Effect of epidermal growth factor receptor status on the outcomes of patients with metastatic gastric cancer: A pilot study.

The expression of epidermal growth factor receptor (EGFR) has been linked to clinical outcome in several solid tumors. However, the clinical significance of EGFR (c-erbB1) in gastric cancer remains unclear. The present study was designed to detect the clinical implications of EGFR in the Turkish population. Paraffin-embedded tissue microarrays containing gastric cancer tissue were obtained from 30 patients. EGFR expression was detected using immunohistochemistry. The correlation of this biomarker to the clinicopathological features and survival of patients with gastric cancer was studied. The overall positivity rate of EGFR was 63.3%. EGFR expression was significantly correlated with an improved progression-free survival (PFS) and overall survival (OS) rate (P=0.039 and 0.01, respectively). EGFR expression is a good prognostic marker for patients with gastric cancer.

Radiologic diagnosis of a type-III pleuropulmonary blastoma.

Pleuropulmonary blastoma (PPB) is a rare and aggressive dysontogenic neoplasm, occurring in children under the age of 6 years in most cases. CT and MRI findings are well-known, a mixed solid and cystic lesion with variable contrast enhancement and a necrotic centre. We report the radiologic features of type III PPB case.

Primary mucinous borderline tumor of the vermiform appendix mimicking ovarian carcinoma; case report.

INTRODUCTION: Primary adenocarcinoma of the vermiform appendix is a very rare entity. Borderline mucinous tumor of the appendix is a much more rare disease. CASE: We present a 71-year-old woman with primary mucinous borderline tumor of the vermiform appendix. She was misdiagnosed as an ovarian carcinoma patient and operated on by a gynecologic oncology team. Her frozen section analysis of an appendicial mass resulted as borderline tumor of appendix vermiformis, and right hemicolectomy, as is advised in invasive colon tumors, was not carried out. CONCLUSION: Borderline mucinous tumor of the appendix vermiformis should be kept in mind in patients who have pseudomyxoma peritonei during surgery. Tumoral resection may be the definitive therapy in these patients.

Malignant primary peritoneal mesothelioma: report of two cases and review of literature.

INTRODUCTION: Malignant primary peritoneal mesothelioma is a rare and highly aggressive tumor. This tumor can be misdiagnosed as ovarian carcinoma. CASE: Two cases of malignant primary peritoneal mesothelioma that were misdiagnosed as ovarian carcinoma were operated in our instutition. Patients were 74 and 45 years-old at admittance. CONCLUSION: Malignant primary peritoneal mesothelioma is being a problem for gynecologic oncologists because of the close similarity with epithelial ovarian cancer. Diagnosis and treatment of these patients are still under debate.

Role of the antiangiogenetic drug paclitaxel on healing of intestinal anastomosis: an experimental study.

BACKGROUND: The aim of intraperitoneal administration of antineoplastic agents is the prevention of the implantation of tumoral cells after surgical intervention or the treatment of peritoneal carcinomatosis. The efficiency of intraperitoneal administration of paclitaxel, which is also an antiangiogenetic agent, has been investigated recently. The aim of this experimental study was to evaluate, taking into consideration its antiangiogenetic properties, the effects of intraperitoneal paclitaxel on healing of end to end colonic anastomosis. METHODS: 42 rats were allocated to 2 main groups (n = 21 for each group) to be evaluated on postperative day 3 (group A) and postoperative day 7 (group B). Each of the two main groups was divided into 3 subgroups (7 rats each). These subgroups were determined as control and two treatment groups administered paclitaxel in a dose of 2.5 mg/kg and 3.5 mg/kg intraperitoneally. Anastomosed segments of colon were harvested on postoperative day 3 or 7 and evaluated to determine bursting pressure of anastomoses, hydroxyproline levels and neovascularization with CD-31. RESULTS: In both groups, there were no significant differences between control and paclitaxel-treated groups with respect to bursting pressure. The level of hydroxyproline showed a significant decrease in all paclitaxel-treated groups compared with control groups (p = 0.001). Neovascularization was found to be decreased significantly on day 3 in the doses of paclitaxel 2.5 mg/kg (6.4 +/- 1.63) and 3.5 mg/kg (5.89 +/- 1.01) compared with control (8.02 +/- 0.88) (p = 0.029 and p = 0.005, respectively). There were no significant differences in neovascularization in either groups on postoperative day 7. CONCLUSION: We suggest that intraperitoneal administration of paclitaxel during surgical procedure decreases the hydroxyproline content and neovessel formation that are necessary for healing of intestinal anastomosis.

Analysis of clinicopathological prognostic parameters in adenocarcinoma of the gastric cardia.

BACKGROUND: The optimal extent of resection for carcinoma of gastric cardia remains a subject of controversy. Although both total gastrectomy (TG) and proximal gastrectomy (PG) have their own advantages, similar survival rates were given for both. The main aim of this study is to investigate whether the extent of resection is an important prognostic factor in carcinoma of the gastric cardia. METHOD: Records of 60 patients with carcinoma of gastric cardia, operated on between the January 1989-January 1993 at Istanbul University, Cerrahpasa Medical Faculty Department of General Surgery, were reviewed retrospectively. The relationship between clinico-histopathological variables and 5-year survival was retrospectively analysed. RESULTS: Of the 14 clinico-histopathological variables, eight (age, local invasion, grade, lymphatic micro-invasion, depth of penetration, lymph node involvement, type of operation and stage of disease) were found to have a significant influence on survival. Among those clinico-histopathological variables that influenced 5-year survival on univariate analysis, only age (p = 0.0029) and depth of tumour penetration (p = 0.008) independently affected survival. CONCLUSION: According to our results, depth of tumour penetration and age are the only variables which were found to independently affect 5-year survival. Depth of tumour penetration may serve as a potential marker for a biologically more aggressive tumour. The extent of resection (TG vs. PG) does not affect the long-term survival of the adenocarcinoma of the cardia.

Secondary amyloidosis in Castleman's disease: review of the literature and report of a case.

It is quite rare to diagnose secondary amyloidosis during the course of Castleman's disease (CD). A 51-year-old female who complained of fatigue, weight loss, and fever was diagnosed with CD -- plasma cell type -- in our hospital in 1993. One year after diagnosis, she developed nephrotic syndrome, the etiology of which was found to be secondary amyloidosis based on renal biopsy. As the patient rejected therapy, she was discharged after only symptomatic treatment. At her last follow-up in March 2001, she had no complaints; physical examination, blood chemistries, and urinalysis were normal. Abdominopelvic tomography revealed no lymphadenopathy in the abdomen, which had been previously present. We could identify 17 other cases of CD with secondary amyloidosis in the literature. Ours is the 18th such case and the 2nd case of multicentric CD leading to amyloidosis. This case also shows that CD might sometimes run a relatively benign course being cured with no therapy, whereas it might have a rapidly fatal downhill course -- even with therapy -- in others. Still, effective treatment strategies need to be developed.

Anorectal melanoma metastatic to the breast.

Anorectal melanoma is an extremely rare malignancy with poor prognosis. Patients generally present with a sensation of mass and rectal bleeding, which is usually attributed to hemorrhoids or polyps. It can not be diagnosed early because of these benign symptoms, so it is bulky at the time of presentation. Despite aggressive surgery, 5-year survival is less than 10%. We present a case of inoperable anorectal melanoma which metastasized to the left breast and abdominal lymph nodes. We also briefly reviewed the appropriate literature, emphasizing the diagnostic and therapeutic approaches.

Histopathologic features and expression of Bcl-2 and p53 proteins in primary gastric lymphomas.

The aim of this study is to present a histopathologic and immunohistochemical analysis of primary gastric lymphomas which were reclassified according to the concept of mucosa associated lymphoid tissue (MALT). The resected specimens from 41 patients with primary gastric lymphoma were investigated retrospectively. Immunohistochemical study was done to analyze the immunophenotype and bcl-2 and p53 proteins expression. Twenty three of the cases had tumors mainly located in the antrum. Histologically, 12 were low grade and 20 were high grade B-cell lymphoma of MALT, 9 other B-cell nonHodgkin's lymphomas. Helicobacter pylori was identified in 72% of the cases. According to Musshoff's modification, most of the MALT lymphoma cases had stage I or II disease. There was significant difference between low and high grade cases, in respect to depth of invasion in gastric wall. Immunohistochemically, the neoplastic cells in all MALT lymphomas expressed B-cell phenotype. Bcl-2 protein was found to be expressed in 59% and p53 protein expression was detected in 72% of cases. Among the B-cell lymphoma of MALT, bcl-2 positivity decreased and p53 positivity increased significantly as the histological grade advanced. So, an inverse correlation was observed between the expression of bcl-2 and p53. In conclusion, most primary gastric lymphomas are low or high grade B-cell MALT lymphomas and appear to arise in MALT acquired as a reaction to Helicobacter pylori infection. Expression of bcl-2 and p53 in gastric lymphomas may be associated with transformation from low-grade to high-grade disease.

Histopathologic features of the spontaneous pustular lesions of Behçet's syndrome.

BACKGROUND: Papulopustular lesions are common in Behçet's syndrome (BS). A debate exists as to whether they are different from ordinary acne. This has important clinical and pathophysiologic implications. OBJECTIVE: The aim of this study was to evaluate the histopathologic features of papulopustular lesions seen both in BS and acne vulgaris (AV). METHODS: Representative samples were obtained from 17 patients with BS and six patients with AV. The detailed histopathologic features were evaluated by a dermatopathologist blinded to the diagnoses. RESULTS: Considering the epidermis, follicle epithelium, and dermis separately, no differences could be found between the two groups. CONCLUSIONS: The papulopustular lesions seen in these two disorders cannot be distinguished on the basis of clinical and histopathologic findings.

The effect of granulocyte colony-stimulating factor (G-CSF) on bacterial translocation in the splenectomized rat.

BACKGROUND/AIMS: We created a study group in order to investigate the effects of splenectomy and filgrastim. Filgrastim is an immunomodulator granulocyte colony-stimulating factor (G-CSF), that affects bacterial translocation. MATERIALS AND METHODS: We created 3 study groups with 30 male Sprague-Dawley rats; the first group included sham splenectomy, the second group was splenectomy, and the third group was splenectomy+ filgrastim group. RESULTS: The mean bacterial colony count of the cecum were 2.5 x 10(9) in group 1, 1.2 x 10(10) in group 2 and 3.5 x 10(9) in group 3. The differences between these groups were accepted as statistically significant. The mean counts of the terminal ileum were 1.1 x 10(9) in group 1, 5.5 x 10(10) in group 2 and 2.5 x 10(10) in group 3. The p values of group 1-2 were 0.036 (statistically significant) and 0.123 in groups 2-3) were not statistically significant. The mean counts of the liver were 0.2 x 10(4), 1 x 10(10) and 3.4 x 10(5), respectively. In comparison of the groups the p values of the first and last 2 groups were found to be 0.047 (statistically significant). The mean counts of the mesenteric lymph node were 0.7 x 10(3), 1 x 10(10) and 0.9 x 10(6) respectively. The p values were 0.343 for the first and the last 2 groups both. As they were above 0.05, they were not statistically significant. The degrees of liver Kupffer cell hyperplasia were (+) 40%, (+2) 50% and (+3) 10% (group 1), (+) 10%, (+2) 40% and (+3) 50% (group 2), (+2) 60% and (+3) 40% (group 3) (p = 0.0039). The rates of the absence of pathology in mesenteric lymph nodes were 70% (group 1), 90% (group 2) and 100% (group 3) (p = 0.049). These findings were statistically significant. CONCLUSIONS: We found that splenectomy has activated the whole predisposing factors of bacterial translocation and created the latter itself. In addition, we showed that filgrastim, a recently widespread used G-CSF, decreases bacterial translocation significantly.

Value of lymph node biopsy in the diagnosis of acquired toxoplasmosis.

Toxoplasmic lymphadenitis generally involves a solitary lymph node in the head and neck regions, without systemic symptoms. In order to determine the frequency of toxoplasmic lymphadenitis, we reviewed the histological sections of 731 consecutive patients with reactive lymph node hyperplasia. Amongst 731 patients, 112 had histological features supporting a diagnosis of toxoplasmic lymphadenitis (15.3 per cent). In 80 of these patients (71 per cent), either Indirect Haemaglutination test (IHA), in 37 cases, or the Enzyme-Linked Immunosorbent Assay (ELISA) for detecting toxoplasmic IgG or IgM antibodies, in 43 cases, were performed. In 76 out of 80 patients (95 per cent), histological features correlated well with serological studies. The IHA test was positive in 30 patients with a titre of 1/64 or higher. The IgG-ELISA test was positive in 11 whereas the IgM-ELISA test was positive in 28 patients. These results provide further evidence of the distinctive nature of the histological changes in toxoplasmic lymphadenitis, which should enable the clinician to make a confident diagnosis of acute acquired toxoplasmosis.

Inflammatory pseudotumor of pelvic lymph nodes.

Inflammatory pseudotumor of lymph nodes (IPT) is a rare, recently described benign cause of lymphadenopathy. The IPT is composed of a proliferation of spindle cells, small vessels and inflammatory cells without atypia and formed by high and poor cellular areas. This study reports a case of IPT. It was a 50-years-old man in whom the abdominal mass was an incidental finding during exploratory laparatomy. The mass was a lymphadenopathy measuring 12 x 10 x 5 cm in diameters. Histologic examination revealed IPT of the lymph nodes. The patient has remained asymptomatic for more than 10 months following surgery without any treatment. In conclusion, IPT of the lymph nodes is being recognized increasingly and should be considered in the differential diagnosis of lymphadenopathies. Inflammatory pseudotumor (IPT) of the lymph nodes resembling the IPT of other organs was recently described as a possible cause of lymphadenopathy. Histologically, the process showed a proliferation of spindle cells associated with a mixture of polymorphic inflammatory cells and small blood vessels involving the connective tissue framework (hilum, trabecula, capsule) of the lymph node. In this report, the case of a patient with IPT of pelvic lymph nodes is presented with the clinical and pathological features.

Re-evaluation of skin-explant model in graft-versus-host disease prediction.

An in vitro skin explant model has been proposed for prediction of graft versus host disease and reported to be highly sensitive and specific for this purpose. In this study we have re-evaluated this model in both HLA full-matched BMT recipient-donor sibling pairs and also in HLA one haplotype-matched parent-children pairs. All assessments were made blindly by 3 independent observers. The predictive value of the test for the occurrence of clinical GvHD in 14 BMT patients was found to be less sensitive than reported previously (correlation coefficients were +0.019, +0.067 and -0.061 between clinical GvHD and in vitro primed allogeneic, primed mixed and unprimed allogeneic settings, indicating "poor" correlation). False positive and false negative results were high and there were also significant discrepancies between three blind observations in the grading of skin changes. Weighted kappa analysis revealed that there were "fair" correlations between the 3 observers (K = 0.25). These results indicated that the skin explant model is an unpredictable test system and there are great problems in standardization of the method.