Use of BRAF immunohistochemistry as a screening test in detecting BRAFV600E mutation in melanomas.

OBJECTIVE: BRAF mutation is detected in 50-70% of melanomas. The molecular methods used to detect BRAF mutations are 80-90% sensitive, specific, and expensive methods. Immunohistochemistry is a relatively common, rapid, relatively inexpensive method in pathology practice compared to molecular techniques. AIMS: We aimed to compare immunohistochemical and molecular methods in our case of malign melanoma in which we investigated BRAF mutation with "real time PCR" method and to investigate the compatibility of molecular test results of BRAF immunohistochemistry results as a preliminary test. METHODS: Selected blocks of 30 patients with metastatic melanoma who came to our department for BRAF mutation detection were subjected to real time PCR molecular method and immunohistochemical study was performed with BRAF primer antibody. RESULTS: BRAF mutation was detected by molecular method in 7 of 30 cases (23.33%). CONCLUSION: In all of these 7 cases, positive immunohistochemical staining was identified (100%). In conclusion, the use of BRAF immunohistochemistry as a screening test in the detection of mutant disease will allow the cost-effective use of molecular testing.

Endometrial stromal sarcoma with coexistent endometrioid adenocarcinoma in a woman with previous breast cancer: a preliminary case report.

Endometrial stromal sarcoma (ESS) is a rare neoplasm of the uterus. The authors report a case of low-grade ESS coexistent with endometrioid adenocarcinoma of the uterus in a woman with a previous history of breast cancer. To the best of their knowledge, such a case has not been reported to date.

The effect of serum magnesium levels and serum endothelin-1 levels on bone mineral density in protein energy malnutrition.

An inadequate and imbalanced intake of protein and energy results in protein-energy malnutrition (PEM). It is known that bone mineral density and serum magnesium levels are low in malnourished children. However, the roles of serum magnesium and endothelin-1 (ET-1) levels in the pathophysiology of bone mineralization are obscure. Thus, the relationships between serum magnesium and ET-1 levels and the changes in bone mineral density were investigated in this study. There was a total of 32 subjects, 25 of them had PEM and seven were controls. While mean serum ET-1 levels of the children with kwashiorkor and marasmus showed no statistically significant difference, mean serum ET-1 levels of both groups were significantly higher than that of the control group. Serum magnesium levels were lower than normal value in 9 (36%) of 25 malnourished children. Malnourished children included in this study were divided into two subgroups according to their serum magnesium levels. While mean serum ET-1 levels in the group with low magnesium levels were significantly higher than that of the group with normal magnesium levels (p < 0.05), mean bone mineral density and bone mineral content levels were significantly lower (p < 0.05). In conclusion, many factors play a role in the pathophysiology of changes in bone mineral density in malnutrition. Our study suggested that lower magnesium levels and higher ET-1 levels might be important factors in changes of bone mineral density in malnutrition. We recommend that the malnourished patients, especially with hypomagnesaemia, should be treated with magnesium early.

Expression of transient receptor potential vanilloid receptor 1 and toll-like receptor 4 in aggressive periodontitis and in chronic periodontitis.

BACKGROUND AND OBJECTIVE: The objective of the present study was to evaluate the expression and the distribution of the transient receptor potential vanilloid receptor 1 (TRPV1) and of toll-like receptor 4 (TLR4) in tissue samples from patients with periodontal disease (aggressive periodontitis and chronic periodontitis) and from healthy controls. MATERIAL AND METHODS: Ten tissue samples from each disease group (aggressive periodontitis and chronic periodontitis) and from healthy subjects were obtained during routine oral surgical procedures. Subgingival specimens were collected from sites with advanced loss of support (probing depth>5mm) and specimens from the corresponding healthy controls were obtained during tooth extraction for orthodontic reasons or following surgical extraction of an impacted third molar. The distribution of TRPV1 and TLR4 receptors in human gingival tissue was studied by immunohistochemistry. RESULTS: Both TLR4 and TRPV1 were detected in gingival tissues from healthy subjects, and from patients with chronic periodontitis and aggressive periodontitis, particularly in gingival keratinocytes, fibroblasts, inflammatory cells and the endothelial lining of capillaries in connective tissues. Histologic examination of the samples from healthy controls disclosed that clinically healthy gingiva does not correspond to histologically healthy gingiva. Subsequently, these samples were redesignated as gingivitis samples. TRPV1 was down-regulated in all cell types in samples obtained from patients with chronic periodontitis compared to samples obtained from patients with gingivitis, whereas TLR4 was down-regulated only in the epithelium and in gingival fibroblasts. In contrast, the levels of these markers in patients with aggressive periodontitis were similar to those in healthy patients. CONCLUSION: Local expression of TRPV1 and TLR4 in gingival tissues may contribute to both physiological and pathological processes in the periodontium. Our data suggest that TRPV1 and TLR4 may play a role specifically in the pathophysiology of chronic periodontitis.

The effect of pre-operative conventional and hyperfractionated radiotherapy schedules on wound healing and tensile strength in rats: an experimental study.

We examined the effects of pre-operative conventional and hyperfractionated radiotherapy schedules on wound healing and tensile strength in 90 female Wistar rats weighing between 182 and 240 g. The animals were randomized into three groups (n = 30 each). Group I was sham-irradiated. Group II (conventional) received 20 daily fractions of 200 cGy, to a total dose of 4000 cGy. Group III (hyperfractionated) received 40 fractions of 120 cGy, twice daily, to a total dose of 4800 cGy. Four weeks after radiotherapy, incision and primary repair with simple suturing was performed on one side of the neck. Twenty-one days after wounding, all the rats were sacrificed. Non-parametric Kruskal-Wallis and Mann-Whitney U-tests were used for the statistical analysis of wound tensile strength. The chi-squared test was used for the statistical analysis of the histopathologic findings. The hyperfractionated group had a significantly lower tensile strength than that of the control group (P = 0.03, z = -2.18). According to the histopathologic findings, fibrosis was increased significantly in the hyperfractionated group as compared to the other groups (P = 0.038, chi2 = 6.52). Hyperfractionated radiotherapy significantly reduced the wound tensile strength in the early evaluation period as compared to the control group.

Comparison of histopathologic effects of carnitine and ascorbic acid on reperfusion injury.

OBJECTIVE: Reperfusion injury can be seen after acute arterial occlusion, acute myocardial infarctus and during open heart surgery and vascular surgery. Protective effects of ascorbic acid and carnitine on reperfusion damage were tested and compared using histopathologic examination on ischemia model in the rabbit hind limb. METHODS: Four groups (each containing ten animals) were used. In group I (G1), only anesthesia was administered and a biopsy was taken from the soleus muscle after 6 h. In group II (G2), group III (G3), and group IV (G4), after induction of anesthesia, arterial blood circulation of right posterior extremity was blocked by a tourniquet proximally. After four hours of ischemia, just before releasing of tourniquet, physiologic saline solution, sodium ascorbate (Redoxan) and L-carnitine (Carnitine) were administered intravenously to G2, G3 and G4, respectively. Following 2 h of reperfusion, biopsies were taken from soleus muscles. All of the biopsy slides were observed under the light microscope from the aspect of six different histopathologic criteria (loss of striation, nuclear centralisation, formation of ring and/or splitting, changing on diameters of muscle fibers, necrosis and minimal fibrosis) of ischemic muscle. RESULTS: Ischemic change criteria were seen less frequency in both vitamin C and carnitine groups compared to the control and placebo groups. However, this protective effect was statistically significant only for the aspect of segmental necrosis, centralization of nuclei and diameter change parameters in G3 and in G4. When G3 and G4 were compared, the differences on protective effects were significant only from the aspect of fibrosis (P<0.001) and changing on diameter of the fibers (P<0.001). CONCLUSIONS: Both sodium ascorbate and carnitine are effective on reducing the reperfusion injury in skeletal muscle. But when we compared these two agents to each other, we found that carnitine seems a little more protective on our experimental model.

Correlation of proliferating cell nuclear antigen and bcl-2 expression with tumor front grading and metastasis in laryngeal squamous cell carcinoma.

This study was designed to examine the immunohistochemical expression of proliferating cell nuclear antigen (PCNA) and bcl-2 protein in 45 cases with advanced laryngeal squamous cell carcinoma who had undergone total laryngectomy with unilateral modified radical neck dissection, and the relation of this expression to some prognostic factors such as tumor front grading and neck lymph node metastases. Sections were reevaluated for routine histologic grade, tumor front grading and neck lymph node metastases, and were stained with monoclonal antibodies against PCNA and bcl-2. Significant correlation was present between the severity of PCNA expression and incidence of lymph node metastasis (p<0.05). No correlation was found between the severity of PCNA expression and tumor front grading. Bcl-2 expression did not associate with either parameters. In conclusion, PCNA is important in predicting prognosis and no association is present between the bcl-2 protein expression and prognostic factors.

Serum levels of insulin, IGF-1, and IGFBP-1 in pre-eclampsia and eclampsia.

OBJECTIVES: To investigate whether the serum concentrations of insulin, insulin-like growth factor-1 (IGF-1), and insulin-like growth factor binding protein-1 (IGFBP-1) were altered in women with mild pre-eclampsia, severe pre-eclampsia, and eclampsia. METHODS: In this prospective study, we investigated 20 mild pre-eclamptic, 20 severe pre-eclamptic, and 20 eclamptic patients in the third trimester. The control group consisted of 20 healthy pregnant women. Serum levels of insulin, IGF-1, and IGFBP-1 were measured. RESULTS: In patients with eclampsia, serum levels of IGF-1 were lower, and IGFBP-1 were higher, respectively, than control and other study groups (P<0.001) The values of IGF-1 in mild pre-eclampsia and severe pre-eclampsia were lower compared with control groups (both P<0.01), but there were no differences between mild and severe pre-eclampsia. The serum levels of IGFBP-1 in severe pre-eclampsia were higher compared with control groups (P<0.01), but there was no statistical difference between mild pre-eclampsia and other groups. CONCLUSIONS: IGF-1 was lower, and IGFBP-1 was higher in pre-eclamptic and eclamptic patients than controls, these alterations were related to the severity of pre-eclampsia.

The effects of natural ostium and nasoantral window on mucosal regeneration after maxillary sinus surgery in rabbits.

The aims of the study were to investigate the effects of natural ostium and the nasoantral window on the mucosal regeneration after maxillary sinus surgery and to detect the changes in the mucociliary clearance during regeneration process. Twenty-eight rabbits were studied. In the study group consisting of 21 rabbits, the mucosa of each right maxillary sinus was totally removed, natural ostium was occluded with bone-wax and a nasoantral window was created, while the left sinus mucosa was removed and the natural ostium was left open without creating a nasoantral window. Maxillary sinus mucosa taken during surgery was investigated by light and electron microscopy. The study group was divided into three subgroups. The first group was followed for 2, the second for 4, and the last group for 8 weeks. At the end of these periods, the mucociliary function was evaluated scintigraphically using 99mTc-Human serum albumin. Following this investigation mucosal biopsies were taken from the right and left sinuses and the rabbits were sacrificed. In the control group consisting of 7 rabbits a small hole was opened in the anterior wall of the maxillary sinus of each rabbit and the scintigraphic evaluation was performed for this group at the end of each follow up period as well. In the histopathologic investigation, no difference was found between the natural and the nasoantral window using light microscopy, but there was a difference between them in the electron microscopic findings (p < 0.05, Chi-square test). The scintigraphic, light and electron microscopic findings and gross appearances of the sinuses are discussed.

The influence of calcium infusion on serum prolactin in hyperprolactinemic women.

This study investigated the influence of calcium on serum prolactin (PRL) in hyperprolactinemic and healthy women. Previous studies have shown an inhibitory effect of Ca2+ on serum PRL, related to the degree of hypercalcemia. Serum PRL levels were measured by immunoradiometric assay (IRMA) in subjects before and one hour after 1375 mg Ca2+ injection. Serum PRL level was significantly decreased by calcium injection in hyperprolactinemic women (89.2 +/- 29.1 and 63.3 +/- 35.8 ng/ml; p < 0.01) while it was not significant (p > 0.05) in women with normal PRL levels (12.6 +/- 5.1 ng/ml and 11.3 +/- 4.0 ng/ml). These results indicate that acute alterations in serum calcium levels affect PRL secretion in hyperprolactinemic women.

Intraobserver and interobserver reproducibility of WHO and Gleason histologic grading systems in prostatic adenocarcinomas.

In this study a total of 96 patients with prostatic carcinoma were evaluated retrospectively. Sections prepared from paraffin blocks were examined and all cases were scored according to the World Health Organization (WHO) and Gleason grading systems. We investigated intraobserver and interobserver reproducibility of two grading systems in prostatic adenocarcinomas. In our study the intraobserver reproducibilities of the WHO and Gleason systems were 75.0% and 78.1%, respectively. The interobserver reproducibilities of the WHO and Gleason grading systems were 60.4% and 70.8%, respectively. While there was no difference between intraobserver and interobserver variations in the Gleason system (p > 0.05), there was significant difference between intraobserver and interobserver variations in the WHO system (p < 0.05).

Cecal duplications: a rare cause for secondary intussusception.

Duplications of the alimentary tract are rare congenital anomalies that may occur at any level from mouth to anus. While the oesophagus and the ileum are the most common sites, duplications of the colon are rare. Two cases of ileocolic intussusceptions in 8-month-old girl and 6-month-old boy who were admitted to our hospital with acute abdomen findings are presented. Intraoperatively, cecal cystic duplications leading intussusception were revealed. Intussusception is one of the most important surgical emergence in infancy and typically, it does not involve a lead point in childhood. Although duplication cyst may act as lead point, the review of literature reveals its rarity.

The effect of serum magnesium levels and serum Endothelin-1 levels on bone mineral density in protein energy malnutrition / Efecto de los niveles séricos de magnesio y los niveles séricos de Endotelina-1 sobre la densidad mineral osea en la malnutrición calórico-proteica

An inadequate and imbalanced intake of protein and energy results in protein-energy malnutrition (PEM). It is known that bone mineral density and serum magnesium levels are low in malnourished children. However, the roles of serum magnesium and endothelin-1 (ET-1) levels in the pathophysiology of bone mineralization are obscure. Thus, the relationships between serum magnesium and ET-1 levels and the changes in bone mineral density were investigated in this study. There was a total of 32 subjects, 25 of them had PEM and seven were controls. While mean serum ET-1 levels of the children with kwashiorkor and marasmus showed no statistically significant difference, mean serum ET-1 levels of both groups were significantly higher than that of the control group. Serum magnesium levels were lower than normal value in 9 (36%) of 25 malnourished children. Malnourished children included in this study were divided into two subgroups according to their serum magnesium levels. While mean serum ET-1 levels in the group with low magnesium levels were significantly higher than that of the group with normal magnesium levels (p < 0.05), mean bone mineral density and bone mineral content levels were significantly lower (p < 0.05). In conclusion, many factors play a role in the pathophysiology of changes in bone mineral density in malnutrition. Our study suggested that lower magnesium levels and higher ET-1 levels might be important factors in changes of bone mineral density in malnutrition. We recommend that the malnourished patients, especially with hypomagnesaemia, should be treated with magnesium early.

El consumo inadecuado y desbalanceado de proteínas y calorías energía conduce a la malnutrición calórico-proteica (MCP). Se sabe que la densidad mineral ósea y los niveles séricos de magnesio son bajos en los ninos malnutridos. Sin embargo, no está claro el papel que desempenan los niveles séricos de magnesio y los niveles séricos de endotelina-1 (ET-1) en la patofisiología de la mineralización del hueso. Por consiguiente, las relaciones entre los niveles séricos de magnesio y los niveles séricos de ET-1, y los cambios en la densidad mineral ósea, constituyen el objeto de investigación de este estudio. Hubo un total de 32 sujetos; 25 de ellos tenían DCP y 7 eran considerados. Si bien los niveles séricos promedios de ET-1 de los ninos con kwashiorkor y marasmo no mostraron diferencia estadística significativa, los niveles séricos promedio de ET-1 de ambos grupos fueron significativamente más altos que los del grupo de control. Los niveles séricos de magnesio estuvieron por debajo del valor normal en 9 (36%) de 25 ninos malnutridos. Los ninos malnutridos incluidos en este estudio fueron divididos en dos sub-grupos según sus niveles de magnesio en suero. Mientras que los niveles séricos promedio de ET-1 en el grupo con niveles bajos de magnesio fueron significativamente más altos que los del grupo con niveles normales de magnesio (p < 0.05), la densidad mineral ósea promedio y los niveles promedio del contenido mineral óseo fueron significativamente más bajos (p < 0.05). En conclusión, muchos factores juegan un papel en la patofisiología de los cambios en la densidad mineral ósea por la malnutrición. Nuestro estudio sugirió niveles más bajos de magnesio y niveles más altos de ET-1 podrían ser factores importantes en los cambios de densidad mineral ósea en la malnutrición. Se recomienda que los pacientes malnutridos, especialmente a causa de hipomagnesemia, sean tratados con magnesio lo más pronto posible.

Pulmonary hyalinizing granuloma mimicking lung carcinoma.

Pulmonary hyalinizing granuloma has rarely been reported and is a benign entity of unknown origin. The chest radiograph reveals multiple and frequently bilateral pulmonary nodules. We describe a patient with pulmonary hyalinizing granuloma who presented with a central mass in the left lung mimicking lung carcinoma.

Fas (CD95) and bcl-2 expression in active skin lesions of Behçet's disease.

Over-expression of bcl-2 in lymphocytes has an important role in some immunological and inflammatory diseases. Fas (CD95) is a cell surface molecule that mediates receptor-triggered apoptosis in various cells including autoreactive T cells. In this study we investigated bcl-2 and Fas (CD95) expression in dermal lymphocytes in active skin lesions of Behçet's disease (BD) and in skin biopsy samples with chronic, non-specific inflammations. Tissue sections of 29 skin lesions of Behçet's disease and of 10 chronic non-specific inflammatory process cases from the archives of the Ondokuz Mayis University's Pathology Department were immunohistochemically stained for bcl-2 and Fas (CD95), and lymphocytes in the dermal infiltrate were evaluated for cytoplasmic staining. bcl-2 staining was observed in the skin lesions of 22 cases (75.8%) of Behçet's disease. bcl-2 staining was detected in two (20%) control skin biopsy samples with non-specific chronic inflammation. Fas (CD95) positivity was not detected in lymphocytes in Behçet's disease-related skin lesions. Fas (CD95) staining was observed in only three skin biopsy samples with non-specific chronic inflammation. bcl-2 and Fas (CD95) staining values in Behçet's and non-specific inflammation groups were significantly different (P < 0.01); differences in the bcl-2 staining values between Behçet's patients with mucocutaneous involvement only and mucocutaneous and other systemic involvements were not significant (P > 0.05). Expression of bcl-2 and loss of Fas (CD95) expression in dermal lymphocytes may play a role in the development of skin lesions and may account for the chronic course with periodic exacerbations in BD.

Overexpression of bcl-2 in lymphocytes of psoriatic skin.

Bcl-2 overexpression in lymphocytes play an important part in immunological and inflammatory diseases. In the present study, we investigated the bcl-2 expression in dermal lymphocytes of psoriatic skin biopsy samples. From the archives of the Department of Pathology, Ondokuz Mayis University Medical School (Samsun, Turkey), tissue sections belonging to 28 psoriasis cases and 10 chronic non-specific inflammatory skin disease cases were immunohistochemically stained by bcl-2. Positive staining was semiquantitatively graded from 1+ to 4+. Of the 28 psoriasis cases 20 were found to express bcl-2. Our data suggest that bcl-2-mediated inflammation plays a part in the pathogenesis and recurrent character of psoriasis.

Metastatic breast carcinoma mimicking periodontal disease on radiographs.

BACKGROUND: Tumors can metastasize to the jaws, oral soft tissues, or salivary glands. Metastasis from distant organs and tissues to the jaws or oral cavity is considered rare. RESULTS: The mandible is the most common site of metastasis of the oral and maxillofacial region. Radiographically, there is usually an area of radiolucency with hazy outline. Such lesions are manifested as radiopaque or sclerotic areas. CONCLUSIONS: Radiographic view of a tumor in the present case mimicked a periodontal lesion with an osteolytic area around the roots.

Neutrophilic dermatosis of the dorsal hands in a farmer.

Neutrophilic dermatosis of the dorsal hands is a recently described disorder, which is similar to Sweet's syndrome. It is characterized by erythematous plaques, pustules and haemorrhagic bullae located solely on the dorsal surface of the hands. We describe a 57-year-old man with neutrophilic dermatosis of the dorsal hands that occurred following exposure to a chemical fertilizer. There are few cases reported in the literature regarding neutrophilic dermatosis and the aetiology remains unclear. For the present case, we propose that neutrophilic dermatosis of the dorsal hands might have been induced by the chemical fertilizer.