Detection of HPV DNA in Esophageal Lesions: a Cross-Sectional Study.

BACKGROUND: Several studies have documented human papillomavirus (HPV) in extra-cervical tumors. We aimed to detect HPV type 16 and HPV other than type 16 (OT-16) DNA in esophageal papilloma and esophagus squamous cell carcinoma (ESCC) samples and to compare clinicopathological features of HPV positive and negative patients. METHODS: Materials were obtained from a tertiary care public hospital and studied in an university hospital for this cross-sectional study. Seventy-six tissue samples (50 papilloma and 26 ESCC) were included. After deparaffinization by xylene and DNA extraction by phenol chloroform-isoamyl-alcohol, 76 samples were studied with a G6PDH control kit. Forty-four papilloma and 21 ESCC samples with enough tissues were studied for HPV DNA. HPV OT-16 DNA and HPV type 16 were detected by real time-polymerase chain reaction. RESULTS: Twelve (27.3%) and one (2.3%) of the papilloma samples were HPV type 16 and other than type 16 positive, respectively. Eleven (52.4%) and one (4.8%) of ESCC samples were HPV type 16 and mixed type positive, respectively. CONCLUSIONS: We suggest that HPV infection is common in esophageal papilloma and ESCC. Due to the wellknown association of HPV with premalignant and malignant conditions, follow-up of these patients accompanied by HPV should be implemented.

Primary Large-Cell Undifferentiated Carcinoma of the Ureter.

OBJECTIVE: To report the first case in the literature of a primary large-cell undifferentiated carcinoma (LCUC) of the ureter with a very aggressive behavior and dismal prognosis. CLINICAL PRESENTATION AND INTERVENTION: A 60-year-old woman with a history of intermittent macroscopic hematuria and mild to moderate right flank pain was admitted to the Department of Urology. Tissue biopsies and cytological samples were taken. Pathologic examination was consistent with LCUC. CONCLUSION: LCUC of the ureter is an aggressive tumor with a high proliferation index. Patients might be diagnosed at an advanced stage. LCUC must be considered in the differential diagnosis of urinary tract pathologies.

Surgical and histopathological effects of topical Ankaferd® hemostat on major arterial vessel injury related to elevated intra-arterial blood pressure.

OBJECTIVE: The aim of this study was to assess the surgical and histopathological hemostatic effects of topical Ankaferd blood stopper (ABS) on major arterial vessel injury related to elevated intra-arterial blood pressure in an experimental rabbit model. METHODS: The study included 14 New Zealand rabbits. ABS was used to treat femoral artery puncture on 1 side in each animal and the other untreated side served as the control. Likewise, for abdominal aortic puncture, only 50% of the aortic injuries received topical liquid ABS and the others did not (control). The experiment was performed under conditions of normal arterial blood pressure and was repeated with a 50% increase in blood pressure. Histopathological analysis was performed in all of the studied animals. RESULTS: Mean bleeding time in the control femoral arteries was 105.0±18.3 s, versus 51.4±9.8 s (p<0.05) in those treated with ABS. Mean blood loss from the punctured control femoral arteries was 5.0±1.5 mg and 1.6±0.4 mg from those treated with ABS (p<0.05). Histopathological examination of the damaged arterial structures showed that ABS induced red blood cell aggregates. CONCLUSION: ABS administered to experimental major arterial vessel injury reduced both bleeding time and blood loss under conditions of normal and elevated intra-arterial blood pressure. ABS-induced erythroid aggregation was prominent at the vascular tissue level. These findings will inform the design of future experimental and clinical studies on the anti-bleeding and vascular repairing effects of the novel hemostatic agent ABS.

Bile reflux index after therapeutic biliary procedures.

BACKGROUND: Therapeutic biliary procedures disrupt the function of the sphincter of Oddi. Patients are potential "bile refluxers". The aim of this study was to assess how these procedures affect the histology-based bile reflux index (BRI), which can be used to reflect duodenogastric reflux (DGR). METHODS: Gastric antrum and corpus biopsies were collected from 131 subjects (56 men, 75 women; mean age, 55.9 +/- 15.6 years). Group 1 (Biliary group-BG; n = 66) had undergone endoscopic sphincterotomy, endoscopic stenting, or choledochoduodenostomy for benign pathology; Group 2 (n = 20) had undergone cholecystectomy alone; and Group 3 (n = 6) Billroth II gastroenterostomy. Group 4 (no cholecystectomy; n = 39) had upper endoscopy with normal findings and served as controls. BRI > 14 indicated DGR (BRI [+]). To eliminate confounding effects of Helicobacter pylori (Hp) infection, comparisons were made according to Hp colonization. RESULTS: Fifty-nine subjects (45%) were Hp (+). The frequencies of BRI (+) status in antrum and corpus specimens from Hp (-) BG patients were 74.3% and 71.4%, respectively (85.7% for both antrum and corpus for choledochoduodenostomy). Corresponding results were 60% and 60% for Group 2, 100% (only corpus) for Group 3, and 57.1% and 38.1% for controls (BG, Group 2, and Group 3 vs controls - p > 0.05 antrum, p < 0.05 corpus). Fifty-four BG patients had previously undergone cholecystectomy. Excluding those, the rates of BRI (+) in Hp (-) BG patients were 75% antrum and 62.5% corpus (p > 0.05 for both vs. Group 2). CONCLUSION: Patients who had undergone biliary procedures showed similar bile-related histological changes in both corpus and antrum biopsies, but the changes seen in controls were more prominent in the antrum than corpus. Therapeutic biliary procedures increase the rate of BRI (+) especially in the case of choledochoduodenostomy. Therapeutic biliary procedures without cholecystectomy also increase the rate of BRI (+) similar to that observed in patients with cholecystectomy.

Does the New Proposal for Prostate Cancer Grading Correlate With CAPRA Score?

PURPOSE: To determine if there is a correlation between the newly proposed Gleason grading system by the International Society of Urological Pathology and the Cancer of the Prostate Risk Assessment (CAPRA) score. MATERIAL AND METHODS: The records of all patients that underwent radical prostatectomy at our hospital between 2007 and 2013 were retrospectively reviewed. The study parameters included patient demographics, the percentage of pre-operative prostate biopsies positive for PCa, biopsy Gleason Score (GS), and pre- and post-operative PSA values. RESULT: The study included 146 patients with complete medical records and follow-up data. Mean age of the patientswas 66.6 ± 6.08 years. According to the newly proposed Gleason grading system, 97 (66.4%) patients were grade 1, 20 (13.7%) were grade 2, 8 (5.5%) were grade 3, 11 (7.5%) were grade 4, and 10 (6.8%) were grade 5. The distribution of CAPRA scores was as follows: 1: n = 43 (29.5%); 2: n = 53 (36.3%); 3: n = 22 (15.1%); 4: n = 14 (9.6%); 5: n = 8 (5.5%); 6: n = 4 (2.7%); 7: n = 1 (0.7%); 8: n = 1 (0.7%). Correlation analysis showed that theCAPRA score was significantly correlated with GS based on the newly proposed Gleason grading system (CorrelationCoefficient=0.361, P < 0.001). CONCLUSION: As a strong correlation was noted between these 2 independent grading systems, we think clinicians that seek to predict the prognosis in PCa patients should take into consideration both the newly proposed ISUP grading system and the CAPRA score.

The role of the PLR-NLR combination in the prediction of the presence of Helicobacter pylori and its associated complications.

BACKGROUND/AIM: The aim of this study was to investigate the role of the platelet-to-lymphocyte ratio (PLR)-neutrophil-to-lymphocyte ratio (NLR) combination, in the prediction of the presence of Helicobacter pylori (HP) and its associated complications in the gastrointestinal system. PATIENTS AND METHODS: In all, 1289 patients who underwent esophagogastroduodenoscopy and biopsy for HP were included in the study. RESULTS: The ratio of patients with moderate and severe chronic gastritis was higher in HP (+) group than HP (-) group. The ratio of patients with levels 1-3 atrophy and intestinal metaplasia was higher in HP (+) group. Compared with HP (-) group, HP (+) had higher PLR and NLR levels. The ratio of HP (+) patients was higher in high-risk group compared with low- and medium-risk groups. HP invasion stage, the intestinal metaplasia level, and the ratio of patients with atrophy level "3" were higher in high-risk group compared with low- and medium-risk groups. Regression analysis showed that the PLR-NLR combination was an independent risk factor for both HP presence and moderate and severe chronic gastritis. CONCLUSION: We found the PLR-NLR combination to be a good predictor of HP presence and gastrointestinal complications associated with HP.

Relationship between immunohistochemical staining extent of CD47 and histopathologic features of bladder tumor.

INTRODUCTION: It has been shown that CD47 is an important diagnostic and prognostic marker in many cancer types. However, the relationship between CD47 and bladder tumor stage has not been shown in previous studies. To the best of our knowledge, this is the first study investigating the association of CD47 with stages of bladder cancer. MATERIAL AND METHODS: Surgical specimens of 175 patients were included in the study. The CD47 staining assessment was performed in the following categories; none, focal, moderate and diffuse. The statistics of the study were tested using t-test and analysis of variance. RESULTS: We demonstrated much less CD47 staining extent in Ta tumor pathology compared to T1 and T1+T2+T3+T4 tumor pathology (p = 0.034 and p = 0.016, respectively). We also showed that the average value of CD47 staining extent with CIS+ was significantly higher compared to CIS- among NMIBC (p = 0.0248). However, no significant differences in CD47 staining pattern were observed in the following study groups: high vs. low-grade tumors in non-muscle invasive bladder cancer (NMIBC); MIBC (T2-T4) vs. NMIBC; lymph node involvement (N1-N3) vs. non-lymph node involvement (N0) in MIBC (T2-T4). CONCLUSIONS: Our study demonstrated that CD47 might have a critical role in the progression of Ta to T1 stage. Furthermore, we showed that CD47 is highly expressed in CIS+ NMIBC compared to CIS- NMIBC. Thus, differentiating stages with the help of this new potential marker may help clinicians treat bladder tumors better. Future studies to determine the role of CD47 on pathophysiology, diagnosis and prognosis of bladder tumor are warranted.

Solitary plasmacytoma of the cecum and the ascending colon: surgical resection as a treatment modality.

Colonic solitary plasmacytoma is a rare disease, with few reports occurring in the literature. Solitary plasmacytoma is defined as a plasma cell tumour with no evidence of bone marrow infiltration. Plasmacytoma can present as a solitary tumour in bone or in other parts of the body. The gastrointestinal tract is rarely the site of the disease. We report on the case of a 51-year-old man presenting with a colonic symptomatic mass with unclear biopsy results. A resected specimen showed a solitary plasmacytoma. Surgical resection was an adequate treatment modality in this case. Endoscopic resection, radiotherapy, and chemotherapy are also preferred treatments in selected gastrointestinal plasmacytoma cases.

Effect of intraoperative PEEP application on colonic anastomoses healing: An experimental animal study.

PURPOSE: This study aimed to assess the effect of intraoperative PEEP intervention on the healing of colonic anastomoses in rabbits. MATERIALS AND METHODS: Thirty-two New Zealand type male rabbits were divided into two groups of sixteen animals each. Following ventilation with tracheostomy, colonic resection and anastomosis were performed in both groups. While 10 cm H2O PEEP level was applied in Group I (PEEP), Group II (ZEEP) was ventilated without PEEP throughout the surgery. Half of the both PEEP and ZEEP group animals were killed on the third postoperative day, while the remaining half on the seventh. Anastomotic bursting pressures, the tissue concentrations in hydroxyproline, and histological assessments were performed. Besides, intraoperative oxygen saturation and postoperative arterial blood gas parameters were also compared. RESULTS: On the first postoperative day, both arterial oxygen tension (PO2) and oxygen saturation (SO2) in the PEEP group were significantly higher than in the ZEEP group. On the seventh postoperative day, the bursting pressures of the anastomoses were significantly higher in the PEEP group, however the hydroxyproline content was significantly lower in the PEEP group than that in the ZEEP group. At day 7, PEEP group was significantly associated with increased neoangiogenesis compared with the ZEEP group. CONCLUSION: The anastomotic healing process is positively influenced by the intraoperative PEEP application.

Preoperative local staging of rectal cancer with endorectal MR imaging: comparison with histopathologic findings.

The purpose of this prospective study was to assess the accuracy of endorectal MR imaging in the preoperative local staging of rectal cancers. In 20 cases, we correlated endorectal MR imaging findings with postoperative histopathologic staging according to TNM classification. The accuracy of endorectal MR for determining the T stage of rectal cancer was 85%. The sensitivity and specificity for detecting lymph node metastases were 90.9% and 55.5%, respectively.

The effect of recombinant growth hormone on intestinal anastomotic wound healing in rats with obstructive jaundice.

BACKGROUND/AIMS: Several clinical and experimental studies have shown that obstructive jaundice delays wound healing. Growth hormone may prevent delayed wound healing, since it has effects on the release of mediators in jaundice, as well as increasing the protein synthesis. METHODS: Forty male Wistar rats were allocated to four groups: Group I (n=10): intestinal anastomosis to normal small bowel, Group II (n=10): intestinal anastomosis to normal small bowel followed by growth hormone therapy (2mg/kg/day, subcutaneously), Group III (n=10): intestinal anastomosis to obstructive jaundice rat's small bowel, Group IV (n=10): intestinal anastomosis to obstructive jaundice rat's small bowel followed by growth hormone therapy at the same dosage The animals were observed for seven days then killed. Intraabdominal adhesions, anastomotic complications and anastomotic bursting pressures were recorded and tissue samples from the anastomotic site were obtained to measure hydroxyproline levels and for histopathologic examination. RESULTS: Growth hormone had a beneficial effect on the healing of intestinal anastomosis in both jaundiced and non-jaundiced rats. This was demonstrated by clinical and mechanical parameters such as a significant increase in anastomotic bursting pressure, hydroxyproline content and histopathological scores. CONCLUSION: Growth hormone reverses the adverse effects of obstructive jaundice on small bowel anastomotic healing. It can be hypothesized that this effect is due to augmentation of insulin-like growth factors, protection of hepatocytes, enhancement of intestinal epithelization, and reversal of the resultant malnutritional state caused by growth hormone in obstructive jaundice.

Polyarteritis nodosa presenting with necrotising appendicitis and hepatic aneurysm rupture.

Polyarteritis nodosa is a necrotizing vasculitis which affects small and medium-sized arteries. The clinical features of the disease vary according to the site and extent of involvement. Aneurysmal dilatation and thrombosis in the arteries of the liver and gastrointestinal tract have been reported in polyarteritis nodosa. However, rupture of the hepatic aneurysm and necrotizing appendicitis due to polyarteritis nodosa are uncommon; indeed a case in which these have occurred together has not been reported to date. In this case report, a patient with necrotizing appendicitis and hepatic aneurysm rupture due to underlying poliarteritis nodasa is presented. Extensive intraabdominal hematoma and appendicitis were treated surgically and complete recovery was achieved.

Accuracy of endoscopic ultrasonography in upper gastrointestinal submucosal lesions.

BACKGROUND/AIMS: The aim of this study was to evaluate the accuracy of endoscopic ultrasonography (EUS) and consistency of the EUS findings with histopathologic examination. METHODS: EUS was performed in 90 patients with upper gastrointestinal tract submucosal tumors, followed in Turkiye Yuksek Ihtisas Hospital, Gastroenterology Clinic. Histopathological diagnosis and EUS findings of 25 of 90 patients were compared. RESULTS: 48.9% of the lesions were found to have arisen from muscularis propria, 33.3% from submucosa, 6.6% from mucosa and 10% from muscularis mucosae, and 1.2% from serosa of the 90 patients. In 25 patients histopathologic confirmation was done. 24% of 25 patients were leiomyoma, 20% polyp, 12% lipoma and the remainder were teratoma, carcinoid tumor, adenocarcinoma, polyp and leiomyosarcoma. EUS was successful in detecting all tumors. EUS diagnosis was consistent with histopathogical diagnosis in all patients with EUS findings as leiomyosarcoma (n=2) and polyp (n=6), in 46.2% of patients with EUS findings as leiomyoma, and in 50% of those with lipoma. CONCLUSIONS: EUS is an accurate means of evaluating and diagnosing submuocal lesions of the gastrointestinal tract.

Multiple synchronous anorectal malignant melanoma coexisting with adenocarcinoma of the sigmoid colon.

Primary anorectal malignant melanoma is an exceptionally rare neoplasm associated with poor prognosis. Anorectal malignant melanoma has been very rarely described with coexisting primary tumors of the colorectum. A 56-year-old female patient was admitted with a history of rectal bleeding. She had experienced increasing constipation and a sense of obstruction in the rectum for 6 months. Flexible rectosigmoidoscopy showed a large, pedinculated polypoid lesion extending from the anal canal to the rectum. She underwent a transanal local excision and was diagnosed with a melanoma of the anorectum with positive margins. Therefore, a formal abdominoperineal resection was performed. In addition to multiple synchronous anorectal malignant melanoma, we incidentally found another primary tumor in the proximal surgical margin of the resected specimen. Histopathologically, the lesion was an intramucosal adenocarcinoma of the sigmoid colon. Postoperatively, the patient received adjuvant chemotherapy of six cycles duration. At present, the patient has completed 18 months of follow-up.

Accuracy of endoscopic ultrasound-guided fine needle aspiration cytology on the differentiation of malignant and benign pancreatic cystic lesions: a single-center experience.

OBJECTIVES: The aim was to compare the use of endoscopic ultrasound-guided fine needle aspiration (EUS-FNA) in cytology and the biochemical analysis of cyst fluid, together with the size of the lesion in the differentiation between benign and malignant pancreatic cystic lesions. METHODS: Data of patients who underwent EUS-FNA for pancreatic cystic lesions in our center from January 2006 to October 2010 were retrospectively analyzed. The diagnostic accuracy of EUS-FNA was determined. RESULTS: Of the 56 patients, 37 (66.1%) had evaluable cytology for diagnosis and sufficient cyst fluid was available for biochemical analysis in 58.9% (33/56) of the patients. The sensitivity, specificity, positive predictive value and negative predictive value of EUS-FNA for detecting malignancy were 63%, 100%, 100% and 85%, respectively. EUS-FNA was the most accurate diagnostic method for differentiating malignant and benign pancreatic cystic lesions (88%). Cyst fluid carcinoembryonic antigen (CEA) > 365 ng/mL had a sensitivity of 100% for the detection of malignant cystic lesions. CONCLUSIONS: Although the rate of insufficient cyst fluid aspiration is high, the combination of cytological evaluation and CEA analysis of cyst fluid obtained by EUS-FNA is accurate in differentiating malignant cystic lesions from benign ones. Safe techniques are essential to improve the yield of cyst fluid aspiration by EUS.

Unusual cholangiographic findings in a patient with primary sclerosing cholangitis: cystic dilatation.

A 45-year-old woman with the diagnosis of primary sclerosing cholangitis and ulcerative colitis admitted with the complaints of pruritus and jaundice. Endoscopic retrograde cholangiography revealed entirely narrow, irregular common bile duct and common hepatic duct and unusual cystic dilations in the common hepatic duct and left hepatic duct. Balloon dilation of the common bile duct was performed, and a 10 F double pigtail stent was inserted into the cyst. Three months after the endoscopic retrograde cholangiography, cystic dilatations had completely resolved. Primary sclerosing cholangitis may present with cystic dilatations upto a level that it may resemble Caroli disease.

Endoscopic ultrasonography-guided fine-needle aspiration for diagnosing upper gastrointestinal submucosal lesions: a prospective study of 50 cases.

The objective was to assess EUS-FNA for diagnosing intramural upper GI tract lesions. The subjects were 50 patients (21M/29F) with upper GI submucosal lesions who underwent EUS-FNA at a referral center for GI system over a 12-month period. All cases were followed for 1 year after initial EUS-FNA. Cytologic diagnoses were categorized as benign, malignant, suspicious for malignancy, mesenchymal tumor, endocrine tumor, or nondiagnostic. All tumors were assessed for various cytomorphologic features. The accuracy of the initial FNA diagnoses was evaluated for each patient who also underwent subsequent histopathological examination of a core biopsy and/or surgical biopsy/resection material of the same lesion. According to the site of the lesions; while 84% of all esophageal lesions were diagnosed as mesenchymal; 67% of all gastric lesions were mesenchymal. The sole lesion was nonmesenchymal (benign cyst) in duodenum. The sensitivity, specificity, positive and negative predictive values, and accuracy of EUS-FNA for diagnosing submucosal mesenchymal tumors of the upper GI tract were 82.9, 73.3, 87.9, 64.7, and 80%, respectively. The corresponding values for nonmesenchymal lesions were 100, 85.7, 80, 100, and 90.9%. Our experience confirms that EUS-FNA is an extremely valuable tool for diagnosing submucosal lesions of the upper GI, and is particularly useful in cases where endoscopic forceps biopsy does not lead to diagnosis. Optimal results can be yielded by a close working relationship between the gastroenterologist and pathologist.

Bronchogenic cyst of interatrial septum.

Bronchogenic cyst, also known as inclusion cyst, is a type of congenital endodermal heterotropia derived from an abnormal development of the ventral diverticulum of the foregut or the tracheobronchial tree during embryogenesis. Its interatrial localization is extremely rare and making a final diagnosis without surgery challenges the clinician. Herein, we report a 58-year-old male patient who had an interatrial bronchogenic cyst related to transient ischemic attack.