Unusual Histopathological Findings in Childhood Appendectomy Specimens.

The purpose of this study was to find the unusual findings in the childhood appendectomy specimens and their incidence. The clinicopathological data of 1,306 patients whose ages ranged from 3 to 16 were retrospectively collected. Histopathological findings in appendectomy specimens taken from patients who had a prediagnosis of appendicitis were obtained. Incidental appendectomies were not included in the research. Unusual findings were reevaluated in the histopathological assessment of appendectomy specimens. The number of patients whose pathological findings are considered unusual is 25 (1.91 %). Nine of the patients were girls and 16 of them were boys. Their ages ranged from 6 to 15. Pathological results revealed that there were 16 (1.22 %) cases of parasitosis, 3 (0.23 %) cases of granulomatosis, 3 (0.23 %) cases of eosinophilic appendicitis, 2 (0.15 %) cases of carcinoid tumors, and 1 (0.08 %) case of appendiceal non-Hodgkin's lymphoma. All patients underwent a standard appendectomy. Uncommon histopathological findings in childhood appendectomy specimens are more common than those in adulthood. This kind of certain unexpected lesions of the appendix may require advanced diagnostics, careful clinical care, follow-up for years, and a multidisciplinary approach. Therefore, histopathological examinations of appendectomy specimens must be performed routinely.

A retrospective chart review of evaluation of the cervical lymphadenopathies in children.

OBJECTIVE: Cervical lymphadenopathy is a common finding of physical examination in childhood. The aim of this study was to evaluate the etiology and treatment of cervical lymphadenopathy in children. METHODS: Two hundred eighty two patients' chart reviewed retrospectively who were referred to the Pediatric Oncology Department with cervical lymphadenopathy during the period of November 2007-2009. RESULTS: A total of 9 children had malignant and 273 children had benign disorders. Excisional biopsies were performed to 35 children. A specific etiology was found in 36% in the benign group. CONCLUSION: Primary diagnostic evaluation of childhood cervical lymph node enlargements is based mainly on clinical and physical examinations.

Evaluation of relationship between HIF-1alpha immunoreactivity and stage, grade, angiogenic profile and proliferative index in bladder urothelial carcinomas.

Hypoxia-inducible factor-1alpha (HIF-1alpha) is a critical regulatory protein of cellular response to hypoxia. In this study, we evaluated the relationship of HIF-1alpha with clinicopathologic parameters such as tumor stage and grade, as well as angiogenic profile and proliferation index. The immunoreactivity of HIF-1alpha was assessed in 70 cases of primary bladder urothelial carcinoma. Vascular endothelial growth factor (VEGF) and microvessel density (MVD) were used to evaluate the angiogenic profile. MVD was calculated by immunohistochemical staining of endothelial cells with CD34. Proliferation index was determined by the percentage of Ki-67 nuclear staining in tumor cells. There was a significant relationship between HIF-1alpha immunoreactivity and stage, as well as histologic grade of the tumor (P < 0.001). HIF-1alpha immunoreactivity was also closely related to VEGF expression (P < 0.001), MVD (P = 0.002) and proliferation index (P < 0.001). VEGF, MVD and proliferation index were found to be closely related to tumor stage and histologic grade. There was no correlation between HIF-1alpha immunoreactivity and lamina propria (P = 0.13), muscularis propria (P = 0.009) or vascular invasion (P = 0.1). In this study, HIF-1alpha expression was found to be closely related to prognostic parameters in bladder urothelial carcinoma. For this reason, it may be a useful marker to determine the prognosis and to choose the appropriate treatment modality.

Comparison of osteopontin, beta-catenin and hnRNP B1 expression in lung carcinomas.

This study was performed to compare osteopontin (OPN), beta-catenin and heterogeneous nuclear ribonucleoprotein B1 (hnRNP B1) immunreactivities in small cell lung carcinomas (SCLC) and non-small cell lung carcinomas (NSCLC). Correlation of these three antibodies with grade and clinicopathologic stage of the tumor in NSCLC was also investigated. Twenty-nine SCLC, 6 large cell carcinoma, 36 adenocarcinoma and 30 squamous cell carcinoma (SCC), totally 101 cases, were included in this study. OPN, beta-catenin and hnRNP B1 expressions were immunohistochemically evaluated. OPN positivity was 6.9% in SCLC and 67% in NSCLC. When NSCLC types were individually considered, OPN positivity was 66.7% in large cell carcinoma, 80% in SCC and 55.6% in adenocarcinomas. beta-catenin positivity was observed in 48.6% of NSCLC and none of SCLC cases. These results were statistically significant (p < 0.05). Neither grade nor stage of NSCLC was correlated with osteopontin, beta-catenin or hnRNP B1 immunreactivity. We observed that OPN and beta-catenin are useful in differentiating SCLC from NSCLC. This may be helpful in small lung biopsies where morphology is obscured by crush artifacts.

Randomized comparison of vasodilator effects of iloprost versus diltiazem on flow and pathologic changes in radial arteries: mid-term angiographic control study of the comparison of vasodilators on radial artery vasospasm.

BACKGROUND: The increasing prevalence of routine radial artery (RA) use in coronary artery bypass grafting (CABG) has rendered the pharmacologic prevention of spasm of this artery a critical consideration in the early postoperative period and in the long-term outcome. In this study, we compared the effects of iloprost and diltiazem on vasospasm. METHODS: Seventy patients who underwent CABG with the RA were randomized into 2 groups, and the vasodilator effects of iloprost and diltiazem were studied prospectively. RA flow was measured with Doppler ultrasonography. Following harvesting, a 5-mm piece was removed from the RA distally for pathologic examination. In group B, diltiazem was infused before removing the RA, whereas in group A, iloprost infusion was initiated 5 days before surgery. At the end of a 2-year follow-up, each patient underwent coronary angiography. RESULTS: Doppler flow measurements made during harvesting revealed a statistically significant reduction in flow, and a pathologic examination of the RAs revealed significant luminal narrowing in group B. A 2-year angiographic follow-up revealed all of the RA grafts in group A to be patent. CONCLUSIONS: Our evaluation of the results revealed the superior efficacy of iloprost over diltiazem in preventing RA spasm in the early period, and the 2-year angiographic findings showed that the use of iloprost produced superior mid-term patency.

Is D2-40 a useful marker for distinguishing malignant mesothelioma from pulmonary adenocarcinoma and benign mesothelial proliferations?

Since pulmonary adenocarcinomas, malignant mesotheliomas (MM), and sometimes benign mesothelial proliferations show a great histomorphological resemblance to each other, an immunohistochemical panel is usually necessary for differential diagnosis. D2-40 is an available monoclonal antibody, which is already in use as a lymphatic endothelial marker. It has also been suggested to be useful in identifying the mesothelial differentiation. The aim of this study is to compare D2-40 immunostaining in MM, pulmonary adenocarcinoma, and benign mesothelial proliferations. In this retrospective study, D2-40 immunostaining was investigated in 37 cases of MM, 36 cases of pulmonary adenocarcinoma, and 31 cases of benign mesothelial proliferation. The diagnosis of MM had previously been confirmed by a panel including calretinin, CK5/6, and CEA. Predominantly membranous immunoreactivity was observed in 51% of MMs and in 55% of benign mesothelial proliferations. All the 36 pulmonary adenocarcinomas were negative. These results were statistically significant (p<0.001). We believe that D2-40 may be helpful in the differential diagnosis of MM from pleural involvement of pulmonary adenocarcinoma.

The reliability of mediastinoscopic frozen sections in deciding on oncological surgery in bronchogenic carcinoma.

INTRODUCTION: This study was carried out to determine the accuracy of mediastinoscopic frozen section examination, performed prior to major surgery-especially where mediastinal lymph node metastasis (N2 disease) was suspected. We aimed to find out whether or not mediastinoscopic frozen section analysis was (i) a reliable tool when deciding to continue resection in lung cancer patients and (ii) reliable in diagnosing mediastinal masses. METHODS: One-hundred and thirty-six patients undergoing mediastinoscopy were enrolled in this study. Resection was planned for each case, and biopsies were taken from at least two sites, including the subcarinal lymph node. Thoracotomy and resection were performed when the results of frozen section examination were negative for malignancy in patients with lung cancer. Results of frozen section examination during mediastinoscopy were compared to the results of definitive histological examination of the same specimens stained using haematoxylin-eosin. Additionally, the results of frozen section examination were compared to the results of definitive histological examination of the lymph nodes excised during resection. RESULTS: We determined total sensitivity, specificity, positive predictive and negative predictive values of 94.51%, 100%, 100% and 90%, respectively. In the 105 patients with malignant diseases, these values were 93.33%, 100%, 100% and 91.84%, respectively. In the 31 patients with benign diseases, values were 96.77%, 100%, 100% and 100%, respectively. CONCLUSIONS: It was confirmed that mediastinoscopy supported by frozen section examination plays an important role in establishing diagnosis and planning treatment both in benign and malignant diseases.

A retrospective study on the coexistence of hydatid cyst and aspergillosis.

OBJECTIVES: Hydatid cyst is a zoonotic disease with an endemic regional distribution, and Aspergillus is a saprophytic fungus that may cause allergic pulmonary aspergillosis, aspergilloma, and semi-invasive and invasive aspergillosis. The coexistence of a saprophytic fungus and hydatid cyst is extremely rare. The aim of this retrospective study was to evaluate the coexistence of aspergillosis and echinococcosis in archival materials and to discuss its probable clinical significance. METHODS: Hematoxylin-eosin (HE)-stained sections of 100 archival cases with the diagnosis of hydatid cyst were reevaluated by four pathologists independently. Grocott's methenamine-silver (GMS) and periodic acid-Schiff (PAS) were applied to the slides that were suspected of having co-infection with Aspergillus to confirm the diagnosis. RESULTS: Two cases of aspergillosis and hydatid cyst coexistence were found out of the 100 reevaluated archival cases with a diagnosis of hydatid cyst. Both of the cases were located in the lung, in immunocompetent patients. CONCLUSIONS: Aspergillosis and hydatid cyst coexistence may be important in patients with immune deficiency and in cases with pre- or perioperatively ruptured cysts. There are no reliable data on the specificity and sensitivity of radiological imaging techniques in detecting the existence of Aspergillus in hydatid cysts. Histopathological evaluation is essential for diagnosis and for the planning of management.

Erythrokeratodermia variabilis with adult onset: report of a sporadic case unresponsive to systemic retinoids.

Erythrokeratodermia variabilis is a rare autosomal-dominant genodermatosis characterized by migratory and erythematous patches changing over the course of hours to days, and fixed keratotic plaques. The disease begins mostly at birth or within the first year of life; it very rarely starts after childhood. We present herein a sporadic case with adult onset that was unusually resistant to both isotretinoin and acitretin.

TTF-1 and surfactant-B as co-adjuvants in the diagnosis of lung adenocarcinoma and pleural mesothelioma.

Primary lung adenocarcinomas and metastatic adenocarcinomas may show a great morphologic resemblance to malignant mesothelioma. There are numerous immunohistochemical markers being used, but none of them were proved to be effective enough to reach a certain diagnosis. The current study was performed to evaluate the utility of thyroid transcription factor-1 (TTF-1) and surfactant protein-B (SP-B) expression in the differential diagnosis between lung adenocarcinomas and pleural mesotheliomas. In this retrospective study, TTF-1 and SP-B were applied to 30 cases with adenocarcinoma and 15 cases with pleural mesothelioma, immunohistochemically, using an avidin-biotin detection system. Twenty percent of adenocarcinomas and 13.3% of pleural mesothelioma stained positive for SP-B. TTF-1 stained 24 of the 30 adenocarcinomas (80%) and none of the 15 mesotheliomas (0%). TTF-1 positivity in adenocarcinomas was found to be statistically significant, while SP-B had no important practical value either used alone or in combination with TTF-1. There was no statistically significant correlation between the differentiation level of adenocarcinomas and TTF-1 staining pattern. In conclusion, we believe that TTF-1 may be helpful in distinguishing lung adenocarcinoma from pleural mesothelioma.

Histopathologic assessment of fungal involvement of the paranasal sinuses in Turkey.

OBJECTIVE: To assess paranasal sinus material histopathologically for the presence of fungus. MATERIAL AND METHODS: Paraffin-embedded archival biopsy samples of patients who underwent endonasal sinus surgery between 1992 and 2002 were retrospectively assessed for the presence of fungi. Hematoxylin-eosin-stained sections of the materials were re-evaluated, and Gomori's methanamine silver stain was also applied as required. RESULTS: Fungus (Aspergillus) was detected histopathologically in only 21476 patients, both of whom were immunocompetent. One patient was considered to have chronic indolent sinusitis and the other allergic fungal sinusitis. CONCLUSIONS: Although histopathologic assessment is one of the most important diagnostic tools, on its own it may lead to underestimation of fungal involvement of the paranasal sinuses. Alternatively, fungal involvement of the paranasal sinuses may be very infrequent in Turkey.