Malign cylindroma of the scalp with multiple cervical lymph node metastasis-A case report.

INTRODUCTION: Cylindromas are usually benign tumors as small, solitary, slow-growing nodules of the scalp, face and trunk. Multiple cylindromas may form a "turban tumors" in the autosomal dominant Brooke-Spiegler syndrome. Malignant dermal cylindromas are very rare. There are few cases of malignant transformation of dermal cylindromas in the literature. We present an unusual case of malign cylindroma of the scalp with multiple metastasis to cervical lymph nodules and also this case is the only case that has the most lymph node metastasis. PRESENTATION OF CASE: A 52-year-old man initially presented to our clinic with hyperemic plaque located on his scalp. Measures of the plaque was 20cm×10cm with bilateral, multiple palpable submandibulary lymph nodes. Entire scalp was removed reaching in depth the periostal level and bilateral modified radical neck dissection was performed. The histopathological examination of the scalp specimen was malignant skin ecrine tumor, cylindroma and on the neck dissection specimen, 55 lymph nodes were reported as metastatic out of 79. The patient was treated with chemotherapy and radiotherapy. No recurrence or metastasis was observed during a 5 year follow-up period. DISCUSSION: Malign cylindroma of the scalp rarely presents with multiple cervical lymph node metastasis, however it is important to be aware of this possibility. CONCLUSION: The case reported below is outstanding in literature for being the only case that has the most lymph node metastasis. Although malign transformation of dermal cylindromas is rare, aggressive surgery should be considered with locoregional metastasis of the tumor.

Effects of Beta-d-glucan on diabetic colon anastomosis.

OBJECTIVE: The purpose of this study was to evaluate the effects of beta-D-glucan on the experimental diabetic rat colon anastomosis model. BACKGROUND: Beta-D-glucan is a commonly used macrophage activator and promotes wound healing by increasing macrophage infiltration into the wound. The decrease in the function of macrophages and impaired wound healing can be observed in diabetes mellitus (DM). METHODS: Eighty Spraque-Dawley rats were divided into 4 groups: colon anastomosis (group 1); colon anastomosis + DM (group 2); colon anastomosis + beta-D-glucan (group 3); and colon anastomosis + beta-D-glucan + DM (group 4). Diabetes was induced with streptozotocin (85 mg/kg), and glycemia was assessed before induction at days 14 and 17. Colon anastomosis was performed at day 14. Beta-D-glucan (100 mg/kg/day) was administered 2 days before colon anastomosis and given orally for 5 days. Relaparotomies were done 3 days after colon anastomosis, and anastomotic bursting pressures, anastomotic hydroxyproline levels, malondialdehyde (MDA) levels, and histopathology examinations were studied. RESULTS: There were no differences among groups for hydroxyproline levels. The mean values of anastomotic bursting pressures in group 4 were significantly higher than those of group 2. The mean values of MDA levels in group 2 were significantly lower than those of group 4. Group 2 showed a significant difference in the amount of necrosis, accumulation of polmorphonuclear cells, and edema when compared with groups 1, 3, and 4 (P < 0.001, P < 0.002, and P < 0.001, respectively). CONCLUSION: This study indicates that oral administration of beta-D-glucan significantly improves the impaired anastomotic healing in rats with diabetes mellitus.

Orbital dermoid cyst with intracranial extension in adults: an unusual case.

A case of a dermoid cyst with intracranial extension in a 48-year-old female is reported. Intracranial extension of a dermoid cyst is very rare. During its slow growth, it extends to the cranium from different regions by invading neighboring bones. Treatment is surgery, and there is no indication for radiotherapy or chemotherapy.

Giant occipital osteoid osteoma mimicking calcified meningioma.

Osteoid osteoma is a benign bone tumor, which rarely occurs in the skull, and often causes local pain that is worse at night, characteristically relieved by aspirin. Giant osteoid osteoma in the occipital bone is uncommon. We present a case of a 42-year-old female with an osteoid osteoma of the occipital bone that was totally resected. We discuss the clinical presentation, radiographic findings, and differential diagnosis of occipital osteoid osteoma.

Cystic mature teratoma of the thoracic region in a child: An unusual case.

Cystic mature teratomas of the spinal cord are rare lesions. Teratomas account for up to 0.1% of all spinal cord tumors. Teratomas include tissues that originate from the three germ layers. Several congenital disorders may accompany the teratoma. Teratomas are classified as mature, immature or malignant type according to their histological characteristics. Thoracic spinal teratomas are uncommon in the pediatric age group. More than half of the patients are adults. We present herein a five-year-old male patient who was referred to our clinic with cystic mature teratoma at the T12 level.

Drug resistant MCF-7 cells exhibit epithelial-mesenchymal transition gene expression pattern.

PURPOSE: Multidrug resistance is resistance to structurally unrelated anticancer agents. Large-scale expression analysis by using high-density oligonucleotide microarrays may provide information about new candidate genes contributing to MDR. This study demonstrates alterations in expression levels of several genes related to epithelial-mesenchymal transition (EMT) in paclitaxel, docetaxel, and doxorubicin resistant MCF-7 cells. METHODS: Resistant sublines were developed from sensitive cells by selective paclitaxel, docetaxel, and doxorubicin applications in dose increments. cDNA microarray analysis was performed for sensitive and resistant cells. Genes having statistically significantly altered expression levels more than two-folds compared to the sensitive MCF-7 cells were considered. Genes encoding the determinants of the EMT were evaluated. Immunostaining was performed for relevant protein expressions. RESULTS: Key elements of EMT were transcriptionally activated in paclitaxel, docetaxel and doxorubicin resistant sublines. One of the upregulated genes was Slug, a transcription factor of E-cadherin, occludin repression, and N-cadherin, vimentin activation. Decreased estrogen receptor-α (ER) levels in cells might have stimulated Slug expression. Increased expression levels of TGF-beta receptor2 (TGFBR2) together with SMAD3 might have stimulated EMT in resistant cells. Immunocytochemistry results confirmed loss of ER and E-cadherin, together with high vimentin levels. CONCLUSIONS: EMT was induced in multidrug resistant MCF-7 cells indicating a relationship of this process and drug resistance. However, the relationship of each specific component of EMT with drug resistance requires further analysis.

FAS, FAS ligand, tumor infiltrating lymphocytes, and macrophages in malignant melanoma: an immunohistochemical study.

BACKGROUND: FAS and its ligand, FASL, have important roles in the neoplasia-immunity relationship. In melanoma, the importance of FAS and FASL remains controversial, despite a group of studies. In this study, we aimed to demonstrate the distribution of FAS/FASL in melanotic lesions and to investigate the correlation between tumor infiltrating lymphocytes and macrophages. METHODS: Ten intra-dermal nevi, 12 primary malignant melanoma, and eight skin and 15 lymph node metastases were included in this study. FAS and FASL were studied in all of the groups using classical labeled streptavidin-biotin immunohistochemical method. Tumor infiltrating lymphocyte status and macrophage number demonstrated by CD68 immunostain were also evaluated in primary melanoma and skin metastases. RESULTS: FAS positivity was detected in all of the cases. FASL expressions were seen in 60% of the intra-dermal nevus and in all of the other groups. There were significant differences in FASL between nevus and primary melanoma, nevus and skin metastasis, and nevus and lymph node metastasis. There were strong positive correlations between FAS expression and intra-neoplastic macrophage score and between FASL and density of lymphocyte infiltration in skin metastases. CONCLUSION: Although FAS and FASL expression is a constant feature of melanotic lesions, its diagnostic importance is very limited because of the different results obtained in the past studies. The correlation between FAS status and macrophage number and between FASL status and lymphocyte number in skin metastasis but not in primary lesions might point to diverse FAS/FASL interaction between neoplastic cells and macrophages in the different microenvironments.

Factors in sample volume and quality of CT-guided vertebral biopsy: location and needle trajectory.

AIM: To assess sample volume (by its length and diameter) and sample quality (judging by its integrity) in CT-guided vertebral biopsy due to lesion location and needle trajectory method as individual study variables each. MATERIAL AND METHODS: Of 48 patients, 25 were men and 23 were women; ranging from 33 to 85 years of age, with a median age of 65.5 years. The independent variables were primarily vertebral location and needle trajectory. Two cervical lesions were excluded from location analysis. We examined sample length and width, and macroscopic (5-scale) and microscopic (3-scale) scores as dependent variables. We did not encounter with any major complication and infection. RESULTS: Median sample length and sample diameter were found to be 10 mm and 2 mm, respectively. No relation was observed between the dependent variables and location in the spine. There was a relation between sample length and needle trajectory (p=0.002) with values of 11 mm in the transpedicular method vs. 6 mm in the posterolateral method (p=0.01). CONCLUSION: Transpedicular trajectory had an advantage over the posterolateral method as it provides a longer sample. We believe that transpedicular biopsy should be preferred. Nevertheless, studies are needed to validate the most advantageous standard access position in spine biopsies.

Extranasopharyngeal angiofibroma originating from the nasal septum: a case report.

Angiofibromas (AFs) originate predominantly in the nasopharynx and posterior nasal cavity. The incidence of these lesions is less than 0.5% among all neoplasms of head and neck. They originate outside the nasopharynx rarely and can therefore be misdiagnosed. The nasal septum is an extremely rare site. Only four cases of extranasopharyngeal angiofibromas arising in the nasal septum have been reported so far. We report here a case of a vascular mass arising from the nasal septum in a 19-year-old boy which was extirpated by submucousal resection endonasally. Histopathology confirmed it to be a case of angiofibroma.

Detection of human papillomavirus DNA and genotyping in patients with epithelial ovarian carcinoma.

AIM: The purpose of this study was to investigate the possible role of human papillomavirus (HPV) in Turkish patients with epithelial ovarian cancer by using the highly sensitive technique of polymerase chain reaction (PCR) to identify all the subtypes of this unique oncogenic virus. METHODS: All patients were subjected to initial surgery, and subsequently recruited for postoperative chemotherapy depending on the extent of the disease and their condition. HPV PCR screening was done from paraffin embedded samples. PCR amplifications were done using the MY09/11 primer set after digestion and phenol-chloroform extraction of the DNA. HPV PCR-positive samples were analyzed and genotyped using an OpenGene automated DNA sequencing system. RESULTS: Overall, 94 patients were included in this study. The mean age was 52.7 years (range, 21-76 years). As a histopathologic diagnosis, the majority of the patients had serous papillary tumors (81%). HPV was found to be positive in eight patients (8.5%). All of the positive patients had serous papillary tumors (8/76, 10.5%) and advanced stage disease. Six patients had HPV type 16, and the remaining two patients had HPV type 33. None of the patients had more than one type of HPV. CONCLUSION: HPV may have a role in the carcinogenesis of ovarian cancer. It is worth investigating this possible relation both in large case-control studies and in vitro models by using more sensitive techniques.

Granulomatous mastitis: surgical outcomes.

OBJECTIVE: To report the clinical and pathological features and surgical treatment outcomes of patients with granulomatous mastitis. DESIGN: Case series. PLACE AND DURATION OF STUDY: Ankara Oncology Training and Research Hospital, between 1999-2003. PATIENTS AND METHODS: Data of 16 patients with granulomatous mastitis treated surgically by total excision with disease-free margins were reviewed. Patients given additional medical therapy or treated with mastectomy because of the size and extent of the disease were excluded. RESULTS: The mean age of patients at the time of diagnosis was 31.8 (range: 22-45 years). All patients were diagnosed from the pathological tissue specimens obtained by surgery. Clinical and radiological examinations suggested breast carcinoma in 82.1% patients. Except one patient who developed a fistula from the incision which was treated again with surgery, no other complications were noted, including recurrence of disease during a median follow-up period of 12.8 months (range: 4-30 months). CONCLUSION: Although granulomatous mastitis is a rare benign breast disease, it usually mimics breast carcinoma both clinically and radiologically, making the diagnosis difficult and challenging. As long as good cosmetic results can be achieved, surgical excision is quick, safe and effective treatment method for idiopathic granulomatous mastitis.

Chemoresistant placental site trophoblastic tumor with hilar lymph node metastasis: an unusual site of involvement.

BACKGROUND: Placental site trophoblastic tumor (PSTT) is an uncommon variant of gestational trophoblastic diseases. In most cases, disease is confined to the uterus and treated with a simple hysterectomy. However, 30% of these patients will present with metastatic disease. Patients with metastases frequently have progression of disease and die despite aggressive multiagent chemotherapy. CASE: We present a case of 33-year-old female with PSTT and metastases to the hilar lymph nodes of the right lung. Primary surgical treatment consisting of abdominal hysterectomy and unilateral salpingo-oophorectomy was followed by six cycles of EMA/CO (etoposide, methotrexate, actinomycin D, cyclophosphamide, and vincristine) chemotherapy. After the completion of chemotherapy, betahCG titers stayed within normal range, but a repeated CT scan of chest revealed enlargement of the hilar lymph nodes. The patient underwent right thoracotomy with hilar lymph nodes resection. The resected nodules were pathologically consistent with primary PSTT. CONCLUSION: In this case report, we have determined a PSTT with hilar region metastasis other than parenchyma of lung and confirmed the chemoresistant nature of tumor with the guidance of the previous reports.

Secretory breast carcinoma with extensive intraductal component: case report.

Secretory breast carcinoma is a rare entity. It was first reported in pediatric patients in 1966, and was named juvenile breast carcinoma. Incidences of pediatric and adult patients are similar. Prognosis is favorable in both groups, but distant metastases have been reported. The authors describe a case of secretory breast carcinoma with extensive intraductal component.