Clinicopathological features of metaplastic breast carcinoma.

BACKGROUND: Metaplastic carcinoma of the breast (MpBC) is defined as a group of heterogeneous malignant neoplasms that contain glandular and non-glandular components with mixed epithelial and mesenchymal differentiations. OBJECTIVES: The aim of this study was to research the clinical and pathological characteristics of MpBC determining its rank among all breast cancers. MATERIAL AND METHODS: Metaplastic carcinoma of the breast was found in 7 out of 1,164 patients who had been diagnosed with breast cancer within the period of 12 years in our hospital. Demographic and clinical characteristics of the patients were retrieved from the patient files, and their final status was verified by a phone call. Diagnoses of the patients were confirmed by examining hematohylen and eosin (H&E) preparations. They were stained immunohistochemically for estrogen receptor (ER), progesterone receptor (PR), C-erbB-2, CK5/6 (Sitokeratin5/6), and EGFR (epidermal growth factor receptor), and the subgroups were determined according to the WHO classification. RESULTS: All patients were female with a median age of 61 years (41-87 years). Three of them were diagnosed with stage IIB, 2 with IIIB and 1 with IV. Four patients had squamous type of metaplastic cell differentiation, 1 spindle, 1 adenosquamous, and 1 osteosarcomatous. In 6 out of 7 patients, ER, PR and C-erbB-2 expressions were negative immunohistochemically. In the case of squamous metaplasia, estrogen receptor was 10% and progesterone receptor was 5% positive. CK5/6 was positive in 5 cases. Epidermal growth factor was positive in all cases. CONCLUSIONS: Metaplastic carcinoma of the breast is relatively rare and, in our series, its incidence was 0.6%. According to its immunohistochemical characteristics, MpBC can be interpreted as a subgroup of triplenegative breast cancers (TNBC). Five of the presented patients resembled the subgroup of TNBC with a basaloid phenotype. The chemotherapy regimens suggested in the treatment of MpBC are platin in the epithelial subgroup and high-dose anthracycline in the mesenchymal subgroup. There is a need of new studies that evaluate different choices of treatment as MpBC has a bad prognosis and an aggressive nature.

A rare coexistence of non-functional adrenocortical carcinoma and multicentric papillary thyroid microcarcinoma: a case report.

INTRODUCTION: In this report, we describe a rare case of papillary thyroid carcinoma with adrenocortical carcinoma without excess hormone production. CASE PRESENTATION: A 40-year-old Turkish man was admitted to our institution with a large left adrenal mass that was identified during the work-up for shortness of breath. The patient did not have specific signs and symptoms of hormone excess. The mass was removed surgically. The pathological findings were consistent with adrenocortical carcinoma. The patient was also found to have a multicentric papillary thyroid microcarcinoma. CONCLUSION: Most adrenocortical carcinomas and papillary thyroid carcinomas are sporadic; however, the occurrence of two different endocrine neoplasms during the same period of time is a rare situation, but it is possible, as in our patient. When an endocrine tumor is diagnosed, endocrinologists must be consider the possibility of the existence of another endocrine tumor.

A Rare Presentation of Xanthogranulomatous Cholecystitis as Bouveret's Syndrome.

The purpose of this paper is to present sonographic and CT imaging findings of xanthogranulomatous cholecystitis (XGC) presented as Bouveret's syndrome, a very rare cause of gastric obstruction. While the patient's physical examination, upper GI endoscopy, and radiological findings all pointed to Bouveret's syndrome, CT differential diagnosis suggested either XGC or gallbladder carcinoma, and the final diagnosis was done histopathologically. Our paper aims to increase awareness in radiologically diagnosing XGC cases by introducing the possibility of existence of Bouveret's syndrome.

Exogenous melatonin treatment reduces hepatocyte damage in rats with experimental acute pancreatitis.

BACKGROUND/PURPOSE: The hormone melatonin affects cellular immunity in particular and the immune system in general both directly and indirectly. We report our evaluation of the effects of decreasing and increasing serum melatonin levels on hepatocyte damage in rats with experimental acute pancreatitis. METHODS: Wistar Albino rats with experimentally induced acute pancreatitis were divided into three groups of ten rats each: (1) control (induced acute pancreatitis only); (2) rats with induced acute pancreatitis plus surgical pinealectomy (no melatonin injections); (3) rats with induced acute pancreatitis plus injections of exogenous melatonin. The effects of melatonin levels were evaluated using biochemical and histopathological parameters. RESULTS: Rats undergoing the pinealectomy had increased amylase and lactate dehydrogenase (LDH) levels, while those receiving injections of exogenous melatonin had decreased amylase, aspartate transaminase, LDH, and bilirubin levels but increased levels of alanine transferase levels. CONCLUSION: Melatonin may have a therapeutic or protective effect on acute pancreatitis and obstructive jaundice.

Oxidative stress and lipid peroxidation products: effect of pinealectomy or exogenous melatonin injections on biomarkers of tissue damage during acute pancreatitis.

BACKGROUND: Melatonin (N-acetyl-5-methoxytripta-mine) is a free radical scavenger and a strong antioxidant, secreted by the pineal gland. In this study, we evaluated the effects of decreasing and increasing serum melatonin levels on malonyldialdehyde (MDA), superoxide dismutase (SOD), and reduced glutathione (GSH) levels in pancreatic tissue from rats with experimental acute pancreatitis. METHODS: Experimental acute pancreatitis was induced in three groups of Wistar albino rats (10 animals per group) by pancreatic ductal ligation. The first group had only acute pancreatitis and served as the control. Surgical pinealectomy was added to acute pancreatitis in the second group, removing the source of endogenous melatonin (low melatonin levels group). The third group was given 0.1 ml daily intraperitoneal injections of 20 mg/ml melatonin solution for one week (high melatonin levels group). The effects of melatonin levels were evaluated by comparison of the levels of MDA, SOD, and GS in pancreatic tissue. RESULT: We found that intraperitoneal melatonin injections decreased the levels of MDA and increased the levels of SOD and GSH in pancreatic tissue. CONCLUSION: Exogenous melatonin has a preventive effect on lipid peroxidation and oxidative damage in acute pancreatitis.

Evaluation of the effects of melatonin administration intraperitoneally on rats with acute pancreatitis induced by ductal ligation.

BACKGROUND/AIMS: The aim of this study was to address the protective effects of exogenous melatonin injections intraperitoneally on the histopathological changes in a model of obstructive acute pancreatitis. METHODS: In this study, ductal ligation technique was used in 20 adult male Wistar Albino rats to develop a model of obstructive acute pancreatitis and beginning pancreatic atrophy. Melatonin 20 mg/kg solution was injected in one group of rats intraperitoneally for one week and results were compared with the control group regarding histopathological findings in the pancreatic tissue. RESULTS: The apoptosis rate in control group rats was 30.5%, while it was 12.7% in the melatonin group. Pancreatic edema, hemorrhage and polymorphonuclear leukocyte infiltration decreased remarkably in the melatonin group compared to the control group. CONCLUSIONS: Injection of exogenous melatonin in rats with obstructive acute pancreatitis for seven days prevents acinar cell degeneration, apoptosis and polymorphonuclear leukocyte infiltration.

Sexual dysfunction after curative radical resection of rectal cancer in men: the role of extended systematic lymph-node dissection.

BACKGROUND: This study was designed to determine the incidence and patterns of sexual dysfunction after curative radical resections (CRR) with or without extended systematic lymph-node dissection (ESLND) for rectal cancer Material/Methods: A total of 91 patients with rectal cancer were reviewed with respect to surgical procedures and postoperative sexual functions using the International Index of Erectile Function (IIEF), a 15-item self-administered questionnaire. CCR (abdomino-perineal resections or sphincter-saving anterior resections) was performed in 78 patients (Group I) and ESLND plus CRR in 13 patients (Group II), and sexual functions were also evaluated in the colostomy and non-colostomy subgroups. RESULTS: In the postoperative period, the five domains of IIEF scoring decreased significantly from the preoperative scores in both groups (p<0.05), but the postoperative decreases were not significant between groups I and II (p>0.05). Having a permanent colostomy decreases IIEF scores in all colostomized patients. CONCLUSIONS: CRR and CRR+ESLND both decrease sexual function and lymph-node dissection is not considered to have any additive effect on this decrease. In addition to standard surgery, anxiety about having a malignant disease and permanent colostomy may play an important role in male sexual dysfunction.

Local recurrence and survival rates after extended systematic lymph-node dissection for surgical treatment of rectal cancer.

BACKGROUND/AIMS: Extended systematic lymph-node dissection (ESLND) is a surgical procedure aimed at decreasing the local recurrence rate of rectal cancer and increasing the survival rate. However, it is criticized because it has not shown the expected effects on survival, and it has been shown to increase the proportion of complications in rectal cancer surgery. This study was designed to determine incidence and patterns of recurrence after curative resection with or without ESLND for rectal cancer. METHODOLOGY: A total of 184 patients with rectal cancer were reviewed with respect to surgical procedures, local recurrence and survival rates. RESULTS: 170 of 184 patients with rectal cancer were administered curative surgical resection. ESLND was added to the surgical procedure of 24 of these 170 patients. The local recurrence rate of the patients who did not receive lymph-node dissection was 15%, and the survival rate over 5 years was 58.9%. The local recurrence rate of the patients receiving ESLND was 12.5%, and the survival rate over 5 years was found to be 55.7% (p>0.05). CONCLUSIONS: Because ESLND is a procedure added on to curative resection in the surgical treatment of rectal cancer, it increases the general anesthesia and length of surgery, and it is possible that some complications due to the operation itself may arise. In the current study and in a large amount of research in the literature, a statistically significant effect on the survival rate has not been found. In conclusion, the opinion has been reached that ESLND does not have an important benefit in the curative surgical treatment of rectal cancer.

Prognostic value of serum IL-18 and nitric oxide activity in breast cancer patients at operable stage.

Interleukin-18 (IL-18) is a multifunctional cytokine that was previously termed interferon-gamma-inducing factor. It has been suggested that serum IL-18 level may be used as a prognostic factor in some cancer types. Nitric oxide is a potent biologic molecule involved in the pathogenesis of cancer. In this study, we measured serum IL-18 and nitrate + nitrite levels in 56 patients with nonmetastatic breast cancer and 14 control subjects. Serum IL-18* and nitrate + nitrite** levels were significantly higher in patients with breast cancer when compared to the control subjects (*p < 0.05, **p < 0.001). Serum IL-18 levels were significantly higher in patients whose tumor size was greater than or equal to 5 cm when compared to patients whose tumor size was less than or equal to 2 cm (p < 0.05). Patients who were axillary lymph node negative (ALN) had lower serum IL-18 levels when compared to patients with positive ALN (p < 0.001). Serum IL-18 levels were significantly higher in patients with stage IIB or IIIA when compared to patients with stage I or IIA (p < 0.05). There was no significant difference in serum nitrate + nitrite levels in terms of age, tumor stage, estrogen receptor, and menopausal and ALN status (p > 0.05). In conclusion, serum IL-18 level may be a useful marker to predict prognosis of patients with breast cancer in complete remission after surgery. Long-term follow-up is required to clarify this hypothesis.

Clinical importance of serum interleukin-18 and nitric oxide activities in breast carcinoma patients.

BACKGROUND: Interleukin-18 (IL-18) is a novel immunoregulatory cytokine that was known previously as interferon-gamma-inducing factor. IL-18 levels can be used as a serum indicator for monitoring the clinical course of patients with hematologic malignancies and gastric carcinoma. Nitric oxide (NO) is a pleiotropic molecule that participates in the multistep processing of carcinogenesis. METHODS: In the current study, we measured serum IL-18 and nitrate and nitrite levels in 38 metastatic and 26 nonmetastatic breast carcinoma patients and 16 healthy control subjects. Serum nitrate and nitrite levels were measured as an index of NO generation. RESULTS: The levels of serum IL-18 and nitrate and nitrite were increased significantly in breast carcinoma patients compared with control subjects (P < 0.001). Serum IL-18 levels were significantly higher in the metastatic patients compared with the nonmetastatic patients (P < 0.001). There was no difference in serum nitrate and nitrite levels between metastatic and nonmetastatic patients (P > 0.05). Patients with bone metastasis have higher serum IL-18 levels and lower serum nitrate and nitrite levels compared with patients with liver, lung, and local metastasis (P < 0.001). There was no correlation among serum IL-18, nitrate and nitrite, CA 15-3, and carcinoembryonic antigen levels (P > 0.05). CONCLUSIONS: These findings suggest that serum IL-18 and nitrate and nitrite levels may be useful markers in monitoring metastatic breast carcinoma patients. IL-18 and NO activities in breast carcinoma patients with bone metastasis may be more valuable in the follow-up of these patients.