systemic embolization or by obstruction of blood flow at the mitral or tricuspid valve.

Sudden death due to an unrecognized cardiac hydatid cyst: three medicolegal autopsy cases.

Echinococcosis is a human infection caused by the larval stage of Echinococcocus granulosus. The most common sites of infection are the liver and the lungs. Cardiac hydatid cysts are very rare, even in regions where hydatic cysts are endemic (the Mediterranean, South America, Africa, and Australia). It has been reported that cardiac involvement is seen in about 0.5-3% of human echinococcosis cases. Three cases of cardiac hydatid disease that caused sudden death and which were histopathologically diagnosed are reported. Cardiac echinococcosis is rare, but due to its insidious presentation and affinity to cause sudden death, it is important that it be identified in the histopathological examination.

Endometrial clear cell carcinoma metastatic to the paranasal sinuses: a case report and review of the literature.

BACKGROUND: Paranasal sinus metastasis following endometrial carcinoma is extremely rare and a reflection of disseminated disease. CASE: We report a case of a 72-year-old woman who presented ethmoid and sphenoid sinus metastasis, 14 months after total abdominal hysterectomy and bilateral salpingo-oophorectomy due to an endometrial clear cell carcinoma. CONCLUSION: One should recognize the possibility of a metastatic disease to the sinuses in patients presenting with associated symptoms.