The Clinical Management of Intrascrotal Extratesticular Masses With Evaluation of Histopathologic Findings.

OBJECTIVE: To contribute to the literature by sharing the clinical presentation, surgical approach, postoperative complications management, and follow-up protocols of the patients we operated on due to intrascrotal extratesticular mass. METHODS: Thirty-two patients admitted due to intrascrotal extratesticular mass were included in the study. Demographic and clinical characteristics of the patients such as age, initial clinical presentation, physical examination, radiological imaging findings, such as scrotal Doppler ultrasonography and magnetic resonance imaging, mass size, and characteristics, surgical treatment procedures, operation notes, and patient follow-up visits were retrospectively examined and evaluated from the patient files. RESULTS: The median age of the 32 individuals included in the study was 52 (interquartile range: [45.0-60.5]) years. The primary reason for initial presentation was a palpable mass in 25 (78.1%) patients, pain in 13 (40.6%) patients, and scrotal swelling in 8 (25%) patients. The median mass diameter was 4.4 (interquartile range: [3.1-5.7]) cm. Surgical treatment involved inguinal excision in 29 cases (90.6%) and inguinoscrotal excision in 3 cases (9.4%). All patients were treated with testicle-sparing surgery. The most common tumor location, observed in 27 cases (84.3%), was the epididymis. The most frequent histopathological diagnosis was epididymal cyst, identified in 13 patients (40.6%). Pathology results showed that the mass was removed with negative margins in all patients. CONCLUSION: Testicular-sparing surgery through the inguinal approach is one of the surgical methods that can be preferred for intrascrotal extratesticular masses. This approach can both preserve the testicle and achieve successful surgical results. Studies with larger samples are needed on this subject. TRIAL REGISTRATION: This study was approved by the Erzurum Medicine Faculty University Local Ethics Committee (approval number: BAEK 2023/08-105).

Relevance of Pulmonary Alveolar Echinococcosis / Relevancia de equinococosis alveolar con afectación pulmonar

BACKGROUND: Pulmonary alveolar echinococcosis (PAE) is a chronic disease caused by Echinococcus multilocularis with very low incidence in developed countries. METHODS: This single-center, retrospective study included 34 patients who were diagnosed with PAE between January 2001 and February 2019 (15 males, 19 females, mean age: 52.4 ± 15.8 years, age range: 28-78 years) in Ataturk University Medical School, Erzurum, Turkey. RESULTS: The liver was the primary involved organ in all cases. Pulmonary involvement was detected in 13.0% (34/261) of all cases with hepatic alveolar echinococcosis (AE), and three patients (8.8%) had both pulmonary metastasis and brain metastasis. The route of spread to the lungs based on radiological data was hematogeneous in 25 patients (73.5%), transdiaphragmatic in three patients (8.8%) and both hematogeneous and transdiaphragmatic in six patients (17.7%). AE showed bilateral involvement in 19 patients (55.9%), whereas only the right lung was involved in 12 patients (35.3%) and the left lung in three patients (8.8%). Of the patients, five underwent surgery due to PAE and 29 patients received medical therapy with albendazole. A total of three patients died during the follow-up period (2, 5 and 10 years after the diagnosis of PAE), while 31 patients continued with follow-up and treatment for a mean duration of 5.4 ± 3.8 years (1-14 years). CONCLUSIONS: Patients with hepatic AE must, as a matter of course, be screened for possible lung involvement. Albendazole therapy may slow down disease progression in patients with widespread pulmonary involvement who are not eligible for surgery

INTRODUCCIÓN: La equinococosis alveolar con afectación pulmonar (PAE) es una enfermedad crónica causada por Echinococcus multilocularis, cuya incidencia es muy baja en los países desarrollados. MÉTODOS: Estudio unicéntrico, retrospectivo en el cual se diagnosticaron 34 pacientes con PAE entre enero de 2001 y febrero de 2019 (15 varones y 19 mujeres, edad media: 52,4 ± 15,8 años, rango de edad: 28-78 años) en la Escuela Médica Univesitaria de Ataturk, Erzurum, Turquía. RESULTADOS: En el total de los casos incluidos en el estudio el hígado fue el principal órgano afectado. La afectación pulmonar se detectó en el 13% (34/261) de los casos con equinococosis alveolar (AE), y 3 pacientes (8,8%) presentaron tanto metástasis pulmonar como cerebral. De acuerdo con los datos radiológicos, la propagación a los pulmones fue por vía hematógena en 25 pacientes (73,5%), transdiafragmática en 3 pacientes (8,8%) y tanto hematógena como transdiafragmática en 6 pacientes (17,7%). Diecinueve pacientes (55,9%) presentaron PAE con afectación pulmonar bilateral, mientras que 12 pacientes (35,3%) presentaron afectación solo del pulmón derecho y 3 (8,8%) solo del izquierdo. De todos los pacientes, 5 fueron sometidos a cirugía debido a la PAE y 29 recibieron tratamiento médico con albendazol. Tres pacientes fallecieron durante el período de seguimiento (2,5 y 10 años después del diagnóstico de PAE), mientras que 31 continuaron con el seguimiento y el tratamiento durante 5,4±3,8 años de media (1-14 años). CONCLUSIONES: Los pacientes con AE hepática se deben cribar de manera rutinaria para detectar una posible afectación pulmonar. El tratamiento con albendazol puede ralentizar la progresión de la enfermedad en pacientes con afectación pulmonar extendida que no son aptos para cirugía

The Diagnostic Value of the Changes in the Renal Glomerulus in the Postmortem Diagnosis of Freshwater Drownings.

Drowning is one of the major causes of unintentional injury death worldwide. As there are no pathomorphological findings specific to the diagnosis of drowning, definitive postmortem diagnosis of drowning continues to be a significant problem in forensic medicine. This study aims to present an additional diagnostic sign in cases of freshwater drowning by investigating the histopathological changes of renal tissue in the postmortem diagnosis of freshwater drowning. For this purpose, 103 cases were investigated in which the causes of death were freshwater drowning (n = 45), traffic accidents (n = 33) and acute myocardial infarction (n = 25). Renal corpuscular structures of selected cases were examined stereologically and histopathologically. Renal corpuscle diameter, renal corpuscle surface area, glomerular tuft surface area, and Bowman space were calculated by stereological method. When compared with the glomeruli of the control group, renal corpuscle diameter, renal corpuscle surface area, glomerular tuft surface area, and Bowman space values of kidney tissues of all freshwater drowning cases were found to be decreased (P < 0.001). These changes may be considered as an essential histopathological finding in postmortem diagnosis of freshwater drowning cases.

Relevance of Pulmonary Alveolar Echinococcosis.

BACKGROUND: Pulmonary alveolar echinococcosis (PAE) is a chronic disease caused by Echinococcus multilocularis with very low incidence in developed countries. METHODS: This single-center, retrospective study included 34 patients who were diagnosed with PAE between January 2001 and February 2019 (15 males, 19 females, mean age: 52.4±15.8 years, age range: 28-78 years) in Ataturk University Medical School, Erzurum, Turkey. RESULTS: The liver was the primary involved organ in all cases. Pulmonary involvement was detected in 13.0% (34/261) of all cases with hepatic alveolar echinococcosis (AE), and three patients (8.8%) had both pulmonary metastasis and brain metastasis. The route of spread to the lungs based on radiological data was hematogeneous in 25 patients (73.5%), transdiaphragmatic in three patients (8.8%) and both hematogeneous and transdiaphragmatic in six patients (17.7%). AE showed bilateral involvement in 19 patients (55.9%), whereas only the right lung was involved in 12 patients (35.3%) and the left lung in three patients (8.8%). Of the patients, five underwent surgery due to PAE and 29 patients received medical therapy with albendazole. A total of three patients died during the follow-up period (2, 5 and 10 years after the diagnosis of PAE), while 31 patients continued with follow-up and treatment for a mean duration of 5.4±3.8 years (1-14 years). CONCLUSIONS: Patients with hepatic AE must, as a matter of course, be screened for possible lung involvement. Albendazole therapy may slow down disease progression in patients with widespread pulmonary involvement who are not eligible for surgery.

Pulmonary metastasectomy with laparotomy in alveolar echinococcosis.

Pulmonary alveolar echinococcosis is a tumor-like parasitic disease that occurs typically after hepatic involvement. In this article, we present a case of metastatic pulmonary alveolar echinococcosis that underwent laparotomy for hepatic involvement, in which we performed pulmonary metastasectomy with transdiaphragmatic intervention. Thoracic computed tomography revealed a metastatic nodule of approximately 1 cm in the superior segment of the right lung lower lobe. Approximately 7x3 cm diaphragmatic resection was performed due to diaphragmatic invasion. Pulmonary wedge resection for lung metastasis was performed intraabdominally from diaphragmatic defect. We believe that this technique can be applied safely in carefully selected patients with pulmonary involvement.

Human papillomavirus infection in patients with laryngeal carcinoma.

BACKGROUND: The aim of this study was to determine the HPV positivity rate in patients with laryngeal cancer, and to determine the effect of HPV positivity on survival. An additional aim was to determine if patients with HPV positive laryngeal cancer are more sensitive to chemotherapy and if such sensitivity differs according to chemotherapy protocol. METHODS: The study included laryngeal specimens obtained from 82 laryngeal cancer patients and 11 laryngeal specimens with normal laryngeal mucosa that were obtained from our hospital's paraffin block archives between 1995 and 2013. HPV was detected via chromogenic in situ hybridization (cISH) and confirmed via genotyping. RESULTS: HPV was not detected in any of the 82 laryngeal cancer patients' laryngeal specimens, nor in any of the 11 archived laryngeal specimens with normal laryngeal mucosa via cISH. Genotyping confirmed these findings; none of the HPV types studied were detected in any of the specimens. As none of the study samples were HPV positive, it was not possible to compare survival, recurrence, or chemotherapy sensitivity. CONCLUSIONS: HPV infection is not a leading cause of laryngeal cancer; however, additional research on HPV positivity in patients with laryngeal cancer and its effect on recurrence, survival, and chemotherapy sensitivity is warranted.

The Protective Effect of Thiamine Pryophosphate Against Sugar-Induced Retinal Neovascularisation in Rats.

The aim of this study was to investigate the effect of thiamine pyrophosphate (TPP), administered via sugar water, on retinal neovascularisation in rats. Animals were assigned to three groups, namely the TPP sugar-water group (TPSWG, n = 12), the control group (CG, n = 12) and the healthy group (HG, n = 12). The TPSWG was injected intraperitoneally with TPP once a day for 6 months. CG and HG rats were given distilled water in the same way. TPSWG and CG rats were left free to access an additional 0.292 mmol /ml of sugar water for 6 months. The fasting blood glucose (FBG) levels of the animals were measured monthly. After 6 months, biochemical, gene expression and histopathologic analyses were carried out in the retinal tissues removed from the animals after they were killed. The measured FBG levels were 6.96 ± 0.09 mmol/ml (p < 0.0001 vs. HG), 6.95 ± 0.06 mmol/ml (p < 0.0001 vs. HG) and 3.94 ± 0.10 mmol/ml in the CG, TPSWG and HG groups, respectively. The malondialdehyde (MDA) levels were found to be 2.82 ± 0.23 (p < 0.0001 vs. HG), 1.40 ± 0.32 (p < 0.0001 vs. HG) and 1.66 ± 0.17 in the CG, TPSWG and HG, respectively. Interleukin 1 beta (IL-1ß) gene expression was increased (3.78 ± 0.29, p < 0.0001) and total glutathione (tGSH) was decreased (1.32 ± 0.25, p < 0.0001) in the retinal tissue of CG compared with TPSWG (1.92 ± 0.29 and 3.18 ± 0.46, respectively). Increased vascularisation and oedema were observed in the retinal tissue of CG, while the retinal tissues of TPSWG and HG rats had a normal histopathological appearance. A carbohydrate-rich diet may lead to pathological changes in the retina even in nondiabetics, but this may be overcome by TPP administration.

Prevalence of Epidermal Growth Factor Receptor Mutations in Patients with Non-Small Cell Lung Cancer in Turkish Population.

AIMS: Epidermal growth factor receptor mutation analysis in non-small cell lung cancer is important for selecting patients who will receive treatment with tyrosine kinase inhibitors. In this study, we aimed to investigate the prevalence of epidermal growth factor receptor mutations and mutation patterns in the Turkish population. METHODS: We retrospectively reviewed molecular pathology reports of 959 cases with lung cancer analysed for epidermal growth factor receptor mutations. We analysed all four epidermal growth factor receptor exon mutations using a real-time polymerase chain reaction platform. RESULTS: In this study, the epidermal growth factor receptor mutation rate in the Turkish population was 16.7% (160 of 959). The epidermal growth factor receptor mutation frequency was significantly higher in women (37.1%, n=96) than in men (9.1%, n=64) (p<0.001). In addition, the epidermal growth factor receptor mutation rate was higher in the adenocarcinoma histologic type (p<0.001). Patients with mutations were older than those without mutations (p=0.003). The most frequent mutations were exon 19 deletions (48.8%, 78/160) and exon 21 L858R point mutations (38.1.1%, 61/160). We also detected compound mutation patterns in three cases (1.9%). CONCLUSION: The prevalence of epidermal growth factor receptor mutations in the Turkish population was slightly higher than that in the Caucasian population and lower than that in the East Asian population. The results of this study may provide guidance in personalized therapy of non-small cell lung cancer in the Turkish population.

Investigation of BRAF mutation analysis with different technical platforms in metastatic melanoma.

In metastatic melanoma, the detection of somatic mutations in the BRAF gene is crucial regarding patient selection for targeted therapy. Several screening methods have been developed to identify BRAF gene mutations. In this study, our objective was to evaluate the detection of the BRAF V600 mutations using two molecular methods, real-time polymerase chain (real-time PCR) assay and pyrosequencing, and immunohistochemistry (IHC), and to compare the results of these different technical platforms. This study included 98 patients diagnosed with metastatic melanoma at the Hacettepe University, Department of Pathology between 2002 and 2014. BRAF mutation analysis was tested with real-time PCR, pyrosequencing and IHC methods. The results of all three tests were compared with a reference test, and the sensitivity, specificity rates and kappa coefficient values were analysed for each test. We successfully analysed BRAF mutations using all three methods in 92 patients. According to our findings, the pyrosequencing method had the highest kappa value regarding the determination of BRAF V600 mutations. The kappa values were at almost perfect agreement levels in pyrosequencing and real-time PCR assay (kappa coefficient for pyrosequencing=0.895 (95% CI: 0.795-0.995); kappa coefficient for real-time PCR=0.871 (95% CI: 0.761-0.981). The kappa value was at a substantial agreement level in the IHC analysis (kappa coefficient=0.776 (95% CI: 0.629-0.923). According to our results, we found that real-time PCR and pyrosequencing methods were equally excellent in determination of BRAF V600 mutations. The IHC method, which is commonly used in routine pathology practice, can also be safely used as a screening test for determination of BRAF V600 mutations.