Molecular subtypes of invasive breast cancer: correlation between PET/computed tomography and MRI findings.

OBJECTIVE: The aim of the study was to investigate the diagnostic value of fluorodeoxyglucose-18 (FDG)-PET/computed tomography (CT) and MRI parameters in determining the molecular subtypes of invasive breast cancer. METHODS: Data from 55 primary invasive breast cancer masses in 51 female patients who underwent pre-treatment PET/CT and MRI scans, and histopathological diagnosis at the authors' center were retrospectively reviewed. The relationship between FDG-PET/CT and MRI parameters, including maximum and mean standard uptake values (SUVmax and SUVmean, respectively), mean metabolic index (MImean) and metabolic tumor volume (MTV) values obtained from FDG-PET, and shape, margin, internal contrast-enhancement characteristics, kinetic curve types, functional tumor volume (FTV), apparent diffusion coefficient (ADC) values obtained from MRI was evaluated. Subsequently, differences among molecular subtypes (i.e. luminal A, luminal B, c-erbB-2 positive, and triple-negative) in terms of PET/CT and MRI parameters were evaluated. RESULTS: The luminal B subtype of invasive breast cancer had higher SUVmax and SUVmean (P = 0.002 and P = 0.017, respectively) values than the luminal A subtype. In addition, the triple-negative subtype had a higher SUVmax (P = 0.028) than the luminal A subtype. There was a statistically significant positive correlation between pathological tumor volume (PTV) and SUVmean (P = 0.019, r = 0.720). SUVmax and ADC were negatively correlated (P = 0.001; r = -0.384). A very strong positive correlation was detected between MTV and FTV (P = 0.000; r = 0.857), and between MTV and PTV (P = 0.006, r = 0.796), and between FTV and PTV (P = 0.006, r = 0.921). CONCLUSION: Results of the present study suggest that SUVmax was superior to MRI findings in predicting molecular subtypes and that MRI was superior to PET/CT in predicting PTV.

Schwannoma Localized Retroperitoneally in a 14-Year-Old Boy.

Schwannomas usually occur in adults being between the second and fifth decades, and such neoplasms are extremely rare in a pediatric population. In addition, they are not normally found in the retroperitoneal region. Here, we present a pediatric case of a retroperitoneal schwannoma in an adrenal location where the tumor was not able to be preoperatively differentiated from other benign or malign adrenal gland tumors. In our opinion, this tumor can be included in the differential diagnosis of a nonfunctioning retroperitoneal adrenal mass in children.

Rectus abdominis muscle endometriosis.

Endometriosis is characterized by an abnormal existence of functional endometrial tissue outside the uterine cavity, typically occuring within the pelvis of women in reproductive age. We report two cases with endometriosis of the abdominal wall; the first one in the rectus abdominis muscle and the second one in the surgical scar of previous caesarean incision along with the rectus abdominis muscle. Pre-operative evaluation included magnetic resonance imaging. The masses were dissected free from the surrounding tissue and excised with clear margins. Diagnosis of the excised lesions were verified by histopathology.

Human papilloma virus frequency and genotype distribution in a Turkish population.

OBJECTIVES: To determine human papillomavirus (HPV) frequency, genotypes and the relation between cervical smear results, risk factors and types in women living in Manisa, Turkey. MATERIALS AND METHODS: A total of 410 women were included in the study. Cervical specimens were obtained for linear array HPV genotyping and pathological testing. Conventional Pap test and Bethesda system were used for evaluation of cytology specimens. RESULTS: A total of 410 women with a mean age of 34.9 years were tested. A positive result of any HPV was found in 35 patients (8.5%). Among them, 26 different serotypes of HPV were identified and the most frequent type was HPV 16 (28.5%) followed by type 45 and 53 (11.4%). Patients were infected by 65.7% high risk, 11.4% probable high risk and 22.9% low risk HPV types. Multiple HPV positive results were found in 13 patients (37.1%). Patients with single partner, history of abnormal smear or condyloma had positive HPV results and this was statistically significant (p<0.05). Correlation analysis showed a statistically weak relation between positive HPV and abnormal smear results (r=0.120). CONCLUSIONS: Determining HPV types of genital HPV infections is important for epidemiological studies. We have found the rate of positive HPV as 8.5% which implies the need for extended screening programs in order to diagnose oncogenic HPV at an early stage.

Adnexal torsion with dystrophic calcifications in an adolescent: a chronic entity?

Intermittent pelvic pain caused by ovarian cysts in adolescence may be due to torsion or partial torsion of the ovary. We present a case of 18-year old adolescent with symptomatic left ovarian torsion with calcifications demonstrated by pelvic MRI and ultrasonography prior to surgery. The pathologic investigation demonstrated dystrophic calcifications. We speculated that the pattern of the intermittent pain in the story of the patient and the dystrophic calcifications in pathologic investigation which is thought that it might have been potentially developed as a result of chronic hypoxia due to intermittent partial torsions over a period of two years.

Coexistence of psoriasis and bullous pemphigoid: remission with low-dose methotrexate.

The coexistence of psoriasis vulgaris and bullous pemphigoid is rare. Here, we report a 90-year-old patient with a 20-year history of psoriasis. She developed vesicles and bullae suddenly and was diagnosed as bullous pemphigoid. Low-dose methotrexate therapy quickly cleared both psoriatic and bullous lesions.

Leptin expression in proliferative, secretory and hyperplastic endometrial tissues.

OBJECTIVE: The goal of this study was to detect endometrial leptin expression in proliferative and secretory phases and then to compare the results with that of hyperplastic endometrium. MATERIAL AND METHODS: Seventeen proliferative, 23 secretory phase and 18 hyperplastic endometrial tissues diagnosed in our hospital between 2002 and 2007 were included in the study. These samples were stained with leptin antibody using an immunohistochemical method. Endometrial glandular and surface epithelium and stroma were evaluated for staining distribution and intensity. CONCLUSION: Staining intensity seen in early proliferative phase samples (2.33±0.51) increased significantly throughout the middle (2.40±0.54) and late phases (2.83±0.40) (p<0.05). Early secretory phase samples had the least staining intensity (1.42±0.53), while it increased significantly in later periods (2.38±0.51) (p<0.05). There was no difference in staining intensity among proliferative, secretory and hyperplastic tissues (p>0.05). CONCLUSION: Although endometrial leptin expression was observed in a differential manner throughout the whole menstrual period, no difference was seen in endometrial hyperplasia. We consider that leptin does not play a role in hyperplastic transformation of the endometrium.

A patient with Bartter syndrome accompanying severe growth hormone deficiency and focal segmental glomerulosclerosis.

Bartter syndrome is a rare autosomal recessive, salt-losing disorder characterized by hypokalemic hypochloremic metabolic alkalosis. A 10-year-old boy had severe growth retardation (height standard deviation score -8.15). He had a thin, triangular face, prominent ears and forehead, and big eyes. Megacystis, bilateral hydroureteronephrosis, and residual urine were detected in ultrasonography, but there was no vesicoureteral reflux. Lumbosacral magnetic resonance (MR) showed posterior disc bulging at L4-5. Serum sodium and chloride levels were normal, but mild hypokalemia was overlooked initially. During follow-up, hypokalemic hypochloremic metabolic alkalosis developed, with high urinary chloride and potassium excretion (52 and 43 mEq/L, respectively). The patient, with renal salt loss, was thought to have classic Bartter syndrome due to absence of nephrocalcinosis, presence of persistent hypercalciuria and sensorineural deafness, and presence of relatively mild clinical and laboratory findings, except polyuria initially. The child was treated with indomethacin, spironolactone, and oral potassium in addition to growth hormone (GH). During treatment, he had considerable increase in weight and height compared with the period of GH therapy only. We present this case because, although growth retardation is a major feature of Bartter syndrome, associated GH deficiency is rarely reported in the literature. Diagnosis of Bartter syndrome was made later, as our patient was followed for megacystis and megaureter secondary to the neurogenic bladder and GH deficiency initially; and proteinuria associated with focal segmental glomerulosclerosis responded to treatment for Bartter syndrome.

Nested variant of transitional cell carcinoma with osseous metaplasia of the urinary bladder: a case report and review of published reports.

Nested variant of transitional cell carcinoma (NV-TCC) of the bladder is a rare and relatively new entity. The tumor is aggressive contrasted by its benign histopathologic appearance, and characterized by irregular urothelial nests and/or tubules. Herewith, a case with exceptional osseous metaplasia is presented emphasizing its diagnostic difficulties, because it can be confused with benign diseases or conventional TCC.

Hormone receptor expressions and proliferation markers in postmenopausal endometrial polyps.

BACKGROUND/AIMS: Endometrial polyps are quite common in the general population, they have a significant role in postmenopausal bleeding, and the pathogenesis is unclear. The aim of this study was to investigate proliferation markers and expression of estrogen and progesterone receptors in endometrial polyps in postmenopausal women. METHODS: Endometrial polyps were removed by hysteroscopy from 36 women who presented with postmenopausal bleeding. None were using hormonal therapy. The control group consisted of 16 inactive-atrophic postmenopausal endometrial specimens removed at hysterectomy. Immunohistochemistry was used to demonstrate expression of estrogen and progesterone receptors and the cell growth and apoptosis markers, Ki67, bcl-2, c-erbB-2. RESULTS: In both the glandular epithelium and stroma of endometrial polyps, estrogen and progesterone receptors, Ki67 and bcl-2 showed significantly more positive staining than the inactive endometrium from the control group. There was no difference in expression of c-erbB-2 between the two groups. CONCLUSIONS: Estrogen may have a role in the development of postmenopausal endometrial polyps, either by direct stimulation of localized proliferation or by stimulation of proliferation via other pathways, such as activation of Ki67 or through inhibition of apoptosis via bcl-2. c- erbB-2 is unlikely to play any role in development of these lesions.

A case of endometrial stromal sarcoma with curvilinear calcification.

BACKGROUND: Although many histopathological, clinical, and imaging findings of ESS have been described, intense calcifications have not been reported previously. CASE: A 54-year-old female was admitted with vaginal bleeding and abdominal pain. Gynecologic examination revealed a huge, firm pelvic mass extending up to the epigastrium. Transabdominal ultrasonography and computed tomography demonstrated a well-demarcated uterine mass containing heterogeneous solid and cystic areas and a centric curvilinear calcification. Histopathological diagnosis was established as undifferentiated high-grade endometrial stromal sarcoma. CONCLUSION: Endometrial stromal sarcomas should be considered in the differential diagnosis of uterine masses containing curvilinear calcifications.

Col IV and Fn distribution in prostatic adenocarcinoma and correlation of 67LR, MMP-9 and TIMP-1 expression with Gleason score.

OBJECTIVE: To assess the immunoreactivity of 5 proteins related to basement membrane (BM) and extracellular matrix in order to investigate whether any of them correlates with differentiation of prostatic adenocarcinoma (PAc). Two of these markers are collagen type IV (Col IV), the collagenous component of basement membrane, and fibronectin (Fn), an adhesion protein in extracellular matrix. Others are matrix metalloproteinase-9 (MMP-9), a type IV collagenase, tissue inhibitor of matrix metalloproteinase-1 (TIMP-1), which has a high affinity for MMP-9, and 67-kd laminin receptor (67LR), which belongs to the non-integrin laminin binding receptor family. STUDY DESIGN: Forty-three PAc cases with Gleason scores ranging between 5 and 10 and 10 benign prostatic hyperplasia (BPH) cases, the control group, were included in the study. Formalin-fixed and paraffin-embedded tissue slides from each case were immunostained with the avidin-biotin-peroxidase method. Immunoreactivity was determined by means of a scoring system similar to the Gleason scoring system. RESULTS: Overexpression of Col IV, Fn, 67LR and MMP-9 was detected in PAc as compared with BPH, whereas no difference was determined in TIMP-1 expression. Among these, only 67LR correlated statistically with Gleason score. CONCLUSION: Expression of 67LR in tumor cells was significantly increased in parallel to tumor grade. This may be useful in microscopic evaluation of PAc.

Features of chronic inflammation at the gastric cardia and the relationship with Helicobacter pylori infection and oesophagitis.

BACKGROUND: The etiopathogenesis of chronic inflammation at the gastric cardia is still debated. It is suggested that carditis may be a finding of gastro-oesophageal reflux disease (GORD) or it may occur as a result of the gastritis caused by Helicobacter pylori (H. pylori) infection. AIM: To examine morphological features of carditis, as well as the associations of carditis with Helicobacter pylori gastritis and oesophagitis as a marker of gastro-oesophageal reflux disease. PATIENTS AND METHODS: Endoscopic biopsy specimens obtained systematically from oesophagus, cardia, corpus and antrum of 135 dyspeptic patients were retrospectively evaluated. In biopsies, we have searched for any correlations between clinical, endoscopic, and histological features. RESULTS: Carditis was detected in 123 (91.1%) of the cases. The mean age of the carditis group was 47.9 years and the male-to-female ratio was 1.08:1. The relation of carditis with age and sex was not significant (p = 0.19 and p = 0.24, respectively). All cases of the carditis group had concomitant chronic gastritis. In these cases, chronic inflammation, degree of neutrophil-mediated activity and H. pylori colonisation were significantly correlated in cardia, corpus and antrum (p < 0.001). Intestinal metaplasia was observed in 14 cases (11.3%) and, was associated with H. pylori colonisation (p < 0.001). Microscopic oesophagitis detected in 37.7% cases also showed correlation with reflux symptoms and endoscopic oesophagitis but not carditis. When all cases with carditis were evaluated for H. pylori infection and oesophagitis, which are presumed risk factors for carditis, H. pylori infection appeared to be an independent risk factor for carditis (p = 0.012), while oesophagitis did not. CONCLUSIONS: This study suggests that carditis is commonly found in patients presenting with dyspepsia and the histological features of carditis were similar to those seen in H. pylori gastritis in antrum and corpus. In addition, our data have also shown that carditis was significantly associated with H. pylori infection but not with symptoms or signs of GORD.

Combination thymosin-alpha 1 and interferon-alpha 2b in the treatment of anti-HBe-positive chronic hepatitis B in Turkey.

BACKGROUND/AIMS: The most prevalent type of chronic hepatitis B in Turkey is anti-HBe-positive. No consistently effective therapy is yet available for the treatment of these patients. The aim of this study was to assess the efficacy and safety of interferon-alpha and thymosin-alpha 1 combination in the treatment of naive anti-HBe-positive and HBV DNA-positive chronic hepatitis B patients. METHODOLOGY: Twenty-one patients were enrolled in the study. All patients had documented anti-HBe-positive, HBV DNA-positive chronic active hepatitis B without evidence of cirrhosis. Patients received a 26-week combination course of 1.6 mg thymosin-alpha 1 subcutaneously twice a week and 10 MIU interferon-alpha subcutaneously three times a week, followed by interferon-alpha monotherapy at the same dose for another 26 weeks. After treatment patients were observed for a further 26 weeks. Endpoints were a normalization of alanine aminotransferase and negativity of HBV DNA at weeks 52 and 78, as well as an improvement in liver histology at week 78. RESULTS: Eighteen (87.7%) of the 21 patients responded by losing serum HBV DNA and normalizing alanine aminotransferase values at the end of the 52-week treatment period. Sixteen (76.2%) of these patients became sustained responders, with normal alanine aminotransferase and negative HBV DNA at the end of 78 weeks. Two patients were non-responders, two relapsed and one had a breakthrough during therapy. Significant improvements in the Knodell histological activity index were observed in the responders. No adverse events other than those seen previously with interferon monotherapy were reported. CONCLUSIONS: Combination interferon-alpha 2b and thymosin-alpha 1 treatment may provide a safe and effective therapeutic approach for the difficult-to-treat anti-HBe-positive chronic hepatitis B patients. Further controlled studies are needed to assess the full role of this treatment strategy.

Histological and clinical predictive value of determination of tissue CagA status by PCR in Helicobacter pylori infected patients; results of the large population based study in western Turkey.

BACKGROUND/AIMS: Early experimental and epidemiological studies have suggested that the presence of cagA gene was a virulence factor for Helicobacter pylori. We aimed to investigate the clinical significance of tissue CagA status in Helicobacter pylori infected patients and to assess its association with histological changes in gastric mucosa. METHODOLOGY: Three hundred and forty-five patients with Helicobacter pylori infection established by both urease test and histological examination were included in the study. The symptoms of the patients were recorded according to the Glasgow dyspepsia scale. Biopsies (cardia, corpus, angulus and antrum) were evaluated histologically according to the Sidney system. The cagA status was determined by polymerase chain reaction method from an antral biopsy. Polymerase chain reaction studies were performed by Wizard genomic DNA purification system (promega). We also determined the serum levels of tumor necrosis factor-alpha, and gastrin. They were all prescribed lansoprazole (30 mg b.i.d.), clarithromycin (500 mg b.i.d.), and amoxycillin (1 g b.i.d.) for a week. At the 8th week a second endoscopy was performed and further biopsy specimens were obtained from the same sites. Mann-Whitney U and chi 2 tests were used for statistical analyses. RESULTS: Two hundred and thirty-five patients (68.1%) were infected with cagA-positive strains of Helicobacter pylori and the other 110 patients (31.8%) were infected with cagA-negative strains. We compared the parameters and measurements studied in this trial between the patients infected with cagA-positive and negative Helicobacter pylori strains. Helicobacter pylori density was greater in the cagA-positive group by 1.9 +/- 0.9 than in the cagA-negative group by 1.2 +/- 0.7 (P = 0.01). Helicobacter pylori activity and chronic inflammation also were significantly higher in the cagA-positive group with the values of 1.4 +/- 0.8 and 2.1 +/- 1.1 than in the cagA-negative group with 0.7 +/- 0.2 and 1.3 +/- 0.5, respectively (P = 0.001, P = 0.002). The presence of atrophy and lymphoid aggregate was not different between the two groups (P > 0.05). However intestinal metaplasia was shown to be significantly frequent in patients infected with cagA-positive Helicobacter pylori strains (0.001). Serum tumor necrosis factor-alpha and gastrin levels which were accepted as the markers of inflammation in Helicobacter pylori infection were increased in the cagA-positive group compared with the cagA-negative group. Serum tumor necrosis factor-alpha level was 11.3 +/- 7.0 pg/mL in the cagA-positive group and 4.9 +/- 2.7 pg/mL in the cagA-negative group (P = 0.001). Gastrin level also showed a significant difference between two groups by 66.8 +/- 31.1 pg/mL and 37.2 +/- 19.2 pg/mL, respectively, in the cagA-positive and negative groups (P = 0.001). The virulent strains seem to cause peptic ulcer more frequently. Peptic ulcer was determined in 17% of patients in the cagA-positive group but this ratio was 9% in the cagA-negative group (P = 0.608). Although, all these differences of the degree of inflammation, clinical spectrum and biochemical parameters were seen, interestingly there was no significant difference in the severity of the symptoms of the patients in both groups according to Glasgow dyspepsia severity score (P = 0.20). CONCLUSIONS: Our results confirm that cagA-positive strains of Helicobacter pylori cause greater histological changes. However this virulence is not associated with more severe symptoms. The histological changes can be predictable by determining the tissue cagA status.