Evaluation of the role of radiotherapy in the management of dermatofibrosarcoma protuberans.

PURPOSE: The aim of this study was to evaluate the role of radiotherapy (RT) in the management of dermatofibrosarcoma protuberans (DFSP). METHODS: Twenty-eight patients treated with RT for DFSP between 1974 and 2012 at Gulhane Military Medical Academy (GMMA) Radiation Oncology Department were retrospectively evaluated. Twenty-five out of 28 patients (89%) received postoperative RT and 3 received definitive RT alone. In the 25 patients receiving postoperative RT, the type of surgical excision was limited excision in 5 patients and wide excision in the remaining 20. Median RT dose was 63.21±3.7 Gy (range 50-70). RESULTS: At a median follow-up of 5 years, 5-year overall survival (OS) for the whole patient group was 93%. No relationship was determined between the total delivered RT dose and OS. The 5-year OS of the 10 female patients was 90% whereas it was 94% for the 18 male patients (p>0.05). Five-year disease-free survival (DFS) for the patients undergoing wide excision with RT vs. those undergoing limited excision with RT was significantly superior (p <0.05) in patients treated with wide excision and RT. CONCLUSION: RT is an effective treatment option for DFSP patients with positive postoperative margins, recurrent disease and selected inoperable cases.

Statin therapy and diabetic skin.

PURPOSE: Statins are widely used drugs for reducing cholesterol levels. The aim of this study was to observe the effects of statin therapy on skin histopathology in both normal and diabetic mice. METHODS: 45 Swiss albino mice were studied in 4 sub-groups: control, statin-treated control, diabetic, and statin-treated diabetic. The first group was diabetic-induced with 250 mg/kg of streptozosin administered intravenously. The second group served as the control. Four weeks after streptozosin injection, both diabetic and control groups were divided into 2 sub-groups and 1 mg/kg/d simvastatin was injected for 14 d intraperitoneally to form the statin-treated control and statin-treated diabetic groups. The remaining 2 groups formed the untreated control and untreated diabetic groups. Histopathological examination of the skin was made with haematoxylin eosin staining under a light microscope. RESULTS: There was no apparent difference between the groups in epidermal thickness, proliferative activity, dermal thickness and composition. Cystic dilatations in the infundibulum of hair follicles with distorted and smaller sebaceous glands were seen in the statin-treated control, diabetic, and statin-treated diabetic groups. CONCLUSION: We conclude that there is altered lipid synthesis in the sebaceous glands in both diabetic and statin-treated groups.

Acrokeratoelastoidosis treated with the erbium:YAG laser.

Acrokeratoelastoidosis is a rare skin disorder characterized by grouped, small, firm, translucent papules distributed on the margins of the hands and feet. We report a 21-year-old white patient with acrokeratoelastoidosis in whom Er:YAG laser surgery was carried out, resulting in a slight post-treatment improvement of the disease with slight flattening of the lesions. No clinical recurrence of the lesions developed during the 6 months of follow-up. We suggest that Er:YAG laser surgery of acrokeratoelastoidosis may be considered as a treatment option for this rare disease; however, patients should be informed of the limited clinical improvement obtained with this treatment.

Effects of allergen immunotherapy on the nasal mucosa in patients with allergic rhinitis.

Despite the varied immunological changes occurring after allergen immunotherapy, the precise mechanism, or the mechanisms responsible for clinical effectiveness of allergen immunotherapy have not been clearly determined. Postulated immunomodulatory mechanisms include a decrease in cellular responsiveness, a production of blocking antibodies, a reduction in the number of mast cells, and activation of T-cell suppressor mechanisms. Nineteen allergic rhinitis patients (study group) with house dust mite sensitivity and 10 nonallergic control subjects were studied. In the study group, the nasal mucosal biopsies were obtained prior to immunotherapy and were repeated after 1 year, and specimens were evaluated by light and electron microscopy. After the third month of immunotherapy, nasal symptom scores were reduced significantly and disappeared in the sixth month (p <0.01). No significant changes were observed in the levels of immunoglobulins, IgG subclasses and complement levels (p <0.05), except IgG4/IgG1 ratio (p <0.05). A comparison of histopathological findings of nasal mucosa in each case revealed an improvement in epithelial loss, inflammation, thickening of basal membrane and fibrosis (p <0.05). A significant correlation was observed between epithelial loss and mast cell accumulation with symptom score (p <0.001). These results suggest that the improvement of nasal epithelial cells and reduction of mast cell accumulation in nasal mucosa may be one of the mechanisms that could explain the improvement of nasal allergy symptoms following immunotherapy.

The effect of Helicobacter pylori eradication on duodenal gastric metaplasia.

We investigated the incidence of duodenal gastric metaplasia and its response to Helicobacter pylori eradication in patients with duodenal ulcer or erosive duodenitis. Gastric and duodenal biopsies were taken from patients with endoscopically detected H. pylori positive duodenal ulcer or erosive duodenitis, and the presence and extent of duodenal gastric metaplasia was recorded. Patients were given omeprazole 20 mg twice daily for 2 weeks, and amoxicillin 1 g and clarithromycin 500 mg twice daily for 10 days, and then ranitidine for a further 8 weeks. Biopsies were repeated 6 months after the start of treatment. Duodenal gastric metaplasia was initially present in 22 patients (52%) and was more frequent in ulcer patients than in duodenitis patients, but not significantly so (69% versus 45%). After treatment, H. pylori was eradicated in 68% of duodenal gastric metaplasia patients and the duodenum was normal endoscopically in 85% of these patients. Duodenal gastric metaplasia was improved or eliminated in 12/15 H. pylori eradicators (80%) and in 5/7 H. pylori non-eradicators (71%), a non-significant difference. The improvement in duodenal gastric metaplasia appeared to be independent of H. pylori eradication.

Prostate rhabdomyosarcoma in a young adult: a case study.

Prostate rhabdomyosarcoma is a very rare malignancy in young adults. This case study presents an 18-year-old adult with prostate rhabdomyosarcoma treated with a combined regimen of radiotherapy and chemotherapy.

A shorter lag period of mesenchymal malignancy on Marjolin's ulcer.

Marjolin's ulcers generally appear on a burn scar a long time after initial burn injury. A 21-year-old man sustained a thermal burn injury to his right elbow. The ulcer appeared 3 years after and the tumour enlarged and reached a size of 11 cm in diameter in a short period of time. The tumour mass was excised and the donor site was grafted. Right axillary lymph node dissection was carried out. Immunohistochemical studies showed that the nature of the tumour was mesenchymal. Both mesenchymal malignancy and shorter lag period are rarely seen in Marjolin's ulcer.

Protective effect of vitamin A on acute radiation injury in the small intestine.

The objective of this study was to examine the influence of vitamin A on the development of early radiation-induced reactions in the rat small intestine. The early effects of intraoperative gamma-radiation on the small bowel utilizing the terminal ileum of Sprague-Dawley rats and the protective effect of supplemental vitamin A on acute radiation injury were investigated. Three groups were included in the study: group I (10 rats) was the surgical control group; group II (13 rats) underwent only intraoperative irradiation; and group III (10 rats) was the vitamin A plus irradiation group. Exteriorized terminal ileal segments of groups II and III were exposed to a single fraction of 20 Gy of intraoperative gamma-irradiation. On the seventh postoperative day, terminal ileal segments of all rats were resected and histopathologically evaluated for ulceration, enteritis cystica profunda, atypical epithelial regeneration, fibrosis, vascular sclerosis, and inflammatory process. Although none of the above findings were present in the surgical control group, group III rats experienced less severe effects than group II rats. The results suggest the early side effects of radiation may be prevented by vitamin A supplementation.

Colonic perforation caused by taeniasis.

In this report, a case of colonic perforation caused by Taenia saginata is presented. Preoperative ultrasonographic examination showed a 'pseudokidney sign' suggestive of colonic carcinoma. Clinical and ultrasonographic appearance of this rare case and the possible perforation mechanism are discussed.

Expression of S-100 protein, epithelial membrane antigen, carcinoembryonic antigen and alpha fetoprotein in normal salivary glands and primary salivary gland tumors.

The distribution of S-100 protein, epithelial membrane antigen, carcinoembryonic antigen and alpha fetoprotein was studied in 38 primary salivary gland tumors. S-100 protein, a useful marker of myoepithelial cells, was demonstrated in some benign tumors. Carcinoembryonic antigen expression was consistently positive in adenoid cystic carcinoma. Demonstration of epithelial membrane antigen helped to confirm the epithelial nature of some neoplastic cells. Alpha fetoprotein was not expressed in any of the cases examined. No correlation was found between immunopositivity and tumor behavior in the present series.

A central odontogenic fibroma exhibiting pleomorphic fibroblasts and numerous calcifications.

A case of an odontogenic fibroma with unusual histopathological features is described. The tumour exhibited numerous, plump, stellate fibroblasts, similar to those found in the so-called giant cell fibroma. This finding has not been described previously in odontogenic fibromas. This case also exhibited an unusually large number of calcifications. Neither of these features should affect the biological behavior of this lesion.