Evaluation of the mir-126, mir-182, and mir-486-5p Expression Signature of Head and Neck Squamous Cell Carcinomas and Lung Squamous Cell Carcinomas.

OBJECTIVE: Although squamous cell carcinomas (SCCs) originating from different anatomic localizations display a similar histological appearance under light microscopy, they may differ in terms of epigenetic and genetic features. The aim of this study was to analyze mir-126, mir-182, and mir-486-5p expression levels in head and neck SCCs and lung SCCs, and to identify localization-specific miRNA expression profiles. MATERIAL AND METHOD: The expression levels of mir-126, mir-182, and mir-486-5p were analyzed in lung, oral cavity, laryngeal, and hypopharyngeal SCCs in 40 patients, using quantitative real-time polymerase chain reaction. RESULTS: The findings showed that lung, oral cavity, laryngeal, and hypopharyngeal SCCs have distinct mir-126 and mir-486-5p expression profiles. It was also observed that mir-126 and mir-486-5p expression levels were highly specific to the tumor localization. CONCLUSION: These findings highlighted that SCCs originating from different anatomic localizations have different miRNA expression profiles. miRNA expression analysis can be used to predict the primary localizations of those SCCs.

Primary Synovial Sarcoma of the Thyroid: Challenges in Cytologic Diagnosis and Review of the Literature.

BACKGROUND: Primary synovial sarcoma (SS) of the thyroid (PSST) is extremely rare. Its differential diagnosis from other neoplasms is essential since it has different management protocols and prognosis. CASE: A 26-year-old man with a 4.5-cm solid lobulated mass was seen at an outside hospital. Fine needle aspiration (FNA) was interpreted as a papillary carcinoma, and a total thyroidectomy was performed. The final histologic diagnosis was spindle epithelial tumor with thymus-like differentiation (SETTLE). No metastases were detected at that time, and the patient received radioactive iodine treatment. Two years post-surgery, he was seen at our hospital with a local recurrence, and FNA was considered as consistent with SETTLE. The mass was resected, and a left modified radical neck dissection was performed. The tumor revealed necrosis and a high mitotic index. Following histologic, immunohistochemical, and molecular studies, the tumor was classified as a PSST. The patient received chemotherapy and targeted immunotherapy, but he died 41 months after the initial presentation. CONCLUSION: The main diagnostic pitfall of PSST is SETTLE. The presence of mitotic figures and basal lamina material, negative staining for smooth muscle actin, and positive staining for transducer-like enhancer of split 1 antibody favor SS over SETTLE. SYT gene rearrangement is essential to establish the definitive diagnosis of PSST.

Laryngeal cytology: A cytological, histological, P16 and human papillomavirus study.

BACKGROUND: Invasive diagnostic methods, such as punch biopsies, have a potential to produce undesirable side effects in the larynx, such as scarring and vocal dysfunction. This study is an attempt to assess the diagnostic potential of cytology to efficiently diagnose premalignant and malignant laryngeal lesions, while sparing patients the risk of complications of punch biopsies. METHODS: Laryngeal smears, using endocervical-type brushes, and punch biopsies were procured from each patient. Smears were prepared and the brush was cut and put in Surepath preservative solution for cytological analysis and human papillomavirus (HPV) DNA testing. A Real-TM Quant kit that detects 14 HPV types was used for genotyping. Immunohistochemical staining for p16 was performed on cytological and histological specimens. RESULTS: Cytological diagnosis was correct in 84.6%, 100% and 100% of cases with a histological diagnosis of squamous cell carcinomas, high-grade squamous intraepithelial lesions and benign lesions, respectively. However, cytological interpretation was correct only in 25% of low-grade squamous intraepithelial lesions. HPV DNA test was positive in only one case, which was a laryngeal polyp. Testing for p16 was negative in all the cytological and histological material. CONCLUSION: Laryngeal cytology is a useful diagnostic tool in establishing the diagnosis of high-grade squamous epithelial cell abnormalities. Recognition of low-grade lesions, however, is challenging. HPV genotyping and p16 staining do not seem to be helpful ancillary techniques in cytological material procured from the larynx.

The presence and prognostic significance of human papillomavirus in squamous cell carcinoma of the larynx.

The aim of the present study was to evaluate the role of HPV in laryngeal squamous cell carcinoma and correlate it with patients' clinicopathological data. In total, 78 laryngeal squamous cell carcinoma patients enrolled in this study. The presence of genotype-specific HPV DNA was evaluated using Genotyping Assay in formalin-fixed paraffin-embedded tissue which was diagnosed between 2005 and 2015. All samples were also evaluated for p16 immunohistochemical staining. HPV DNA and p16 status were assessed in terms of location, smoking, alcohol consumption, lymph node status, tumor stage, overall survival, disease-free survival, perineural invasion, and vascular invasion retrospectively. Five test samples were excluded from the study due to inadequate deoxyribonucleic acid purity. HPV DNA was detected in 19 of 73 (26.02%) in patients with laryngeal squamous cell carcinoma. Human papilloma virus genotyping revealed double human papilloma virus in one case (types 16 and 59) and HPV 16 in the remaining cases. Although HPV-positive cases showed slightly better 3 years survival than HPV-negative ones, this finding was not statistically significant (overall survival p = 0.417, HPV positive: 92.3%, HPV negative: 81.4%, and disease-free survival p = 0.526, HPV positive: 93.8%, HPV negative: 80.9%). The presence of HPV DNA was not significantly associated with any clinicopathological features (p > 0.05). Among 73 patients, only 4 had an immunohistochemical staining of p16 and these patients were also HPV DNA 16 positive. Although our study results revealed a slightly better survival in patients with HPV DNA positivity for HPV 16 compared to the negative ones, the difference was not statistically significant. However, an increasing rate in especially high-risk-type HPV-16 prevalence in laryngeal squamous cell carcinoma by RT-PCR method was observed compared to our previous study. Although the presence of HPV in laryngeal SCCs seems to be associated with slightly better prognosis, additional studies may be needed, since our results were not statistically significant. We believed that HPV is not an adequate biomarker for diagnostic and prognostic purposes in laryngeal squamous cell carcinoma.

Could S6K1 immunopositivity be used to distinguish early and advanced stages of endometrioid endometrial adenocarcinoma?

OBJECTIVE: To assess whether the immunopositivity of S6K1, a crucial effector of the mTOR signaling pathway, varies between early-stage low-grade and advanced-stage high-grade endometrial endometrioid adenocarcinoma (EEA) as well as to discuss its prognostic significance. MATERIAL AND METHODS: A total of 22 normal endometrial tissue samples (Control group) and 41 EEA specimens (Study group) were enrolled in the study, and all the samples underwent immunohistochemical staining for S6 kinase alpha (S6K1). The study group was further evaluated in two subgroups; stage 1A, grade 1 (Group 1) and stage ≥1A, grade 2 or 3 (Group 2). Group 2 patients were considered as a poor prognosis for EEA. The samples were examined by two independent pathologists. Statistical analyses were performed using the Student's t-test for continuous variables, the Chi-square test for categorical variables, and one-way analysis of variance for the comparison of multiple variables. RESULTS: The immunopositivity rate for all the included EEA patients was 56.1%, whereas none of the 22 normal endometrial tissue samples revealed immunoreactivity for S6K1. The immunopositivity rates were significantly different between Groups 1 and 2 [38.1% (8/21) and 75.0% (15/20), respectively, p=0.039]. When S6K1 positivity was used as a criterion of poor prognosis in EEA, the sensitivity, specificity, positive predictive value, and negative predictive value were calculated to be 62%, 75%, 72%, and 65%, respectively (OR: 4.9 and 95% CI: 1.3-18.7). CONCLUSION: S6K1 was positive in the majority of EEAs and malignancies at an advanced stage. Higher grade disease had a significantly higher rate of S6K1 positivity. S6K1 immunopositivity appears to be a promising method to predict poor prognosis in EEA.

Molecular alterations in malignant blue nevi and related blue lesions.

Malignant blue nevi (MBN) are extremely rare dermal melanocytic tumors that arise in association with atypical cellular blue nevi (ACBN), cellular blue nevi (CBN), common blue nevi (BN), or de novo. The frequency of BRAF, NRAS, and KIT mutations in malignant melanoma varies according to histological subtype and localization. These mutations are rarely observed in blue nevi, which have recently been shown to carry activating mutations in GNAQ/GNA11 genes. Only few small molecular studies of MBN have been published. The aim of the present study was to analyze in MBN and related blue lesions such as ACBN, CBN, and BN the prevalence of BRAF, NRAS, KIT, GNAQ, and GNA11 gene mutations and their association with clinicopathological features. We included in our study 12 MBN, 6 ACBN, 29 CBN, and 35 common BN diagnosed between 1996 and 2014. Sanger sequencing method was used for mutation analysis. Overall, GNAQ exon 5 mutation was the most frequent alteration (46 %), in 2 of 12 (17 %) MBN, 1 of 6 (17 %) ACBN, 22 of 29 (76 %) CBN, and 13 of 35 (37 %) common BN. BRAF V600E and GNA11 exon 5 mutations were respectively detected in 3 of 12 (25 %) and in 2 of 12 (17 %) MBN while none in ACBN, CBN, and common BN. None of the cases harbored NRAS exon 2/3, KIT exon 9/11/13/17/18, or GNAQ/GNA11 exon 4 mutations. GNAQ gene exon 5 mutations are rare in MBN and ACBN but frequent in CBN and common BN. Remarkably, BRAF V600E and GNA11 exon 5 mutations were only detected in MBN, whereas none were found in ACBN, CBN, or common BN. Our data contribute new elements to the limited data on molecular alterations in MBN.

BRAF, KIT, NRAS, GNAQ and GNA11 mutation analysis in cutaneous melanomas in Turkish population.

BACKGROUND: KIT and mitogen-activated protein kinase cascade are important for melanomagenesis. In the present study, we analyzed the frequency of BRAF, NRAS, KIT, GNAQ and GNA11 gene mutations and investigated their association with clinicopathological features of melanomas in Turkish population. MATERIALS AND METHODS: Forty-seven primary cutaneous melanomas were included in our study. Sanger sequencing method was used for mutation analysis in all cases. RESULTS: Mean age was 62.1 (29-101) years. Female:male ratio was 17:30. Among 47 melanomas, 14 (29.8%) BRAF, 10 (21.3%) NRAS, 4 (8.5%) KIT and 1(2.1%) GNAQ gene mutations were detected. Two of the KIT mutations were found in acral lentiginous melanoma (ALM). In the head and neck region, mutation frequency was significantly lower than in other locations (P = 0.035). The only GNAQ gene mutation (p.Q209L) was detected in a melanoma arising from blue nevus located on the scalp. None of the melanomas harbored NRAS exon 2, KIT exon 13/17/18, GNAQ exon 4 and GNA11 exon 4/5 mutations. Overall mutation frequency did not show significant difference between metastatic (8/14, 57.1%) and nonmetastatic (18/33, 54.5%) patients. We did not observe any significant association between mutation status and gender or age of various patients. CONCLUSIONS: Our results support that BRAF and NRAS gene mutations are common in cutaneous melanomas. The activating mutations of KIT gene are rare and especially seen in ALM. GNAQ and GNA11 mutations are infrequent in cutaneous melanomas and may be associated only with melanomas arising from blue nevus.

Trimetazidine significantly reduces cerulein-induced pancreatic apoptosis.

OBJECTIVE: Acute pancreatitis continues to be associated with significant rates of mortality and morbidity, and therapeutic options are still very limited. We aimed to investigate the efficacy of trimetazidine on cerulein-induced pancreatic apoptosis and histopathological and biochemistrical consequences of acute pancreatitis. METHODS: Thirty-two Wistar albino rats were randomized into four groups (group 1: control group; group 2: acute pancreatitis group; group 3: acute pancreatitis and trimetazidine treatment group; group 4: placebo group). Acute edematous pancreatitis was induced by subcutaneous cerulein injection (20 µg/kg) four times at one-hour intervals. Trimetazidine was prepared in suspension form. In group 3, after gas anesthesia, trimetazidine was administrated to rats via a catheter. Serum interleukin (IL)-1ß, tumor necrosis factor (TNF)-α, amylase, lipase and leukocyte levels, pancreatic apoptotic status and pancreatic Schoenberg scores were determined for all groups. Results are given as the mean ± SD. A value of P<0.05 was accepted as statistically significant. SPSS for Windows v15.0 was used for statistical analyses. RESULTS: In the acute pancreatitis group IL-1ß, amylase, lipase and leukocyte levels were elevated and pancreatic histopathological evaluation revealed a diagnosis of acute pancreatitis IL-1ß amylase and lipase levels and pancreatic inflammation were decreased significantly in the trimetazidine group (P<0.01). White blood cell counts and TNF-α concentrations for the trimetazidine group and the acute pancreatitis group were not significantly different. Trimetazidine significantly reduced apoptosis in pancreatic tissues and Schoenberg scores were also significantly reduced (P<0.05). CONCLUSION: In this study, we showed that trimetazidine treatment significantly decreases the levels of IL-1ß, amylase and lipase reduces pancreatic apoptosis and ameliorates the histopathological findings of cerulein-induced acute pancreatitis. Trimetazidine could be a new therapeutic option in the early treatment of acute pancreatitis.

miR-205 and miR-200c: Predictive Micro RNAs for Lymph Node Metastasis in Triple Negative Breast Cancer.

PURPOSE: We examined expression profiles of 16 micro RNAs (miRNAs) in triple negative breast cancers to identify their potential as biomarkers for lymph node metastasis. METHODS: The expression profiles of miR-9, miR-21, miR-30a, miR-30d, miR-31, miR-34a, miR-34c, miR-100, miR-122, miR-125b, miR-146a, miR-146b, miR-155, miR-181a, miR-200c, and miR-205 were examined by using real-time quantitative reverse transcription polymerase chain reaction in tumor samples and corresponding benign breast tissues. Their associations with histopathological features and prognostic parameters were assessed. RESULTS: When compared with the expression in benign breast tissues, seven of the miRNAs (miR-31, miR-205, miR-34a, miR-146a, miR-125b, miR-34c, and miR-181a) were downregulated more than 1.5-fold in tumor tissues, whereas, only miR-21 was found to be upregulated more than 1.5-fold in tumor tissues. Although miR-200c levels were decreased only 1.12-fold in tumor tissues, the reduced expressions of miR-200c and miR-205 were significantly associated with lymph node metastasis (p=0.021 and p=0.016, respectively). CONCLUSION: Our results demonstrate that miR-205 and miR-200c expression levels may be useful in predicting lymph node metastasis in triple negative breast cancer patients.

Effectiveness of interleukin-1 receptor antagonist (Anakinra) on cerulein-induced experimental acute pancreatitis in rats.

AIM: Acute pancreatitis (AP) is defined as an inflammatory disease of the pancreas. The purpose of this study was to examine the effectiveness of Anakinra on cerulein-induced experimental pancreatitis rat model by using the results of biochemical and histopathological findings. MATERIALS AND METHODS: Cerulein was administered to induce AP in rats. Group 1 was the sham group. Subcutancerulein was injected to the rats in group 2 for experimental pancreatitis group. In groups 3 and 4, 100 and 50 mg/kg intraperitoneal Anakinra were injected after the induction of experimental pancreatitis by subcutaneous cerulein in rats, respectively. Lastly, in group 5, rats were injected with intraperitoneal saline and subcutan cerulean for placebo group. The following parameters were evaluated: histopathological score of pancreatitis, apoptotic index, amylase, lipase, TNF-α levels, IL-1ß and the leukocyte count. RESULTS: When the results of serum amylase, lipase, TNF-α and IL-1ß levels, the leukocyte count, histopathologic scores and apoptotic indices of control group compared to the results of other groups, the differences exhibited statistical significance (all p < 0.05). On the other hand, when the results of fourth group compared with the results of third group, the data demonstrated statistical insignificance (p > 0.05). However, no any significant differences were found between the results of fourth and fifth groups (p > 0.05). CONCLUSION: In the light of these results, cerulein is an appropriate agent for experimental AP rat model and Anakinra has a favorable therapeutic effect on acute experimental pancreatitis model. Moreover, Anakinra significantly decreases cerulein-related pancreatic tissue injury and pancreatic apoptosis.

HLA-G in testicular germ cell tumors.

BACKGROUND: HLA-G is a non-classical major histocompatibility complex class I molecule. HLA-G expression has been found in various types of solid and hematological malignancies. It is also expressed in normal testicular and epididymal tissue. However, expression of HLA-G in testicular germ cell tumors has not been extensively studied. The aim of this study was to investigate whether HLA-G protein is present in different components of testicular germ cell tumors. PATIENTS AND METHODS: 34 testicular cancer patients, for whom tumor tissue was available, were included in the study. Immunohistochemical staining was performed on tissue sections from formalin-fixed, paraffin-embedded tissue samples. RESULTS: 7 (20.6%) patients had positive HLA-G staining in at least 1 component of the tumor sample. In 3 of 7 patients with intratubular germ cell neoplasia, staining with HLA-G was seen in this component. All of the choriocarcinoma components were strongly positive, and about 40% of teratoma components had immunopositivity. The components of seminoma and embryonal carcinoma, and most yolk sac tumors were negative. HLA-G immuno-positivity was not associated with tumor size, retroperitoneal lymph node involvement, distant metastasis, or relapse/refractory status. CONCLUSION: This study demonstrated that testicular choriocarcinoma and some teratomas express HLA-G, but not seminoma, embryonal carcinoma, and yolk sac tumors.

Expression of P-cadherin (cadherin-3) and E-selectin in the villous trophoblast of first trimester human placenta.

OBJECTIVE: Although trophoblastic invasion has a critical role in human placental development, very little is known about them. The aim of the present study was to localise the expression of P-cadherin (cadherin-3) and E-selectin in first trimester placenta. MATERIAL AND METHODS: This study was conducted on 140 patients who had applied to Gülhane Military Medical Academy, Haydarpasa Education Hospital, Department of Obstetrics and Gynaecology between 2005 and 2006. The patients were divided into three groups: ectopic pregnancy group (Group 1), spontaneous abortion group (group 2) and curettage group (group 3 and/or control group). Patients with a history of systemic diseases (such as thrombophilia), a disease or anatomical diagnosis that may cause recurrent abortion or an aetiological factor for ectopic pregnancy were excluded from the study. Paraffin blocks were stained with E-selectin and P-cadherin in accordance with the procedure. Demographic characteristics of patients (patient age, gravida, parity, number of previous abortions, and last menstrual period) and staining intensities were compared using Analysis of Variance (ANOVA) among groups. RESULTS: According to the average scale score of P-cadherin staining of cells, the three groups were statistically different from each other (p=0.0001). This difference stems from statistically significantly lower scores in the spontaneous abortion group than in both the ectopic pregnancy group (p<0.001) and the control group (p<0.001). E-selectin immunostaining showed no positive staining in the groups. CONCLUSION: In placental trophoblasts, decreased P-cadherin immunoreactivity plays a role in the aetiopathogenesis of spontaneous abortion.

Can horizontal diameter of colorectal tumor help predict prognosis?

OBJECTIVE: We aimed to investigate the relationship between the horizontal tumor diameter and prognosis. MATERIAL AND METHODS: Patients' records were analyzed retrospectively. Patient data, including age, gender, vertical penetration, anatomic location, differentiation of the tumor, tumor node metastasis (TNM) stage, survival rate, and disease-free survival, were analyzed to find out if there was any correlation with horizontal tumor diameter. RESULTS: A total of 439 colorectal cancer patients were enrolled. Patients were stratified into two groups according to the horizontal tumor diameter (≤4.5 cm vs. >4.5 cm). Poorly differentiated tumors were significantly larger than other differentiation groups (p=0.003). The horizontal diameter increased with increase in T-stage (p<0.001). Similarly, the number of positive lymph nodes increased significantly as the size of the horizontal tumor diameter increased (p<0.001). The relationship between TNM staging and the horizontal diameter of tumors in both groups was examined, and it was found that the progression of tumor stage was accompanied by increased horizontal diameter (p<0.001). It was also found that the horizontal tumor diameter was not correlated with local recurrence (p=0.063). However, distant metastasis was higher in patients with a tumor larger than 4.5 cm (p=0.02). Although the disease-free survival was shorter in patients with a horizontal tumor diameter more than 4.5 cm, the difference was not statistically significant. CONCLUSION: There is a significant relation between horizontal diameter of the tumor and depth of the tumor, lymph node involvement, overall survival, and distant metastasis. Horizontal diameter of the tumor can possibly be used as a prognostic factor in colorectal cancer patients.

Comparison of deferoxamine and methylprednisolone: protective effect of pharmacological agents on lipid peroxidation in spinal cord injury in rats.

STUDY DESIGN: Experimental study. OBJECTIVE: To investigate the protective effect of deferoxamine (DFO) administration in comparison with methylprednisolone (MP) on lipid peroxidation and antioxidants after spinal cord injury (SCI) in rats. SUMMARY OF BACKGROUND DATA: DFO is used for treating an iron-chelating agent, which is also used in the treatment of iron poisoning and thalassaemia. The neuroprotective effect of DFO was evaulated as a therapeutic agent for SCI. METHODS: Forty Wistar rats were randomly divided into 5 groups as sham laminectomy (n = 8), laminectomy with SCI (n = 8), laminectomy with SCI and 0.9% saline intraperitoneal (i.p.) (n = 8), laminectomy with SCI and 30 mg/kg MP i.p. (n = 8), and laminectomy with SCI and 30 mg/kg DFO i.p. (n = 8). Neurological deficits were examined 24 hours after trauma, and all rats were killed. Spinal cord segments were harvested for both biochemical and histopathological evaluation. RESULTS: At 24 hours post-SCI, whereas malondialdehyde levels were increased, superoxide dismutase, catalase, and glutathione peroxidase levels were decreased in groups I, II, and III. MP and DFO treatment decreased MDA levels and increased superoxide dismutase CAT, and glutathione peroxidase levels in control and study groups. There was no statistically significant difference between treatment with MP and DFO (P> 0.05). All rats were paraplegic after SCI, except in the sham group. Histopathological improvement was observed in control and study groups. CONCLUSION: This study indicates that beneficial effects may be provided and further studies need to investigate the dose-dependent beneficial and side effects of DFO in SCI. LEVEL OF EVIDENCE: N/A.

CYP1A1 (Ile462Val), CYP1B1 (Ala119Ser and Val432Leu), GSTM1 (null), and GSTT1 (null) polymorphisms and bladder cancer risk in a Turkish population.

We aimed to investigate bladder cancer risk with reference to polymorphic variants of cytochrome p450 (CYP) 1A1, CYP1B1, glutathione S-transferase (GST) M1, and GSTT1 genes in a case control study. Polymorphisms were examined in 114 bladder cancer patients and 114 age and sex-matched cancer-free subjects. Genotypes were determined using allele specific PCR for CYP1A1 and CYP1B1 genes, and by multiplex PCR and melting curve analysis for GSTM1 and GSTT1 genes. Our results revealed a statistically significant increased bladder cancer risk for GSTT1 null genotype carriers with an odds ratio of 3.06 (95% confidence interval=1.39-6.74, p=0.006). Differences of CYP1A1, CYP1B1 and GSTM1 genotype frequencies were not statistically significant between patients and controls. However, the specific combination of GSTM1 null, GSTT1 null, and CYP1B1 codon 119 risk allele carriers and specific combination of GSTM1 present, GSTT1 null, and CYP1B1 432 risk allele carriers exhibited increased cancer risk in the combined analysis. We did not observe any association between different genotype groups and prognostic tumor characteristics of bladder cancer. Our results indicate that inherited absence of GSTT1 gene may be associated with bladder cancer susceptibility, and specific combinations of GSTM1, GSTT1 and CYP1B1 gene polymorphisms may modify bladder cancer risk in the Turkish population, without any association being observed for CYP1A1 gene polymorphism and bladder cancer risk.

Primary retroperitoneal mucinous cystadenoma with a sarcoma-like mural nodule: an immunohistochemical study with histogenetic considerations and literature review.

Primary retroperitoneal mucinous cystadenomas (PRMCs) are extremely rare tumors and their association with sarcoma-like mural nodules (SLMNs) has not been described thoroughly. The aim of this study is to characterize the gross and microscopic features and the immunohistochemical profile of the first case of PRMC with SLMN and to discuss the differential diagnosis of SLMNs. The literature related to primary retroperitoneal mucinous tumors is reviewed in an attempt to clarify the histogenesis of the epithelial and sarcomatoid components of the associated mural nodules. A 34-yr-old woman presented with a 14-cm retroperitoneal cystic lesion with a 6-cm mural nodule. An immunohistochemical study with a panel of 19 antibodies and a histochemical study for mucin stains were performed. The epithelial component of the PRMC showed positive staining for cytokeratin (CK) 7, CK AE1/3, epithelial membrane antigen, carcinoembryonic antigen, and calretinin. The neoplasm was not immunoreactive for CK 20, CK 5/6, and the other antibodies used in this study. In addition, it stained positively for mucin by mucicarmine, periodic acid-Schiff, and Alcian blue. The stromal cells of the cyst showed estrogen receptor positivity. SLMN cells were negative for all CKs and other epithelial markers used in the study, but they showed diffuse positive staining for vimentin and CD68, and positive staining for Ki-67 was demonstrated in 25% of these cells. The immunohistochemical and histochemical profiles of PRMC were similar to those of ovarian mucinous neoplasms and the mesothelium. The formation of SLMNs seems to be related to subepithelial hemorrhage and some reactive epithelial changes near the mural nodules. The specific immunohistochemical and morphologic features of SLMNs are helpful in differentiating them from malignant mural nodules, including true sarcomas, osteoclast-rich undifferentiated carcinomas, and carcinosarcomas. Such a differentiation is critical in view of its significant impact on the management of these neoplasms, particularly in young patients who desire to preserve their fertility.